Abstract
Simple SummaryKaposi’s sarcoma (KS) in people living with HIV (PLHIV) occurs in the vast majority of cases when viral replication is not controlled and when CD4 immunosuppression is important. However, clinicians are observing more and more cases of KS in PLHIV with suppressed viremia on antiretroviral treatment. These clinical forms seem less aggressive, but cause therapeutic dead ends. Indeed, despite repeated chemotherapy, recurrences are frequent. Immunotherapy and specific treatment regimens should be evaluated in this population.Since the advent of highly effective combined antiretroviral treatment (cART), and with the implementation of large HIV testing programs and universal access to cART, the burden of AIDS-related comorbidities has dramatically decreased over time. The incidence of Kaposi’s sarcoma (SK), strongly associated with HIV replication and CD4 immunosuppression, was greatly reduced. However, KS remains the most common cancer in patients living with HIV (PLHIV). HIV physicians are increasingly faced with KS in virally suppressed HIV-patients, as reflected by increasing description of case series. Though SK seem less aggressive than those in PLHIV with uncontrolled HIV-disease, some may require systemic chemotherapy. Persistent lack of specific anti-HHV-8 cellular immunity could be involved in the physiopathology of these KS. These clinical forms are a real therapeutic challenge without possible short-term improvement of anti-HHV-8 immunity, and no active replication of HIV to control. The cumulative toxicity of chemotherapies repeatedly leads to a therapeutic dead end. The introduction or maintenance of protease inhibitors in cART does not seem to have an impact on the evolution of these KS. Research programs in this emerging condition are important to consider new strategies.
Highlights
Thanks to the efficacy and wide access of combined antiretroviral treatment for controlling HIV replication, the risk of Kaposi’s sarcoma (KS) in people living with HIV (PLHIV) has greatly declined over the past 25 years in resource rich settings [1,2,3,4]
We postulate that the pathological presentation of KS in HIV-patients optimally treated by combined antiretroviral treatment (cART) constitutes a specific pattern, due to HHV-8 chronic antigen exposure, immune modulation by viral proteins, and local immune exhaustion
The four series of virally suppressed patients living with HIV (PLHIV) with KS we report in this article (Table 1) include patients treated in the last 10–15 years, and during this period, antiretroviral drugs have changed
Summary
Thanks to the efficacy and wide access of combined antiretroviral treatment (cART) for controlling HIV replication, the risk of Kaposi’s sarcoma (KS) in people living with HIV (PLHIV) has greatly declined over the past 25 years in resource rich settings [1,2,3,4]. KS may present as a de novo complication, or as a recurrent disease, with repeated episodes over time. There are very few published case series of virologically controlled patients presenting with KS (Table 1) [5,6,7,8]. Our group assumes that KS in virally suppressed patients is an emerging complication in PLHIV, with specific clinical, physiopathological and therapeutic difficulties, justifying a specific review to encourage further research. We aim to provide an overview of KS in virally suppressed patients on the (1) latest available epidemiological data, (2) reported clinical features, (3) immunopathological pathways, (4) therapeutic issues, including the impact of protease inhibitors.
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call