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Predicting the evolution of Kaposi sarcoma, in the highly active antiretroviral therapy era

Boffi El Amari, Emmanuelle
Toutous-Trellu, Laurence
Baumann, Michele
Cathomas, Gieri
Steffen, Ingrid
Erb, Peter
Mueller, Nicolas J.
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Published in AIDS. 2008, vol. 22, no. 9, p. 1019-28
Abstract BACKGROUND: The outcome of Kaposi sarcoma varies. While many patients do well on highly active antiretroviral therapy, others have progressive disease and need chemotherapy. In order to predict which patients are at risk of unfavorable evolution, we established a prognostic score. METHOD: The survival analysis (Kaplan-Meier method; Cox proportional hazards models) of 144 patients with Kaposi sarcoma prospectively included in the Swiss HIV Cohort Study, from January 1996 to December 2004, was conducted. OUTCOME ANALYZED: use of chemotherapy or death. VARIABLES ANALYZED: demographics, tumor staging [T0 or T1 (16)], CD4 cell counts and HIV-1 RNA concentration, human herpesvirus 8 (HHV8) DNA in plasma and serological titers to latent and lytic antigens. RESULTS: Of 144 patients, 54 needed chemotherapy or died. In the univariate analysis, tumor stage T1, CD4 cell count below 200 cells/microl, positive HHV8 DNA and absence of antibodies against the HHV8 lytic antigen at the time of diagnosis were significantly associated with a bad outcome.Using multivariate analysis, the following variables were associated with an increased risk of unfavorable outcome: T1 [hazard ratio (HR) 5.22; 95% confidence interval (CI) 2.97-9.18], CD4 cell count below 200 cells/microl (HR 2.33; 95% CI 1.22-4.45) and positive HHV8 DNA (HR 2.14; 95% CI 1.79-2.85).We created a score with these variables ranging from 0 to 4: T1 stage counted for two points, CD4 cell count below 200 cells/microl for one point, and positive HHV8 viral load for one point. Each point increase was associated with a HR of 2.26 (95% CI 1.79-2.85). CONCLUSION: In the multivariate analysis, staging (T1), CD4 cell count (<200 cells/microl), positive HHV8 DNA in plasma, at the time of diagnosis, predict evolution towards death or the need of chemotherapy.
Keywords AIDS-Related Opportunistic Infections/drug therapy/epidemiology/mortalityAdultAgedAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountCD4-Positive T-LymphocytesDisease ProgressionFemaleHIV Infections/drug therapy/epidemiologyHIV-1Herpesvirus 8, Human/metabolismHumansIncidenceMaleMiddle AgedPrevalencePrognosisProspective StudiesRNA, Viral/bloodRetrospective StudiesRisk FactorsSarcoma, Kaposi/drug therapy/epidemiology/mortalitySwitzerland/epidemiologyViral Load
Stable URL http://archive-ouverte.unige.ch/unige:1128
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PMID: 18520345
Research groups Swiss HIV Cohort Study
Unité HIV (46)
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