Franceschi S, Dal Maso L, Rickenbach M, Polesel J, Hirschel B, Cavassini M, Bordoni A, Elzi L, Ess S, Jundt G, Mueller N, Clifford GM, the Swiss HIV Cohort StudyKaposi sarcoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy. Br J Cancer 99: 800-804

International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France.
British Journal of Cancer (Impact Factor: 4.84). 10/2008; 99(5):800-4. DOI: 10.1038/sj.bjc.6604520
Source: PubMed


Between 1984 and 2006, 12 959 people with HIV/AIDS (PWHA) in the Swiss HIV Cohort Study contributed a total of 73 412 person-years (py) of follow-up, 35 551 of which derived from PWHA treated with highly active antiretroviral therapy (HAART). Five hundred and ninety-seven incident Kaposi sarcoma (KS) cases were identified of whom 52 were among HAART users. Cox regression was used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI). Kaposi sarcoma incidence fell abruptly in 1996-1998 to reach a plateau at 1.4 per 1000 py afterwards. Men having sex with men and birth in Africa or the Middle East were associated with KS in both non-users and users of HAART but the risk pattern by CD4 cell count differed. Only very low CD4 cell count (<50 cells microl(-1)) at enrollment or at HAART initiation were significantly associated with KS among HAART users. The HR for KS declined steeply in the first months after HAART initiation and continued to be low 7-10 years afterwards (HR, 0.06; 95% CI, 0.02-0.17). Thirty-three out of 52 (63.5%) KS cases among HAART users arose among PWHA who had stopped treatment or used HAART for less than 6 months.

Download full-text


Available from: Matthias Cavassini
  • Source
    • "Od czasu wprowadzenia do leczenia ART zmieniło się podejście do leczenia chłoniaków, ale również zmienił się ich rodzaj i przebieg kliniczny. Wprowadzenie ART spowodowało istotne obniżenie częstości zachorowania na mięsaka Kaposiego i NHL [45] [46], jednak nie udowodniono wpływu ART na częstość występowania HL [47]. Obserwuje się, że u chorych poddawanych ART lokalizacje pozawęzłowe oraz obciążające czynniki prognostyczne oceniane według Międzynarodowego Indeksu Prognostycznego (IPI; International Prognostic Index) występują rzadziej w porównaniu z erą sprzed leczenia ART. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with non-Hodgkin's lymphoma (NHL) and coexisting infection with HBV, HCV or HIV constitute a major problem for clinicians concerning interdependence of the viral infection, lymphoma and antineoplatistic treatment. In patients with NHL and HCV infections complex virology diagnostics should be performed before lymphoma treatment is administered. If there are no indications to initiate antiviral therapy, the lymphoma treatment should be administered like in a subject without HCV infection. The risk of life-threatening complications of HCV reactivation is minimal and should not be taken into consideration when decisions related to lymphoma treatment are to be made. In the case of indolent NHL as the efficacy of HCV eradication is associated with remission achievement, it is effective to start therapy with antiviral schedules of inteferon with ribavirin. On the contrary, previous or chronic HBV infection is a risk factor for HBV reactivation and for reactivation-related mortality. Antiviral prophylaxis with lamivudine is to be considered routinely with its duration of 7 days before antineoplastic therapy initiation and ending 6 months after therapy completion. In patients not previously exposed to HBV active immunization is recommended, unless the subject was earlier vaccinated. Finally, patients with HIV infection and NHL should be treated with concomitant ART administration and adequate chemotherapy schedules (including rituximab). Schedules with reduced intensity should be restricted to patients with CD4+ cells count less than 100 cells/mm3. Special attention should be paid to intrathecal therapy and supportive treatment during chemotherapy.
    Full-text · Article · Mar 2015 · Acta haematologica Polonica
  • Source
    • "The Role of Human Herpesvirus 8 Molecular Characterization in the Management of HIV Infected Patients Diagnosed with Malignancies Associated with Its Infection 222 8-associated diseases outcome. Some authors have alerted that the risk of KS remains substantially increased in HIV infected subjects and further decreases have not been observed [3]; being KS recently diagnosed in patients with controlled HIV infection and CD4 counts over 200 T cells [4]. Epidemic KS incidence has not been significantly reduced in Cuba although locally produced antiretroviral drugs started being introduced as a form of treatment since 2001. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the progress has been reached with Human herpesvirus 8 (HHV-8) research, there are gaps in the knowledge of viral induced oncogenesis. The aim of the present study was to identify possible associations between HHV-8 subtypes, HHV-8 loads and clinical manifestations of HIV infected patients diagnosed with different malignancies associated with HHV-8 infection. Forty six HIV-1 infected individuals diagnosed with different HHV-8 associated diseases were studied [37 epidemic Kaposi’s sarcoma (KS), 3 pleural effusion lymphoma (PEL); 5 peripheral lymphadenopathies (PL); 1 Hodgkin’s lymphoma (HL); 1 non Hodgkin’s lymphoma (NHL)]. HHV-8 loads were determined by quantitative real time PCR (qRT-PCR) whilst HHV-8 subtypes were determined by open-reading frame (ORF)-K1 gen genotyping. HHV-8 subtypes B, A, C, A5 and E were exhibited by 31.8%, 23.4%, 19.1%, 17% and 8.5% of the studied patients, respectively. The median HHV-8 viral load did not differ between subtypes (p > 0.05) but HHV-8 viral loads were sig- nificantly higher in PEL than in epidemic KS lesion or lymph nodes (p = 0.04). Subtype B was detected in 60% of pa- tients with B cell lymphoma (NHL, PEL and HL) whereas subtype E was only detected in patients with epidemic KS diagnosis. Our data suggest that HHV-8 DNA quantification instead of subtype identification could be used as a surro- gate marker for monitoring its infection, not only in epidemic KS patients but also in HIV infected individuals with lymphoproliferative disorders.
    Full-text · Article · Sep 2013 · World Journal of AIDS
  • Source
    • "Currently, treatment options for localized cutaneous KS lesions include surgery [47], radiation [48, 49], cryotherapy/laser therapy [50–52], intralesional injection of chemotherapy (vinblastine; [53, 54]), topical therapy (cis-retinoic acid [55]), and (imiquimod [56]). Highly active antiretroviral treatment (HAART) is recommended for all patients with AIDS-related KS [57–59], despite the finding that its initiation is associated with temporary progression of KS lesions within the first three to six weeks, corresponding with the well-described immune reconstitution syndrome [60, 61]. Despite this observation, HAART is recommended for all patients with KS, as the benefits are thought to strongly outweigh the risks. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose. Kaposi's sarcoma (KS) is a rare low-grade vascular tumor associated with the human herpes virus 8. By analyzing the epidemiology, staging, and treatment of KS, we hoped to improve the quality of care at our institution. Methods. Review of the Mount Sinai Medical Center tumor registry database in Miami Beach, FL, USA, identified 143 cases of KS between January 1, 1987 and December 31, 2007. Results. The majority of patients were non-Hispanic whites, non smoking males diagnosed between 1987 and 1996. Most of the patients were HIV positive, with an equal percentage diagnosed with local or distant disease. Most patients received no chemotherapy or radiation. There were no significant differences in patient survival based on sex, HIV status, or radiation received. There was a trend toward improved survival among older patients who smoked, received no chemotherapy, and had localized stage at diagnosis. Multivariate analysis revealed that non-Hispanic whites had a significant worse survival than Hispanic whites (HR = 0.55, 95% CI (0.33, 0.90), P = 0.02). Patients diagnosed between 1987 and 1996 had a worse survival than those between 1997 and 2007 (HR = 0.33 (95% CI 0.19, 0.55), P < 0.0001). Conclusion. This large retrospective study provides further insight into KS. Ethnicity and date of diagnosis are important predictors of long-term survival.
    Full-text · Article · Dec 2012
Show more