by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
June 2, 2020
Palich, R et al. for the CancerVIH Study Group. Recurrence and Occurrence of Kaposi’s Sarcoma in Patients Living with Human Immunodeficiency Virus (HIV) and on Antiretroviral Therapy, despite Suppressed HIV Viremia. Clin Infect Dis 2020;70(11):2435–38. DOI: 10.1093/cid/ciz762.
Kaposi’s sarcoma (KS), caused by HHV-type 8 was a common AIDS-defining cancer in the earlier years of the epidemic however the incidence significantly declined since 1996 in the era of combination ART. However, the risk of developing KS remains significantly higher in people living with well-controlled HIV, as compared to the general population. This study from France included patients with HIV and KS reported between 2014 and 2017. To be eligible for inclusion patients had to be on suppressive ART for at least one year and with a CD4 count of > 500 cells/mm3. Seventy-two cases of KS were submitted to the CancerVIH multidisciplinary committee of whom 21 (29%) fulfilled inclusion criteria. The majority (81%) were male with a median age of 54 years. This was a first KS episode in 8 patients and a recurrent episode in 13. The median CD4 T cell count at KS diagnosis was 375/mm3 for first episodes and 478/mm3 for those with recurrent KS. A cutaneous KS lesion was the only lesion in 11 (52%) patients but 10 (48%) had other lesions. Additional sites of involvement included 33% with visceral invasion (bronchial or gastric lesions), 27% with lymph node involvement, and 18% had bone involvement. In the patients with recurrent KS, the median time since the first appearance was 4 years and 12 had previously received chemotherapy for the disease. Specific oncologic treatments and in some cases adjustments in ART were recommended by the CancerVIH group. At 17 months post-treatment, 38% were “stable”, 37% had regression, and 25% were still progressing. The authors note that treatment of KS in suppressed patients with HIV remains very challenging with an inherent risk of toxicities from chemotherapy along with potential drug-drug interactions with ART. A prospect cohort study in this unique patient population is needed to optimize clinical management of KS.
Although the incidence of KS has significantly declined in the post-ART area, there continue to be reports of patients with well-controlled HIV disease. Similar to lymphomas, the risk of some cancers remains significantly higher in PWH compared to the general public. The pathophysiology of KS in the context of viral suppression has yet to be determined although the patients in this cohort had low CD4/CD8 ratios suggesting a role for immune activation. Other papers have suggested that HIV and age-associated Immunosenescence are a possible contributing factor. This would increase the likelihood of more cases of KS as the HIV population ages.
The author has no conflicts of interest to disclose.
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