Highly active anti-retroviral therapy (HAART) prolongs time ... : AIDS (original) (raw)

Clinical: Original Papers

Highly active anti-retroviral therapy (HAART) prolongs time to treatment failure in Kaposi‚s sarcoma

Bower, Marka; Fox, Paulb; Fife, Katea; Gill, Jasb; Nelson, Markb; Gazzard, Brianb

From the Department of aOncology and bHIV Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.

Note: Part of this work has been presented in abstract form at the third National AIDS Malignancy Conference, Bethesda, Maryland, USA in May 1999.

Correspondence to: Mark Bower, Department of Oncology, Medical Day Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Tel: 44-181-237-5054; fax: 44-181-746-8863; e-mail: [email protected]

Received: 4 May 1999; revised: 2 August 1999; accepted: 13 August 1999.

Abstract

Objective:

To evaluate the impact of highly active antiretroviral therapy (HAART) on Kaposi‚s sarcoma.

Design:

Retrospective study of patients who had received systemic or local treatment for AIDS-related Kaposi‚s sarcoma who subsequently commenced HAART.

Methods:

Case note review to determine time to treatment failure for Kaposi‚s sarcoma before and after starting HAART. Time to treatment failure was calculated from the end of last therapy to the start of the next new treatment for Kaposi‚s sarcoma.

Results:

The cohort contained 78 patients. Only 38% had good risk Kaposi‚s sarcoma (stage T0I0) at presentation. The median time to treatment failure before starting HAART was 0.5 years. Initial HAART therapy was three or more drugs including a protease inhibitor for 38 (49%), three or more drugs without a protease inhibitor for 27 (35%) and a two-drug protease combination for 13 (16%). The median follow-up after starting HAART was 12 months (range, 0.5-52 months) and anti-Kaposi‚s sarcoma treatment has been required for 24 (31%) patients. The median time to treatment failure for Kaposi‚s sarcoma from the start of HAART is 1.7 years. This is statistically longer than the time to treatment failure for the same cohort of patients before they started HAART (log rank χ2=16.5, P<0.0001). The serum HIV RNA viral load (VL) at the time of Kaposi‚s sarcoma progression revealed virological failure of HAART (defined as VL>5000 copies/ml) in 14 of 24 (58%) and good control (VL<200 copies/ml) in five of 24 (21%).

Conclusion:

HAART is associated with prolonged time to treatment failure in Kaposi‚s sarcoma. Progression of Kaposi‚s sarcoma while on HAART is not necessarily associated with virological failure as determined by rising viral RNA titre.