AIDS-related Kaposi's Sarcoma Research Articles

Visceral involvement as initial manifestation of AIDS-related Kaposi's sarcoma.

Visceral involvement as initial manifestation of AIDS-related Kaposi's sarcoma.

Visceral involvement as initial manifestation of AIDS-related Kaposi's sarcoma.

Visceral involvement as initial manifestation of AIDS-related Kaposi's sarcoma.

Efficacy of chemotherapeutics in classic and non-classic Kaposi sarcoma: A single-center retrospective real-world data.

ABSTRACTKaposi sarcoma (KS) is a rare disease, and especially for classic KS, a gap exists in the literature about which chemotherapeutics should be given. Here we present our institutional data on the demographic characteristics, treatment, and treatment efficacy in 16 patients with KS treated with chemotherapy. We retrospectively analyzed the demographic and clinical characteristics of and the chemotherapeutic agents administered to the 16 patients with KS diagnosed in our center based on the medical records obtained. The median age, gender, KS type, involved site, cytotoxic agents administered, progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety profiles of the patients were evaluated. The median age at disease onset was 61.07 years (range, 39.4–85.8 years). Among the patients, one had immunosuppression-related KS, four had acquired immune deficiency syndrome-related KS, and 11 had classic KS. Regarding the first-line cytotoxic therapy, seven patients received pegylated liposomal doxorubicin (PLD), six received paclitaxel, two received oral etoposide, and one received the doxorubicin, bleomycin, and vincristine regimen. The Kaplan–Meier analysis showed that the PFS was 39.9 months (95% confidence interval (CI), 7.7–72.0). In the first-line setting, a significant difference in PFS was observed between the PLD- and paclitaxel-treated groups (unreached vs. 12.8 months; p = 0.033). The OS was 66.1 months (95% CI, 30.2–102.0). The ORR and DCR of the 16 patients were 43.8%, and 81.3%, respectively. No grade 3 or 4 toxicity was observed. This retrospective study showed that among the most preferred chemotherapeutic agents, PLD seems better than paclitaxel in terms of PFS and response rates, and it showed a good safety profile in patients with KS.

Effect of innate and adaptive immune mechanisms on treatment regimens in an AIDS-related Kaposi's Sarcoma model

Kaposi Sarcoma (KS) is the most common AIDS-defining cancer, even as HIV-positive people live longer. Like other herpesviruses, human herpesvirus-8 (HHV-8) establishes a lifelong infection of the host that in association with HIV infection may develop at any time during the illness. With the increasing global incidence of KS, there is an urgent need of designing optimal therapeutic strategies for HHV-8-related infections. Here we formulate two models with innate and adaptive immune mechanisms, relevant for non-AIDS KS (NAKS) and AIDS-KS, where the initial condition of the second model is given by the equilibrium state of the first one. For the model with innate mechanism (MIM), we define an infectivity resistance threshold that will determine whether the primary HHV-8 infection of B-cells will progress to secondary infection of progenitor cells, a concept relevant for viral carriers in the asymptomatic phase. The optimal control strategy has been employed to obtain treatment efficacy in case of a combined antiretroviral therapy (cART). For the MIM we have shown that KS therapy alone is capable of reducing the HHV-8 load. In the model with adaptive mechanism (MAM), we show that if cART is administered at optimal levels, that is, 0.48 for protease inhibitors, 0.79 for reverse transcriptase inhibitors and 0.25 for KS therapy, both HIV-1 and HHV-8 can be reduced. The predictions of these mathematical models have the potential to offer more effective therapeutic interventions in the treatment of NAKS and AIDS-KS.

Kaposi sarcoma incidence, survival and trends: Data from the information network on rare cancers in Europe (RARECAREnet)

BackgroundThis study provides updated information on Kaposi sarcoma (KS) in Europe during 1995–2007 from the RARECARENet project. MethodsData comes from 59 population-based cancer registries in 22 countries. KS was defined as ICD-O-3 morphology code 9140 combined with any topography code. Crude and age-adjusted incidence rates and relative survival for years of diagnosis 2000–2007 and with trends during 1995–2007 were calculated overall, by age and by country. ResultsThe crude annual incidence rate was 0.28 per 100,000 and age-adjusted incidence was 0.23 per 100,000; incidence increased with age, from 0.18/100,000 at age 0–44 to 0.25/100,000 at age 45–64 and 0.69/100,000 at age 65 and over. Age-adjusted incidence in males was more than four times that in females. Portugal, which had the highest incidence of AIDS in Europe, had by far the highest incidence of KS at age 0–44, 1.44/100,000, more than four times the rate in any other country. Incidence among males in Europe aged 0–44 fell significantly between 1995–1998 and 1999–2002, followed by a significant increase in 2003–2007. Younger patients, with predominantly AIDS-related KS, formerly had a worse prognosis, but since 1999–2001 5-year relative survival increased for patients aged under 65, and by 2005–2007 was 83–86 % for all three age groups 0–44, 45–64, and 65 and over. ConclusionSurvival and quality of life for the increasing number of people in Europe affected by KS should improve further following the development of evidence-based guidelines for its management. Population-based cancer registries will continue to play a vital role in monitoring the burden of KS and improvements in its outcome.

Rapid and Elevated Tumor Responses to Wekley Paclitaxel for AIDS-Related Kaposi Sarcoma

Kaposi sarcoma is a rare condition, it is an incurable disease with a poor prognosis, the treatment of this pathology is variable including surgery, Radiotherapy, chemotherapy and antiviral treatments. A number of drugs approved for the treatment of KS associated with AIDS, in particular the pegylated liposomal doxorubicin (DLP) which is currently the standard, Paclitaxel, have also shown efficacy against advanced SK. We report a case of a patient with kaposi's sarcoma associated with HIV metastatic in the lung, liver and lymph nodes and who presented an almost complete response after 4 months of chemotherapy with weekly Paclitaxel at a dose of 100 mg in our department of medical oncology at CHU Hassan II in Fez. Of interest is the complete response to paclitaxel treatment in a patient followed for metastatic kaposi sarcoma.

Conjunctival Kaposi’s sarcoma in Acquired Immunodeficiency Syndrome (AIDS) patient: a case report

Background: Kaposi’s sarcoma (KS) is malignant neoplasm of the vascular endothelium, caused by Human Herpes Virus 8 (HHV 8). Clinical variants consist of classic KS, iatrogenic KS, and AIDS KS. The manifestation of KS in the eye may occur in the eyelids, the lacrimal sac or gland, the orbit and bulbar or palpebral conjunctiva. This case study aims to demonstrate the incidental finding of conjunctival Kaposi sarcoma (KS) leading to acquired immunodeficiency syndrome (AIDS) diagnosis.Case Presentation: A 34-years old male patient presented with a three-month history of progressively growing reddish mass in bulbar conjunctiva of the left eye. A mass with notable aggressive tumor characteristics heightened the suspicion for KS and comprehensive assessments were done accordingly. The patient was found to suffer from human immunodeficiency virus (HIV)/AIDS. Multistep approach treatment was commenced to treat AIDS-related KS and prevent recurrence in this case.Conclusion: Patients with undiagnosed HIV infection would benefit from early diagnosis initiated by AIDS-defining illnesses such as KS. Given early identification and comprehensive management, KS abridged the time to diagnosis of HIV infection.

Impact of Insurance Status on Outcomes in Patients with AIDS-Defining Cancers

Background: Mortality among people living with the human immunodeficiency virus (PLWH [HIV]) diagnosed with acquired immunodeficiency syndrome (AIDS)-defining cancers has greatly decreased with the advent of highly active antiretroviral therapy (HAART). Recent investigations exploring the impact of insurance coverage have concluded that PLWH with public insurance have greater mortality than their privately insured counterparts. One avenue to augment medical coverage is the Ryan White HIV/AIDS Program, first authorized by Congress in 1990 to provide primary care and support services to PLWH. This study sets out to elucidate whether insurance coverage and Ryan White assistance affect treatment parameters and survival rates in PLWH diagnosed with Kaposi sarcoma (KS) and non-Hodgkin lymphomas (NHL). Methods: This was a retrospective cohort study of PLWH diagnosed with KS or NHL between 2004 and 2018. Baseline characteristics including demographics, insurance coverage, Ryan White assistance, CD4+ T-cell counts, HIV viral load, HAART treatment, performance status, and disease stage were collected. Participants were classified as having private insurance, Medicare, Medicaid, or no insurance. Treatment regimens were assessed as "optimal" or "suboptimal" using the National Comprehensive Cancer Network guidelines for AIDS-related KS and lymphomas as benchmark. Hazard ratios (HR) for survival were calculated using Cox proportional hazards regression models. Results: Among 191 participants with AIDS-defining cancers, 107 had KS, and 96 had aggressive NHL. 18% had private insurance, 14% had Medicare, 46% had Medicaid, and 23% had no health insurance; 44% received Ryan White assistance. Participants with Medicare and those without Ryan White assistance were older. Those with Ryan White assistance also had better performance status (defined as having an Eastern Cooperative Oncology Group score of 0 to 2). There were no significant differences in CD4+ T-cell counts, HIV viral loads, HAART adherence, treatment delays, regimen selection, and response rates across the insurance and Ryan White groups. The median treatment delay for all participants was 20 days. In general, participants with Medicare had lower overall survival than privately insured participants (HR 2.99, 95% confidence interval [CI] 1.14-7.87, p = 0.027). Participants without Ryan White assistance also had lower overall survival (HR 2.82, 95% CI 1.49-5.35, p = 0.002) and progression-free survival (HR 2.56, 95% CI 1.47-4.44, p < 0.001) than those with assistance. Other factors that influenced overall survival were age (adjusted HR 1.04 per year of age; 95% CI 1.01-1.06; p = 0.007), Hispanic ethnicity (adjusted HR 0.46 compared to Whites; 95% CI 0.24-0.91; p = 0.025), and poor performance status (adjusted HR 6.14; 95% CI 3.39-11.12; p < 0.00001). Conclusions: Our study is among the first to examine the impact of insurance coverage on outcomes in AIDS-defining malignancies. We find that PLWH with Medicare and those not receiving Ryan White assistance have lower survival. These differences may be ascribed in part to discrepancies in age, performance status, and prevalence of AIDS- and non-AIDS-related comorbidities. Reassuringly, our analysis suggests Ryan White assistance, despite its coverage limitations, is not associated with increases in treatment delays or suboptimal regimens. Nevertheless, the importance of dedicated care for this population at a multidisciplinary HIV/AIDS and comprehensive cancer center should not be undervalued. Future research should focus on whether the observed differences can be more broadly replicated in the United States. Figure Disclosures No relevant conflicts of interest to declare.

S3367 Acquired Immunodeficiency Syndrome-Related Kaposi Sarcoma of the Rectum in the Absence of Cutaneous Manifestation

S3367 Acquired Immunodeficiency Syndrome-Related Kaposi Sarcoma of the Rectum in the Absence of Cutaneous Manifestation

S2214 Unusual Initial Presentation of HIV With Disseminated Kaposi Sarcoma (KS) as Rectal Bleeding

INTRODUCTION: Kaposi's sarcoma (KS) is a cancer that develops from the cells that line lymph or blood vessels. It usually appears as tumors on the skin or on mucosal surfaces such as inside the mouth, but these tumors can also develop in other parts of the body, such as in the lymph nodes, the lungs or digestive tract. KS involvement of GI tract may remain asymptomatic in the beginning or may present with mild non-specific abdominal symptoms, unlikely to be diagnosed in late stage. Here we are presenting a case of disseminated KS presented with rectal bleed in homosexual undiagnosed HIV patient. CASE DESCRIPTION/METHODS: A 33 yr old male with no significant past medical history, presented with 3-month history of constipation and progressive unintentional weight loss (40 lbs in 3 months). Lately, patient noticed his stool mixed with blood and mucus, early satiety and fatigue. Patient has family history significant for breast cancer and biliary cancer in mother. Patient is sexually active with 5 male partners. On presentation, vitals were stable and physical examination revealed multiple purple non-blanchable lesions on his extremities and trunk, a mass on the hard palate, supraclavicular and inguinal lymphadenopathy, external hemorrhoids, and a palpable mass in the rectum. Labs showing normocytic anemia with Hb of 10.3, ESR of 95 and CRP of 9.88. Patient was found to be positive for HIV with viral load of 118,255 and CD4 count of 236. Patient also had high IgG titers for Chlamydia trachomatis and CT abdomen and pelvis showed rectosigmoid mass with perirectal lymphadenopathy, inguinal adenopathy, and mild retroperitoneal lymphadenopathy. CT chest showed pulmonary metastasis and colonoscopy showed mild non-specific ileitis, nodule in descending colon and neoplasm in the rectum. Biopsy from the descending colon and rectal mass showed ulcerated Kaposi’s sarcoma and positive immunostaining for human herpes virus -8 (HHV-8). Patient was diagnosed with disseminated KS and started on anti-retroviral therapy (ART) and systemic chemotherapy. DISCUSSION: AIDS-associated disseminated KS is a rare entity. ART has resulted in marked decline in the incidence of KS. Due to the rapid and progressive nature of AIDS related KS, early diagnosis and institution of ART is crucial to achieving favorable prognosis. In addition, co-infection of HHV-8 with HIV promotes the oncogenicity of HHV-8 leading to rapid onset and progression of KS. Above patient responding well to the ART and Chemo going for surveillance Colonoscopy.Figure 1.: Kaposi Sarcoma on Hard Palate.Figure 2Figure 3.: Kaposi Sarcoma in Rectum.

1640P Pegylated liposomal doxorubicin (PLD) as first line treatment in AIDS-related Kaposi’s sarcoma (AIDS-KS): A single institution retrospective study

1640P Pegylated liposomal doxorubicin (PLD) as first line treatment in AIDS-related Kaposi’s sarcoma (AIDS-KS): A single institution retrospective study

AIDS-Related Kaposi Sarcoma in a Tertiary University Hospital in Manila, Philippines: A Report of Six Cases

We report six cases of Kaposi sarcoma (KS) seen at the University of the Philippines–Philippine General Hospital, a tertiary university hospital with a 1,500-bed capacity in Manila, from 2017 to February 2020. All cases involved males (21–47 years old) infected with human immunodeficiency virus (HIV). Majority came from Metro Manila and had opportunistic infections at the time of KS diagnosis, most commonly pulmonary tuberculosis. Four patients presented with multiple hyperpigmented cutaneous patches. One patient had both cutaneous lesions and necrotic gingival mass. One patient presented with a gastrointestinal mass. One patient underwent systemic chemotherapy (liposomal doxorubicin) but was eventually lost to follow-up. Although considered the most common tumor arising from HIV-infected persons, KS is considered rare in the Philippines. No studies have been undertaken to determine its incidence. However, the incidence may be expected to rise due to the increasing number of Filipinos diagnosed with HIV daily.

Hidden disseminated extracutaneous AIDS-related Kaposi sarcoma.

A 68-year-old man with past medical history of multiple cerebral infarctions presented to our hospital with subacute paresis. His vital signs on presentation were normal, and his physical examination, other than his neurological findings, was unremarkable. Neurological examinations suggested cerebellar ataxia. Laboratory testing confirmed positive for human immunodeficiency virus (HIV) infection. His CD4-positive lymphocyte count was 45/μL, and HIV-RNA was 2.3 × 105 copies/mL. Brain computed tomography (CT) scan revealed multiple mass lesions and brain magnetic resonance imaging (MRI) with fluid-attenuated inversion-recovery (FLAIR) revealed periventricular hyperintensities, which suggested multiple malignant lymphoma and HIV encephalopathy. His state of consciousness had gradually worsened. Eventually, he died one month after admission. The autopsy unexpectedly showed disseminated Kaposi’s sarcoma (KS). KS lesions were found in the stomach, small intestine, liver, spleen, mesentery and lungs. KS was not observed on his skin. Gross findings revealed multiple nodular lesions in each organ, and hematoxylin and eosin staining showed proliferation of spindle cells with vascular proliferation. Immunostaining was positive both for endothelial marker (CD31 and von Willebrand factor) and lymphatic endothelial marker (D2-40), which were consistent with KS.KS is the most common tumor in AIDS patients. It is caused by the human herpes-virus 8 infection. It manifests an indolent clinical course and mostly involves cutaneous lesions over the lower limbs, trunk and oral cavity. In this case, autopsy revealed disseminated KS pathologically, which was unrecognized before his death. This case highlights the possible existence of disseminated KS even without its cutaneous findings.

1496 Visceral Involvement as the Initial Presentation of Kaposi Sarcoma Carries a Worse Prognosis

INTRODUCTION: AIDS-related Kaposi sarcoma (KS) is a vascular tumor associated with infection by the human herpesvirus-8 (HHV-8) that most commonly affects mucocutaneous sites. In its disseminated form, it can also involve lymph nodes and visceral organs, in particular the respiratory and gastrointestinal tract. Visceral involvement as the initial manifestation of KS is extremely rare and carries a worse prognosis. We present a case of a 54-year-old Male with disseminated KS with rectal involvement presenting with cough and chills. CASE DESCRIPTION/METHODS: 54-year-old Male with a past medical history significant for HIV, not adherent with HAART therapy, who presented to the Emergency Department (ED) with a chief complaint of cough and subjective chills of three days duration. He later endorsed recent sick contacts, bloody diarrhea, and a 40 lb weight loss over the last year. In the ED, he was hypotensive and tachycardic and found to have a CD4 13 with a viral load of 3 million copies/ml. A CT Chest showed evidence of bilateral pleural effusions for which he was started on broad spectrum antibiotics. He underwent bronchoscopy with BAL which showed small nodules suspicious for KS versus Lymphoma. His hospital course was complicated by microcytic anemia (Hb 6.1 on admission) with a positive fecal occult test requiring multiple blood transfusions. Gastroenterology was consulted and the patient underwent colonoscopy which showed evidence of a large, non obstructing, fungating mass in the distal rectum. The mass had a purple hue, was noncircumferential, and was confluent with multiple scattered oozing purple sessile nodules. Biopsies were taken with cold forceps for histology. The rectal biopsy was positive for Human Herpes Virus 8 (HHV-8) and he was diagnosed with disseminated KS. He was subsequently transferred to the National Institutes of Health Clinical Center in Maryland after failed initial treatment for further management and care. DISCUSSION: Visceral involvement as the initial presentation of KS is rare and carries a worse prognosis. While gastrointestinal KS lesions are usually asymptomatic, they may also cause a wide array of symptoms including nausea and vomiting, weight loss, upper or lower gastrointestinal bleeding, and abdominal pain. Because visceral involvement is rare as the initial presentation, the possibility of disseminated KS in an immunocompromised patient is often over looked and thus, a high index of suspicion is required.

2764 An Unusual Presentation of Gastric Kaposi's Sarcoma

INTRODUCTION: Kaposi sarcoma (KS) is a low grade angioproliferative tumor. AIDS-related KS is the most common and aggressive form of KS. The prevalence of AIDS-related KS is up to 30%. Skin is the most commonly affected organ in 78% of cases, The gastrointestinal (GI) tract is the most commonly affected extracutaneous site, and often asymptomatic. In advanced cases, patients may present with GI bleeding, diarrhea, protein-losing enteropathy, intussusception, or perforation. Although only 20% of KS patients experience GI symptoms, some studies have found that up to 80% of KS patients have GI lesions at autopsy. With the advent availability of HARRT therapy, the incidence of Kaposi sarcoma has decreased dramatically. Our objective is to present an unusual presentation of Kaposi sarcoma and its endoscopic findings leading to the diagnosis of KS, to share how endoscopy can be used as a tool for diagnosing and assessing the GI involvement in KS. CASE DESCRIPTION/METHODS: A 35-year-old African American male with HIV, syphilis, and hepatitis B complains of swelling of his legs and scrotum for 2 months. Physical examination revealed abdominal distension, bilateral lower extremity edema, and one skin nodule on his right foot. Laboratory studies revealed Hgb 8.7 g/dL, MCV 95.3 fL/cell, WBC 7500/cmm, CD4 count < 80 cells/uL, and albumin 1.4 g/dL. CT imaging revealed significant abdominal ascites (Figure 1). The patient underwent paracentesis removing 3.5 L of milky fluid. Fluid culture, gram stain and cytology were negative. Given the ascites and hepatitis history, an esophagogastroduodenoscopy (EGD) was completed in evaluating for possible esophageal varices. EGD revealed a nodular fungating lesion that extends diffusely from the gastric body into the duodenal bulb and sweep (Figures 2 and 3). Biopsy revealed cylindrical cells positive for HHV-8, confirming the diagnosis of gastric Kaposi's sarcoma (KS). Immunohistochemical analysis of the skin nodule biopsy confirmed KS. Computed tomography scan of the chest was consistent with pulmonary metastases. Patient is being treated with HAART and will be started on chemotherapy. DISCUSSION: KS is a rare neoplasm, and an AIDS-defining illness in HIV patients. About 40-51% of HIV patients with cutaneous KS will develop gastrointestinal KS, which is typically asymptomatic until growth is extensive enough to cause abdominal pain. This case illustrates the importance of endoscopic evaluation in HIV patients for early detection of gastrointestinal involvement of KS.

1932 The Answer Is on Your Skin: A Case of GI Bleeding Secondary to Kaposi Sarcoma

INTRODUCTION: GI tract bleeding in AIDS patients carries with it a significant degree of morbidity, with a unique differential including different opportunistic infections and malignancies. Kaposi Sarcoma (KS) is a form of malignancy associated with the human herpes-virus 8, recognized as an AIDS defining illness, and is typically recognized by violaceous cutaneous lesions. KS can also have widespread involvement of the visceral organs including the GI tract, where it can manifest as anything from GI bleeding to diarrhea, abdominal pain, nausea/vomiting and weight loss. Here, we describe a case of AIDS-related KS leading to profound GI bleeding. CASE DESCRIPTION/METHODS: A 29 year old male with a history of AIDS (CD4 of 44 cells/mm3and viral load of 18,000 copies/mL) in the setting of anti-retroviral therapy (ART) non-compliance presented with subacute onset shortness of breath, palpitations and malaise over the prior week. Upon review of systems, he endorsed diarrhea and melena over the same timeframe, while denying any other GI tract symptoms. Vital signs on presentation were significant for tachycardia to 103 bpm. Physical exam was notable for violaceous small lesions in buccal mucosa, hard palate, arms and back. His initial labs indicated severe anemia with a hemoglobin level of 4.9 g/dL with a ferritin level of less than 10 indicating severe iron deficiency anemia. After initial resuscitation, the patient underwent upper and lower endoscopy. His EGD showed multiple small round, heaped up ulcers in the gastric antrum, body, and fundus, along with similar ulcers in the second part of the duodenum. His colonoscopy showed similar lesions found in the transverse colon and rectum as illustrated in the images below. Biopsies taken from those lesions along with skin punch biopsies confirmed the diagnosis of Kaposi Sarcoma. He was discharged on Emtricitabine/Tenofovir and Darunavir/Cobicistat with follow up after several months showing dramatic improvement in his skin lesions and resolution of his gastrointestinal symptoms. DISCUSSION: The endoscopic appearance of KS in the GI tract is unique, often appearing as hemorrhagic nodules or plaques, however still requires tissue biopsy for diagnosis. Treatment is centered on ART with the use of systemic chemotherapy typically only needed in case of severe symptoms or lack of response to ART. Our case is a testament to the broad differential to be considered in HIV/AIDS patients with GI bleeding, of which Kaposi Sarcoma should be considered.

Three year survival among patients with aids-related Kaposi sarcoma treated with chemotherapy and combination antiretroviral therapy at Moi teaching and referral hospital, Kenya

BackgroundAIDS-related Kaposi sarcoma (AIDS-KS), a common malignancy in Kenya is associated with high morbidity and mortality. AIDS-KS is treated using bleomycin and vincristine (BV) plus or minus doxorubicin in most low resource settings, with response rates ranging from 24.8 to 87%. Survival in low resource settings has not been well documented. We report the three-year survival in a cohort of seventy patients referred to Moi Teaching and Referral Hospital (MTRH).MethodsStudy participants are part of a randomized phase IIA trial on the use of gemcitabine compared to bleomycin plus vincristine for the treatment of Kaposi sarcoma after combination antiretroviral therapy (cART) in Western Kenya. All patients were followed for three years in MTRH. Survival was determined by three monthly physical examination and analysed using Kaplan-Meier method, while possible determinants of survival such as baseline characteristics, type of chemotherapy, initial CD4 counts, age at enrolment, gender and early response to chemotherapy were analysed using univariate and multivariate Cox regression.ResultsParticipants were aged between 19 and 70 years with 56% being male. The median CD4 count was 224 cells/μl, median duration of HIV diagnosis was 12.0 months and median duration of KS lesions after histology diagnosis before initiating chemotherapy was 4.8 weeks. At three years, 60 (85.7%) patients were alive. Six of those who died were under treatment with BV while four with gemcitabine. There was no difference in the probability of survival between the patients on either treatment arm (HR = 0.573 [95% C. I 0.143, 2.292; p = 0.4311]). Additionally, the hazard ratio (HR) for response after six weeks, age at enrolment and gender indicated that they were not significant determinants of survival. Patients with normal CD4 cell counts (> = 500/μl), had a HR of 0.401(0.05,3.23; p = 0.391), suggesting better survival.ConclusionsPatients with AIDS-KS treated with combined antiretroviral drugs had excellent three-year survival regardless of whether they were treated with BV or gemcitabine as first line therapy. An initial CD4 cell count of > = 500/μl appeared to improve survival while gender, age and early response to chemotherapy were not predictors of survival after three years.Trial registrationNumber PACTR201510001.

Incidence of AIDS-Related Kaposi Sarcoma in All 50 United States From 2000 to 2014.

Although declining rates of incident AIDS-related Kaposi sarcoma (KS) have been reported, KS incidence rates have noted race/ethnic, age, and geographic diversity. We performed a comprehensive assessment of recent secular trends in AIDS-related KS incidence in the United States. We identified incident KS diagnosed in men aged 20-54 years (who comprise most AIDS-related KS in the United States) using the US Cancer Statistics registry data. Joinpoint analysis assessed for trends in age-adjusted incidence rates between 2000 and 2014 calculating average annual percentage changes (AAPCs) with 95% confidence intervals. Heat maps were generated to compare age-adjusted HIV incidence rates with KS incidence rates. Age-adjusted KS incidence rates nationwide decreased from 1.44/100,000 to 0.95/100,000 between 2000 and 2014. Observed rate changes varied across subgroups; eg, there were significant decreases in 30-44 years (AAPC = -5.4%), particularly in Whites and Blacks, significant increases among 20-29 years (AAPC = 2.7), primarily in Blacks, and stable rates among 45-54 years (AAPC = -0.03). In Southern United States, the incidence rates among Blacks did not significantly change. The states with highest average age-adjusted rates over the study period were Georgia (2.71/100,000), New York (2.16/100,000), California (2.02/100,000), Florida (1.90/100,000), and Texas (1.39/100,000), with significantly decreasing trends over time, except Georgia where rates increased (AAPC = 1.8). Although KS incidence rates have decreased nationally, age, racial, and geographic disparities persist, including increasing risk among younger Black men and particularly elevated rates in some southern states and urban areas. Further research is needed to address racial and geographic AIDS-related KS disparities.

Developing medical oncology in Africa.

BackgroundKenya, like most other developing countries, is undergoing an epidemiologic shift of disease patterns characterized by an increasing prevalence of cancer and other non-communicable diseases straining health care resources which were mainly intended for communicable diseases. We describe the development of sustainable cancer prevention and control programs at Moi University and Moi Teaching and Referral Hospital in Western Kenya.MethodsThe cancer prevention and control program at Moi Teaching and Referral Hospital was started by volunteer nurses and clinicians in 2005 in response to a high prevalence of AIDS-related Kaposi sarcoma. Chemotherapy was donated by a local drug store until 2007 when Eli Lilly pharmaceuticals from Indianapolis in the USA started helping the program through the Academic Model Providing Access to Healthcare (AMPATH). Due to good response rates of patients with AIDS-related Kaposi sarcoma, and lobbying by volunteers, the service became a formal department of Moi Teaching and Referral hospital in 2008.ResultsThe department has now grown to become the second largest public cancer centre in the country registering about 9000 patient visits per year. In addition, staff have now specialized in various areas such as medical oncology, palliative care, surgical oncology, nursing and gynaecology oncology.ConclusionsThe development of a medical oncology program requires a multi-disciplinary team focused on integration within existing programs and expansion of collaborative networks in order to provide the best care to patients.

Theranostics Based on Liposome: Looking Back and Forward.

Liposome is one of the oldest yet most successful nanomedicine platforms. Doxil®, PEGylated liposome loaded with doxorubicin (DOX), was approved by the FDA in 1995 for the treatment of AIDS-related Kaposi's sarcoma, and it was the first approval for nanomedicine. Since then, liposome-based therapeutics were approved for the treatment of various diseases and many clinical trials are underway. The success of the liposome-based therapeutics was due to following factors: (1) ease of synthesis, (2) biocompatibility, (3) the ability to load both hydrophilic and hydrophobic agents, and (4) long circulation property after application of polyethylene glycol (PEG). Recently, more functionalities are introduced to liposome platform, which are (1) in vivo imaging probes for optical, magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT), (2) pH and temperature-sensitive lipid moiety, and (3) novel agents for photodynamic and photothermal therapies (PDT, PTT). These conventional and newly tested advantages make the liposome to be one of the most promising nanoplatforms for theranostics.