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

Details

Serval ID
serval:BIB_789F38AF3B63
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Predicting the evolution of Kaposi sarcoma, in the highly active antiretroviral therapy era.
Journal
AIDS
Author(s)
El Amari E.B., Toutous-Trellu L., Gayet-Ageron A., Baumann M., Cathomas G., Steffen I., Erb P., Mueller N.J., Furrer H., Cavassini M., Vernazza P., Hirsch H.H., Bernasconi E., Hirschel B.
ISSN
1473-5571
Publication state
Published
Issued date
2008
Peer-reviewed
Oui
Volume
22
Number
9
Pages
1019-1028
Language
english
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, Adult, Aged, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Disease Progression, Female, HIV Infections, HIV-1, Herpesvirus 8, Human, Humans, Incidence, Male, Middle Aged, Prevalence, Prognosis, Prospective Studies, RNA, Viral, Retrospective Studies, Risk Factors, Sarcoma, Kaposi, Switzerland, Viral Load
Pubmed
Web of science
Create date
05/03/2009 14:07
Last modification date
20/08/2019 14:35
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