Abstract
Kaposi sarcoma (KS) remains a relevant malignancy in human immunodeficiency virus (HIV)-infected patients with a non-standardized management; despite past suggestions that ritonavir-boosted protease inhibitor (bPI)-based regimens could be preferable, no combination antiretroviral therapy (cART) regimen was demonstrated to outperform the others and the impact of new drugs, drug classes or paradigms was never investigated nor proven better than previous therapeutic regimes. In order to do this, we retrospectively collected data regarding HIV-infected patients with a diagnosis of KS last seen in six Italian centers after 1 January 2013. A total of 104 KS cases in 99 patients was analyzed for 945.34 patient-year follow-up (PYFU). Twenty-six patients had visceral localizations. Thirty-three patients were treated with chemotherapy, four with electrochemotherapy, and 12 with α-interferon (α-IFN). At censor, 22% received a bPI-based, 14% a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, and 28% an integrase inhibitor (INI)-based standard cART, 24% a less drug regimen and 12% a mega-cART. Twelve recurrence episodes were observed in seven patients for an incidence of 1.27 per 100 PYFU. Two patients with no evidence of recurrence episodes died for other reasons. In our experience, KS recurrence episodes were infrequent. Despite the increasing use of new antiretroviral drug classes and new treatment paradigms, no excess of recurrence episodes was observed in patients receiving such cART regimens.
Highlights
In more than thirty years since acquired immunodeficiency syndrome (AIDS) was defined, the introduction and the subsequent optimization of combination antiretroviral therapy greatly improved its prognosis [1] and the incidence of many associated events, including Kaposi sarcoma (KS), declined over the years [2,3]
A large cohort study denied an advantage of protease inhibitors (PIs) over non-nucleoside reverse transcriptase inhibitors (NNRTIs) [21] and the development of KS was reported in patients who were successfully treated with boosted PIs [7]
The use of combination antiretroviral therapy (cART) remains the only treatment for mild to moderate cutaneous diseases but there is no evidence about the best regimen for this setting and recent changes in the recommended first line regimens and possible future changes of paradigms for the treatment of human immunodeficiency virus (HIV) infection could have an impact on the control of this AIDS-defining event
Summary
In more than thirty years since acquired immunodeficiency syndrome (AIDS) was defined, the introduction and the subsequent optimization of combination antiretroviral therapy (cART) greatly improved its prognosis [1] and the incidence of many associated events, including Kaposi sarcoma (KS), declined over the years [2,3]. International guidelines recognize cART as the only possible therapy for patients with initial, mild to moderate cutaneous KS disease [10,11,12,13], adding chemotherapy in the context of IRIS of rapidly progressive diseases or of visceral localizations [13]. When KS is diagnosed, international guidelines recommend the rapid initiation of cART, with or without chemotherapy if indicated [10,11,12,13]. In the early ART era, a possible advantage on KS with the use of protease inhibitors (PIs) and ritonavir was found in some studies [14,15,16,17,18]; no definitive evidence was ever provided, PIs were often the first choice for the initiation of cART in human immunodeficiency virus (HIV)-infected patients with KS. A large cohort study denied an advantage of PIs over non-nucleoside reverse transcriptase inhibitors (NNRTIs) [21] and the development of KS was reported in patients who were successfully treated with boosted PIs [7]
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