Immune Reconstitution Inflammatory Syndrome Associated With Kaposi's Sarcoma

• Published in: Journal of clinical oncology Vol. 23; no. 22; pp. 5224 - 5228
• Main Authors: BOWER, M, NELSON, M, YOUNG, A. M, THIRLWELL, C, NEWSOM-DAVIS, T, MANDALIA, S, DHILLON, T, HOLMES, P, GAZZARD, B. G, STEBBING, J
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.08.2005; Lippincott Williams & Wilkins
• Subjects: Adult; Antiretroviral Therapy, Highly Active; Biological and medical sciences; CD4 Lymphocyte Count; Cohort Studies; Dermatology; Disease Progression; Female; Humans; Inflammation; Male; Medical sciences; Middle Aged; Sarcoma, Kaposi - complications; Sarcoma, Kaposi - immunology; Syndrome; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Immune reconstitution; Kaposi sarcoma; Skin disease; Inflammation; Cancerology; Malignant tumor
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2005.14.597

A proportion of patients with HIV infection who subsequently receive highly active antiretroviral therapy (HAART) exhibit a deterioration in their clinical status, despite control of virologic and immunologic parameters. This clinical response, known as the immune reconstitution inflammatory syndrome (IRIS), occurs secondary to an immune response against previously diagnosed pathogens. From our cohort of 5,832 patients treated in the HAART era, we identified 150 therapy-naive patients with a first presentation of Kaposi's sarcoma (KS). Their clinicopathologic features and progress were recorded prospectively. After commencing HAART, ten patients (6.6%) developed progressive KS, which we identify as IRIS-associated KS. In a comparison of these individuals with those whose KS did not progress, we found that IRIS-KS occurred in patients with higher CD4 counts (P = .03), KS-associated edema (P = .01), and therapy with both protease inhibitors and non-nucleosides together (P = .03). Time to treatment failure was similar for both groups, although the CD4 count declined more rapidly at first, in those patients with IRIS-associated KS. Despite this initial decline, in our clinical experience HAART could be successfully continued in those with IRIS-associated KS. We have identified IRIS-KS in a cohort of HIV patients with KS who start HAART.