The early stages of the AIDS-defining cancer Kaposi’s sarcoma (KS) can be successfully treated with HIV drugs alone without the need for additional chemotherapy, research presented to the Fifteenth Annual Conference of the British HIV Association (BHIVA) showed.
Investigators at the Chelsea and Westminster Hospital in London conducted a prospective study to determine the outcome of patients diagnosed with KS since the advent of effective antiretroviral therapy in 1996.
A total of 254 of the hospital’s HIV-positive patients were diagnosed with KS in their twelve-year study period. Nearly all (96%) were men and the median duration of follow-up was four years (maximum, twelve years).
The mean age at the time of KS diagnosis was 39 years. The malignancy was detected an average of four years after patients were first diagnosed with HIV. Just under a fifth of individuals were taking antiretroviral therapy at the time of KS diagnosis and only 7% had an undetectable viral load.
Most of the patients (69%) had less advanced KS (stage T0), the malignancy being mainly restricted to the skin.
At the time of KS diagnosis, median CD4 cell count was 150 cells/mm3. The overall five-year survival rate for the entire cohort was 89%.
Treatment for the 163 antiretroviral-naive patients with stage T0 KS was restricted to HIV treatment alone.
Only one of these patients died because of KS. A further 37 (22%) required chemotherapy. It seemed probable that a weak immune system was the underlying reason for the need to take chemotherapy as two-thirds of the patients requiring this treatment did so within a year of initiating antiretroviral therapy.
The overall five-year survival rate for patients whose treatment consisted solely of antiretrovirals was 91%.
HIV treatment by itself may be sufficient to treat stage T0 KS, the investigators concluded.
Powles S et al. AIDS Kaposi’s sarcoma: outcomes in 254 consecutive patients diagnosed in modern times. Fifteenth Conference of the British HIV Association, abstract 030, Liverpool, 2009.