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The effect of HAART in 254 consecutive patients with AIDS-related Kaposi's sarcoma

Bower, Marka; Weir, Justinb; Francis, Nicholasb; Newsom-Davis, Toma; Powles, Sama; Crook, Tima; Boffito, Martac; Gazzard, Brianc; Nelson, Markc

doi: 10.1097/QAD.0b013e32832d080d
Clinical Science

Objective: A prospective cohort study was performed to evaluate the clinical outcomes of patients with histologically confirmed AIDS-related Kaposi's sarcoma diagnosed since the introduction of HAART.

Methods: Two hundred and fifty-four consecutive patients (96% men) diagnosed with Kaposi's sarcoma between 1996 and 2008 are included. Clinicopathological and treatment details were prospectively collected. The median follow-up is over 4 years and maximum 12 years.

Results: The mean age at Kaposi's sarcoma diagnosis was 39 years and average duration of known HIV seropositivity was 4 years. At Kaposi's sarcoma diagnosis, only 19% patients were on HAART and only 7% patients had an undetectable plasma HIV viral load. Seventy-nine (31%) patients had AIDS clinical Trial Group stage T1 disease at Kaposi's sarcoma diagnosis and 122 (48%) had AIDS clinical Trial Group stage I1 disease (CD4 cell count < 150 cells/μl). Nodular grade Kaposi's sarcoma represented 28% of the tumours and was significantly associated with black African ethnicity and AIDS clinical Trial Group T1 stage disease. The overall 5-year survival is 89% (95% confidence interval 84–93). One hundred and sixty-three patients were treated with HAART alone for T0 stage Kaposi's sarcoma; only one died of Kaposi's sarcoma and only 37 (22%) required chemotherapy, giving a systemic treatment-free survival at 5 years of 74% (95% confidence interval 67–82) and the overall survival at 5 years is 91% (95% confidence interval 87–95).

Conclusion: The high success rate of HAART in a large cohort of AIDS–Kaposi's sarcoma patients over a prolonged period of follow-up will reassure patients and clinicians that this is a well tolerated and effective approach to stage T0 Kaposi's sarcoma.

aDepartment of Oncology, UK

bDepartment of Histopathology, UK

cDepartment of HIV Medicine, Chelsea and Westminster Hospital, London, UK.

Received 30 January, 2009

Revised 7 April, 2009

Accepted 17 April, 2009

Correspondence to Professor Mark Bower, PhD, FRCP, Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Tel: +44 208 237 5054; fax: +44 208 746 8863; e-mail: m.bower@imperial.ac.uk

© 2009 Lippincott Williams & Wilkins, Inc.