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Elmadani M, Mokaya PO, Omer AAA, Kiptulon EK, Klara S, Orsolya M. Cancer burden in Europe: a systematic analysis of the GLOBOCAN database (2022). BMC Cancer 2025; 25:447. [PMID: 40075331 PMCID: PMC11905646 DOI: 10.1186/s12885-025-13862-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 03/04/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Cancer remains a significant public health challenge in Europe, with substantial regional disparities in incidence, mortality, and access to healthcare. This study analyses cancer patterns across Eastern, Northern, Southern, and Western Europe in 2022, highlighting key public health implications and gaps in prevention and treatment. METHODS Using data from GLOBOCAN 2022, this study assessed total new cancer cases, age-standardized incidence and mortality rates (ASRs) per 100,000, and cumulative cancer risk at age 75. The top three cancers by sex and region were also analysed to identify trends and disparities. RESULTS In 2022, Europe recorded 4,471,422 new cancer cases (ASR 280 per 100,000), with a cumulative risk of 27.9% by age 75. Males accounted for 2,359,303 cases (ASR 319.6, cumulative risk 31.9%), while females had 2,112,119 cases (ASR 253.4, cumulative risk 24.7%). Northern and Western Europe had the highest incidence rates, with Denmark leading at 374.7 per 100,000 (cumulative risk 34.9%), likely due to advanced screening and healthcare. Conversely, Eastern Europe had the highest mortality, with 1,091,871 deaths (ASR 135.3), reflecting late diagnoses and limited access of treatment. Hungary exhibited the highest mortality rate (ASR 143.7, cumulative risk 15.8%), followed by Poland (ASR 133.1). Prostate and breast cancers were the most common in males and females, respectively. Lung cancer, despite a lower incidence (ASR 24.7), had the highest mortality (ASR 17.7), while pancreatic cancer showed high fatality (ASR 6.3, mortality ASR 5.6). Thyroid cancer had a relatively high incidence (ASR 7.5) but low mortality (ASR 0.21). CONCLUSIONS Significant regional disparities in cancer burden underscore the need for targeted public health strategies. Expanding cancer screening programs, strengthening smoking cessation and HPV vaccination efforts, and improving healthcare accessibility particularly in Eastern Europe are critical to reducing mortality and enhancing early detection. Differences in mortality-to-incidence ratios also highlight the role of healthcare infrastructure and timely interventions. Future research should explore the socioeconomic and environmental determinants driving these disparities to inform evidence-based cancer control policies across Europe.
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Affiliation(s)
- Mohammed Elmadani
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pecs, Vorosmarty Mihaly Street 4, Pecs, 7621, Hungary.
- Jamhuriya Research Center, Jamhuriya University of Science and Technology, Mogadishu, Somalia.
- Department of Epidemiology, Faculty of Public Health, University of El Imam El Mahdi, Kosti, Sudan.
| | - Peter Onchuru Mokaya
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pecs, Vorosmarty Mihaly Street 4, Pecs, 7621, Hungary
| | - Ahmed A A Omer
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Evans Kasmai Kiptulon
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pecs, Vorosmarty Mihaly Street 4, Pecs, 7621, Hungary
| | - Simon Klara
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pecs, Vorosmarty Mihaly Street 4, Pecs, 7621, Hungary
| | - Mate Orsolya
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pecs, Vorosmarty Mihaly Street 4, Pecs, 7621, Hungary
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Khanmammadov N, Ferhatoglu F, Paksoy N, Dogan İ, Khishigsuren B, Nizam N, Saip P, Aydiner A. The efficacy of second-line chemotherapy in the management of classic and iatrogenic Kaposi sarcoma: An analysis of real-world data. Medicine (Baltimore) 2025; 104:e41404. [PMID: 39928795 PMCID: PMC11813067 DOI: 10.1097/md.0000000000041404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 01/11/2025] [Accepted: 01/13/2025] [Indexed: 02/12/2025] Open
Abstract
Kaposi sarcoma (KS) is a rare angioproliferative malignancy linked to human herpesvirus 8 infection. While systemic therapy is often unnecessary for classic and iatrogenic KS, advanced cases may require chemotherapy. This study aims to evaluate the efficacy and safety of weekly paclitaxel or oral etoposide as second-line treatments for classical and iatrogenic Kaposi sarcoma. We retrospectively analyzed clinicopathological characteristics and treatment outcomes of 32 patients diagnosed with classical and iatrogenic KS at a tertiary cancer center between December 2000 and November 2022. Patients received oral etoposide (50 mg every 3 weeks for 10 days) or weekly paclitaxel (80 mg/m²). The cohort comprised 23 males (71.9%) and 9 females (28.1%), with a mean age of 63 years. Most patients (87.5%) had classical KS, while 12.5% had iatrogenic KS. The objective response rate (ORR) was 75%, with a disease control rate (DCR) of 87.5%. Median progression-free survival (PFS) was 32.1 months, and median overall survival (OS) was 110.2 months. No significant differences in PFS (P = .633) and OS (P = .456) were observed between paclitaxel and etoposide treatments. The treatment regimen was generally well tolerated. Severe hematological toxicities were less frequent, with febrile neutropenia in 1 patient (3.1%), while severe non-hematological side effects included neuropathy in 2 patients (6.2%). Two patients (6.2%) were hospitalized due to complications, with no treatment-related deaths. Weekly paclitaxel and oral etoposide regimens are effective and well-tolerated second-line treatments for classical and iatrogenic Kaposi sarcoma. Given the high ORR and DCR, these therapies represent viable options for patients who progress after initial treatment. Further studies with larger patient populations are needed to confirm these findings.
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Affiliation(s)
- Nijat Khanmammadov
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Ferhat Ferhatoglu
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - İzzet Dogan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Bayarmaa Khishigsuren
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Nihan Nizam
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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Goddard KAB, Feuer EJ, Umar A, Castle PE. Accelerating progress to reduce the cancer burden through prevention and control in the United States. J Natl Cancer Inst 2025; 117:20-28. [PMID: 39222932 PMCID: PMC11717421 DOI: 10.1093/jnci/djae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Improvements in cancer prevention and control are poised to be main contributors in reducing the burden of cancer in the United States. We quantify top opportunities to accelerate progress using projected life-years gained and deaths averted as measures. We project that over the next 25 years, realistic gains from tobacco control can contribute 0.4-17 million additional life-years gained per intervention and 8.4 million additional life-years gained from improving uptake of screening programs over the lifetime of 25 annual cohorts. Additional opportunities include addressing modifiable risk factors (excess weight, alcohol consumption), improving methods to prevent or treat oncogenic infections, and reducing cancer health disparities. Investment is needed in the pipeline of new preventive agents and technologies for early detection to continue progress. There is also a need for additional research to improve the access to and uptake of existing and emerging interventions for cancer prevention and control and to address health disparities. These gains are undeniably within our power to realize for the US population.
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Affiliation(s)
- Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Mazzitelli M, Leoni D, Maraolo A, Marinello S, Calandrino L, Panese A, Calabrò ML, Marino D, Scaglione V, Cattelan A. Kaposi sarcoma and vertebral involvement in people with HIV: a case report and systematic literature review. HIV Res Clin Pract 2024; 25:2393057. [PMID: 39182187 DOI: 10.1080/25787489.2024.2393057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Kaposi Sarcoma (KS) has been historically associated with HIV, especially in people with advanced immunosuppression. Its prevalence decreased over time, but management remains difficult especially when the diagnosis is late and there is a visceral involvement. Bone localization, and particularly the vertebral one, is rare. We herein present a case of vertebral localizations of KS and performed a review literature to assess demographic, clinical characteristics and treatment outcomes in people with HIV. METHODS The systematic review was carried out by following the PRISMA guidelines and registering the protocol in PROSPERO database (n. registration: CRD42024548626). We included all cases of vertebral localizations of KS from January 1rst 1981 to December 31rst, 2023. RESULTS Twenty-two cases, including ours, were ever reported in people with HIV, mostly males (95.4%), with a median age of 35 years (IQR: 32-44), median CD4+ T cell count of 80 cell/mm3 (IQR 13-111), 31.8% with high HIV viral load. Five people received HIV and KS diagnosis simultaneously. In all cases, but one, there were multiple sites involved. Most spine lesions were localized at thoracic and lumbar levels (59.1%), causing pathological fractures in 2 cases. Chemotherapy and radiotherapy were performed in 50% and 18.2% cases, respectively. 22.7% persons died, stability and improvement/disease regression were reported for 13.6% and 22.7% persons, respectively, while 9.9% had a significant disease progression and a person was lost to follow-up. CONCLUSIONS Despite progresses in treatment, late presentation of KS, especially with spine involvement may have a poor prognosis. More efforts are needed to promote access to HIV testing, especially when indicating conditions are present.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Alberto Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Lucrezia Calandrino
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Angela Panese
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Maria Luisa Calabrò
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Dario Marino
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
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Islas-Muñoz B, Chávez-Galán L, Ramón-Luing L, Flores-González J, Ocaña-Guzmán R, Cornejo-Juárez P, González-Rodríguez A, Patricia V. Comparison of IL-6, IL-10, and TNFα Levels Between PLWHIV With and Without Kaposi Sarcoma and Healthy Controls. J Acquir Immune Defic Syndr 2024; 97:416-422. [PMID: 39145728 DOI: 10.1097/qai.0000000000003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/01/2024] [Indexed: 08/16/2024]
Abstract
INTRODUCTION Kaposi sarcoma (KS) is an angioproliferative disease caused by human herpesvirus 8 and is mediated by cytokines in an immunodeficient environment. This study aimed to compare IL-6, IL-10, and TNFα levels among patients with AIDS with disseminated KS (DKS), treatment naïve patients living with HIV without DKS, and healthy controls. Secondary outcomes were to compare cytokines levels in patients with DKS and unfavorable outcomes, and an analysis of the behavior of cytokines over time. METHODS This cohort study was performed at 2 centers in Mexico City. Three groups were included. Group 1: HIV+ treatment naïve with DKS, group 2: HIV+ treatment naïve without KS, and group 3: HIV negative, healthy controls. Plasmatic IL-6, IL-10, and TNFα levels were measured at baseline and over time in groups 1 and 2. RESULTS Seventy-six patients were included: 39 (52%) in group 1, 17 (22%) in group 2, and 20 (26%) in group 3. The median baseline IL-6, IL-10, and TNFα levels were significantly higher in group 1. In group 1, baseline IL-6 was higher in patients who died than in survivors (14.4 vs 5.8 pg/mL P = 0.048). Patients with severe immune reconstitution inflammatory syndrome because of KS had higher IL-6 values than those without it (14.4 vs 5.8 pg/mL P = 0.004). In the repeated measures model in group 1, IL-10 levels were higher in patients who died ( P < 0.001) and developed immune reconstitution inflammatory syndrome-KS ( P = 0.01). CONCLUSIONS IL-6, IL-10, and TNF α levels were markedly higher in patients with DKS. IL-6 and IL-10 levels were higher in patients with unfavorable outcomes.
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Affiliation(s)
- Beda Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Leslie Chávez-Galán
- Integrative Immunology Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico; and
| | - Lucero Ramón-Luing
- Integrative Immunology Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico; and
| | - Julio Flores-González
- Integrative Immunology Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico; and
| | - Ranferi Ocaña-Guzmán
- Integrative Immunology Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico; and
| | | | | | - Volkow Patricia
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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Denaro N, Indini A, Brambilla L, Marzano AV, Garrone O, Tourlaki A. Management and Future Therapeutic Perspectives of Classic Kaposi's Sarcoma: An Evidence-Based Review. Onco Targets Ther 2024; 17:961-976. [PMID: 39530040 PMCID: PMC11552409 DOI: 10.2147/ott.s468787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/31/2024] [Indexed: 11/16/2024] Open
Abstract
Background Kaposi sarcoma (KS) is a cutaneous neoplasm of endothelial origin. The causative agent is the human herpes virus-8 (HHV-8) which, combined with an immune system impairment, causes cell proliferation. To date, high-quality evidence and treatment recommendations for the management of KS are confined to the acquired immune deficiency syndrome (AIDS)-related KS, while the clinical approach to the treatment of classic KS (CKS) is based on small retrospective case series and the experience of clinicians in selected referral centers. Materials and Methods A search of the English literature was conducted through PubMed/MEDLINE databases for studies regarding CKS diagnosis, staging, and treatment, published between January 1990 and September 2023. Results Overall, 122 out of 565 articles were selected. Based on the results of this literature review, we proposed indications regarding the recommended flow chart for diagnosis, staging, and follow-up of patients with CKS. We assess available evidences regarding topic, locoregional, and systemic treatments of CKS. We also provide a focus on novel treatment strategies and therapeutic approaches currently under evaluation in clinical trials. Conclusion CKS is a rare disease and its management requires a multidisciplinary assessment. Treatment in referral centers and enrolment in clinical trials might impact on outcomes.
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Affiliation(s)
- Nerina Denaro
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Indini
- Melanoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lucia Brambilla
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Ornella Garrone
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Athanasia Tourlaki
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Park J, Lee JE. Localized Radiotherapy for Classic Kaposi's Sarcoma: An Analysis of Lesion Characteristics and Treatment Response. Cancers (Basel) 2024; 16:3194. [PMID: 39335165 PMCID: PMC11430677 DOI: 10.3390/cancers16183194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVES Classic Kaposi's sarcoma (CKS) is a rare malignancy with diverse clinical presentations, lacking a standard treatment. While localized therapies are commonly used for symptomatic lesions, radiotherapy (RT) has demonstrated effectiveness. This study aims to evaluate the efficacy of RT for treating skin lesions in CKS. METHODS A retrospective analysis was conducted on patients with KS treated between April 2012 and January 2024. In total, 69 lesions in 16 patients were included. Treatment response was defined as follows: complete response (CR) indicated the absence of clinically detectable skin lesions and symptoms; partial response (PR) was a reduction in lesion height by more than half or a lighter lesion color compared to before treatment. In-field recurrence was the appearance of new lesions within a previously irradiated field. Logistic regression analysis was used to investigate factors influencing response and in-field recurrence. RESULTS The median follow-up period was 52 months (range, 3-138 months). The overall response rate was 100%, with 92.8% of the patients achieving CR and 7.2% receiving PR. PR was observed in three patients with five lesions, all of which remained stable. In-field recurrence occurred in two patients with initially advanced disease, and all recurrent lesions responded to RT. No variables were significantly associated with response or in-field recurrence. CONCLUSIONS RT for CKS showed a 100% response rate, with complete symptom relief in all cases. The effectiveness of RT was evident, even in cases involving disseminated lesions. Further research is needed to determine the optimal RT dose and fractionation.
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Affiliation(s)
| | - Jeong Eun Lee
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea;
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Lee DH, Park SY, Hong N, Kook HD, Jung HJ, Ahn J, Park MY. Very Early Patch Stage of AIDS-related Kaposi Sarcoma: A Case Report. Ann Dermatol 2023; 35:S310-S313. [PMID: 38061728 PMCID: PMC10727859 DOI: 10.5021/ad.22.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/03/2022] [Accepted: 01/12/2023] [Indexed: 12/20/2023] Open
Abstract
Kaposi sarcoma (KS) is a vascular and lymphatic neoplasm caused by human herpesvirus 8 (HHV-8). AIDS-related KS has variable clinical courses ranging from mild disease presenting as an incidental finding to severe disease presenting as an aggressively progressing neoplasm that can lead to poor prognosis or even death. Typical clinical manifestation of KS is known as multiple cutaneous lesions on the extremities, trunk, and face with mucosal involvement. A 46-year-old male with AIDS complained of an erythematous patch on the right forearm which appeared 5 months ago. For a year, he was treated with antiretroviral drugs for AIDS. Physical examination revealed a 2.5-cm solitary erythematous patch only on the right forearm. Laboratory data revealed human immunodeficiency virus (HIV)-1 RNA of less than 40 copies/ml and a CD4 cell count of 264 cells/mm3. Histological examination revealed numerous slit-like spaces and vascular proliferation with primitive blood vessels dissecting between the collagen bundles and the dermis. Immunohistochemical staining showed positive HHV-8 nuclear staining of spindle cells. The histological features and positive HHV-8 immunohistochemical stain were consistent with the diagnosis of early patch stage of AIDS-related KS. KS can readily be misdiagnosed in early patch stage even by experienced clinicians, which leads to requirement of pathologic determination. On close inspection, it can be distinguished from other mimickers by its distinctive histologic features and immunohistochemical staining for HHV-8. Therefore, in cases of HIV-positive patients with clinically or histologically vascular-appearing mucocutaneous lesions, KS should be considered as a possible differential diagnosis.
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Affiliation(s)
- Dong Heon Lee
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - So Yun Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Narang Hong
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hyung Don Kook
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Mi Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea.
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Shi J, Ying G, Zhang Z. A Case of Kaposi's Sarcoma Associated with Disseminated AIDS: The Management Challenges. Infect Drug Resist 2023; 16:6367-6374. [PMID: 37789840 PMCID: PMC10544134 DOI: 10.2147/idr.s428945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
Background As a malignant tumor derived from vascular endothelial cells, Kaposi's sarcoma (KS) is quite common in AIDS patients. Nonspecific clinical symptoms often lead to timely diagnosis or wrong treatment, leading to recurrent disease and poor prognosis. Anti-retroviral therapy (ART) could significantly reduce its morbidity and aggressiveness. As one of the ARTs, liposome anthracyclines are the preferred chemotherapy regimen for disseminated KS with multiple organs or tissue invasion. The curative effect is highly related to the degree of immunosuppression. This is the first case of AIDS with Kaposi's sarcoma, who was cured after ART and two consecutive chemotherapy with doxorubicin liposome without recurrence. This case may provide new ideas and methods for the clinical management of AIDS with Kaposi's sarcoma. Case Description The patient, a male aged 60 years, was hospitalized on 21/11/2018 following having a cough, expectoration, and difficulty breathing. He was infected with HIV eight years ago and presented symptoms of blood-stained sputum. The patient complained that he had not received ART before. After admission, he was diagnosed as KS with disseminated AIDS after multiple biopsies and histopathological examinations. The patient was treated with ten months of ART (lamivudine+tenofovir+dolutegravir) and 14 times of chemotherapy with doxorubicin liposome (20 mg/m2, three times per week, seven times per course of treatment). The patient's disease was finally alleviated, and there was no recurrence during the follow-up. Conclusion The reconstitution of immune function and consecutive chemotherapy with doxorubicin liposome play a vital role in treating KS. In addition, for the early general symptoms of AIDS patients, such as thrombocytopenia and hemorrhagic purple papules, it is necessary to increase vigilance and obtain the results of histopathological verification as soon as possible to diagnose KS patients at an earlier stage and realize clinical intervention in time.
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Affiliation(s)
- Jinchuan Shi
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Gaoxiang Ying
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Zhongdong Zhang
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
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Li W, Wang L, Zhang Y, Liu Y, Lin Y, Li C. A SEER data-based nomogram for the prognostic analysis of survival of patients with Kaposi's sarcoma. J Cancer Res Ther 2023; 19:917-923. [PMID: 37675717 DOI: 10.4103/jcrt.jcrt_2587_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background This study developed the first comprehensive nomogram for predicting the cancer-specific survival (CSS) of patients with Kaposi's sarcoma (KS). Methods Data on the demographic and clinical characteristics of 4143 patients with KS were collected from the Surveillance, Epidemiology, and End Results (SEER) database and used for the prognostic analysis. The patients were randomly divided into two groups: training cohort (n = 2900) and validation cohort (n = 1243). Multivariate Cox regression analysis was used to identify the predictive variables for developing the first nomogram for the survival prediction of patients with KS. The new survival nomogram was further evaluated using the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision curve analysis (DCA). Results A nomogram was developed for determining the 3-, 5-, 8-, and 10-year CSS probabilities for patients with KS. The nomogram showed that tumor stage had the greatest influence on the CSS of patients with KS, followed by demographic variables (race, marital status, and age at diagnosis) and other clinical characteristics (surgery status, chemotherapy status, tumor risk classification, and radiotherapy status). The nomogram exhibited excellent performance based on the values of the C-index, AUC, NRI, and IDI as well as calibration plots. DCA further confirmed that the nomogram had good net benefits for 3-, 5-, 8-, and 10-year survival analyses. Conclusions In this study, by using data from the SEER database, we developed the first comprehensive nomogram for analyzing the survival of patients with KS. This nomogram could serve as a convenient and reliable tool for clinicians to predict CSS probabilities for individual patients with KS.
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Affiliation(s)
- Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Ling Wang
- Department of Obstetrics and Gynecology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yulong Liu
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yinsheng Lin
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
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Current Knowledge of Immunosuppression as a Risk Factor for Skin Cancer Development. Crit Rev Oncol Hematol 2022; 177:103754. [DOI: 10.1016/j.critrevonc.2022.103754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
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Subramaniam A, Giani C, Napolitano A, Ravi V, Frezza AM, Jones RL. Management of Vascular Sarcoma. Surg Oncol Clin N Am 2022; 31:485-510. [PMID: 35715146 DOI: 10.1016/j.soc.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular sarcomas encompass 3 well-defined sarcoma types: hemangioendothelioma, Kaposi sarcoma, and angiosarcoma. These distinct types are exceedingly rare and very different in terms of clinical behavior, biological features, and treatment approach. Because of this rarity and heterogeneity, it is crucial that vascular sarcomas are treated in sarcoma reference centers or networks, in order to ensure optimal management. The diversity of vascular sarcomas also needs to be taken into account in the design of clinical trials, in order to produce meaningful results that can be consistently translated into everyday clinical practice.
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Affiliation(s)
- Aparna Subramaniam
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 0450, FC12.3044, Houston, TX 77030, USA
| | - Claudia Giani
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 0450, FC12.3044, Houston, TX 77030, USA.
| | - Anna Maria Frezza
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
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13
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Xiang P, Liu M, Lu X, Tang W, Liu J. Primary Kaposi's Sarcoma of the Nasal Cavity: Clinical Experience and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2022:1455613221111734. [PMID: 35758033 DOI: 10.1177/01455613221111734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kaposi's sarcoma (KS) is a vascular sarcoma derived from vascular endothelial cells and presents with multiple lesions. It mainly appears on the skin and oral mucosa, usually in the face, oral mucosa, and genitals. Very few cases of primary lesions in the nasal cavity have been reported. It is often difficult to diagnose only by imaging examination. Here, we describe a case of KS in a patient who was human immunodeficiency virus (HIV)-negative, in which the primary sites were the nasal mucosa and nasal septum. A diagnosis was made according to the patient's clinical presentation, physical examination, laboratory examination, imaging examination, and histopathological results. We used surgical resection combined with chemotherapy, with 6 months' postoperative follow-up without recurrence. We reviewed the relevant literature to identify similar cases and summarize the findings reported on this rare manifestation of KS. We recommend that, where possible, antiviral therapy such as interferon, and regular review should continue, to improve the survival rate and patients' quality of life.
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Affiliation(s)
- Peng Xiang
- Graduate School, Youjiang Medical University for Nationalities, Baise, China
| | - Mengya Liu
- Graduate School, Youjiang Medical University for Nationalities, Baise, China
| | - Xueyan Lu
- Graduate School, Youjiang Medical University for Nationalities, Baise, China
| | - Wei Tang
- Graduate School, Youjiang Medical University for Nationalities, Baise, China
| | - Jin Liu
- Department of Otorhinolaryngology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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14
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Mohamed A, Saad E, Babkir A, Khtab K, Abdalla M. Pulmonary Kaposi Sarcoma as an Unusual Etiology of Acute Hypoxemic Respiratory Failure in the Era of Highly Active Antiretroviral Therapy: A Case Report. Cureus 2022; 14:e25014. [PMID: 35712335 PMCID: PMC9196811 DOI: 10.7759/cureus.25014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Kaposi sarcoma (KS) is caused by human herpesvirus 8 (HHV-8). Epidemic KS is described in the human immunodeficiency virus (HIV) population with acquired immune deficiency syndrome (AIDS). It primarily affects the skin, but it may uncommonly disseminate to involve extracutaneous sites such as the gastrointestinal (GI) tract, liver, and lungs. In this case report, the authors report a 26-year-old homosexual male who was admitted with acute hypoxemic respiratory failure. He was diagnosed with an HIV infection about five months before index presentation, and he was commenced on highly active antiretroviral therapy (HAART). Physical examination was remarkable for diffuse cutaneous nodules over the lower extremities, back, and oropharynx. Chest imaging revealed diffuse bilateral infiltrates, mediastinal adenopathy, and a persistent bilateral pleural effusion. Extensive diagnostic workup was negative for underlying infectious etiology. Transbronchial biopsy demonstrated proliferated spindle cells that stained positive for HHV-8 in keeping with pulmonary KS. Skin biopsies also concurred with the diagnosis of cutaneous KS. Interestingly, the cluster of differentiation 4 (CD4) count was 647 cells/mm3, and HIV viral load (VL) was 500 copies/ml. This case demonstrated an atypical natural history of pulmonary KS in an HIV patient as pulmonary and disseminated mucocutaneous KS occurred with a relatively higher CD4 count (≥500 cells/mm3). It also reminds pulmonologists and infectious disease specialists to consider pulmonary KS as a differential diagnosis of acute hypoxemic respiratory failure in HIV patients, even in the absence of other clinical and laboratory criteria that define the AIDS stage.
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15
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Epidemiology of Kaposi's Sarcoma. Cancers (Basel) 2021; 13:cancers13225692. [PMID: 34830846 PMCID: PMC8616388 DOI: 10.3390/cancers13225692] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022] Open
Abstract
Kaposi's sarcoma is an angioproliferative tumor caused by human herpesvirus 8 in the context of immunodeficiency, such as that induced by HIV infection or immunosuppressive therapy. Its incidence has dramatically fallen in patients living with HIV (PLHIV) since the introduction of potent antiretroviral combinations 25 years ago due to the restoration of immunity and better control of HIV replication. However, KS is still one of the most frequently occurring cancers in PLHIV, in particular in men who have sex with men and in sub-Saharan Africa, where it is still endemic. Even in the context of restored immunity, the risk of KS is still more than 30 times higher in PLHIV than in the general population. Recent evidence indicates that early initiation of antiretroviral treatment, which is recommended by current guidelines, may reduce the risk of KS but it needs to be accompanied by early access to care. This review mainly focuses on the recent epidemiological features of KS in the context of HIV infection.
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16
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Peprah S, Engels EA, Horner MJ, Monterosso A, Hall HI, Johnson AS, Pfeiffer RM, Shiels MS. Kaposi Sarcoma Incidence, Burden, and Prevalence in United States People with HIV, 2000-2015. Cancer Epidemiol Biomarkers Prev 2021; 30:1627-1633. [PMID: 34162660 PMCID: PMC8419027 DOI: 10.1158/1055-9965.epi-21-0008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The introduction of combination antiretroviral therapy (cART) has led to a significant reduction in Kaposi sarcoma (KS) incidence among people with HIV (PWH). However, it is unclear if incidence has declined similarly across key demographic and HIV transmission groups and the annual number of incident and prevalent KS cases remains unquantified. METHODS Using population-based registry linkage data, we evaluated temporal trends in KS incidence using adjusted Poisson regression. Incidence and prevalence estimates were applied to CDC HIV surveillance data, to obtain the number of incident (2008-2015) and prevalent (2015) cases in the United States. RESULTS Among PWH, KS rates were elevated 521-fold [95% confidence intervals (CI), 498-536] compared with the general population and declined from 109 per 100,000 person-years in 2000 to 47 per 100,000 person-years in 2015, at an annual percentage change of -6%. Rates declined substantially (P trend < 0.005) across all demographic and HIV transmission groups. Of the 5,306 new cases estimated between 2008 and 2015, 89% occurred among men who have sex with men. At the end of 2015, 1,904 PWH (0.20%) had been diagnosed with KS in the previous 5 years. CONCLUSIONS A consistent gradual decline in KS incidence has occurred among PWH in the United States during the current cART era. This decrease is uniform across key demographic and HIV transmission groups, though rates remain elevated relative to the general population. IMPACT Continued efforts to control HIV through early cART initiation and retention in care need to be maintained and possibly expanded to sustain declines.
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Affiliation(s)
- Sally Peprah
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | | | | | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
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17
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Parada H, Vu AH, Pinheiro PS, Thompson CA. Comparing Age at Cancer Diagnosis between Hispanics and Non-Hispanic Whites in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:1904-1912. [PMID: 34321282 DOI: 10.1158/1055-9965.epi-21-0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population age structure may confound the comparison of age at cancer diagnosis across racial/ethnic groups. We compared age at cancer diagnosis for U.S. Hispanics, a population that is younger on average, and non-Hispanic whites (NHW), before and after adjustment for the age structure of the source population. METHODS We used Surveillance, Epidemiology, and End Results data from 18 U.S. regions in 2015 for 34 cancer sites to calculate crude and adjusted (using age- and sex-specific weights) mean ages at diagnosis. Differences in age at diagnosis comparing Hispanics to NHWs (δ) were assessed using independent sample t tests. RESULTS Crude mean ages at diagnosis were lower among Hispanic males and females for all sites combined and for most cancer sites. After age-adjustment, Hispanic (vs. NHW) males remained younger on average at diagnosis of chronic myeloid leukemia [δ = -6.1; 95% confidence interval (CI), -8.1 to -4.1 years], testicular cancer (δ =-4.7; 95% CI, -5.4 to -4.0), Kaposi sarcoma (δ =-3.6; 95% CI,-6.3 to -0.8), mesothelioma (δ =-3.0; 95% CI,-4.3 to -1.7), and anal cancer (δ =-2.4; 95% CI, -3.9 to -0.8), and older at diagnosis of gallbladder cancer (δ = +3.8; 95% CI, 1.8 to 5.7) and Hodgkin's lymphoma (δ = +7.5; 95% CI, 5.7 to 9.4), and Hispanic (vs. NHW) females remained younger at diagnosis of mesothelioma (δ = -3.7; 95% CI, -6.7 to -0.7) and gallbladder cancer (δ = -3.0; 95% CI, -4.3 to -1.7) and older at diagnosis of skin cancer (δ = +3.8; 95% CI, 3.1 to 4.5), cervical cancer (δ = +4.1; 95% CI, 3.3 to 4.8), and Hodgkin's lymphoma (δ = +7.0; 95% CI, 5.0 to 9.1). CONCLUSIONS On average, Hispanics are diagnosed with cancer at younger ages than NHWs; however, for many cancers these differences reflect the younger age structure in Hispanics. IMPACT Population age structure should be considered when comparing age at cancer diagnosis across racial/ethnic groups.
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Affiliation(s)
- Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California. .,University of California, San Diego Moores Cancer Center, La Jolla, California.,Department of Radiation Medicine and Applied Science, University of California, San Diego, La Jolla, California
| | - Andrew H Vu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Caroline A Thompson
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California.,University of California, San Diego Moores Cancer Center, La Jolla, California.,The Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California
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18
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Delavar B, Kilgore A. A man with a rash. J Am Coll Emerg Physicians Open 2021; 2:e12410. [PMID: 33763660 PMCID: PMC7975130 DOI: 10.1002/emp2.12410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 11/21/2022] Open
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19
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Maaliki N, Ali AA, Isache CL, Aung W. Unusual aetiology of respiratory compromise in a patient with AIDS. BMJ Case Rep 2021; 14:e240849. [PMID: 33758048 PMCID: PMC7993348 DOI: 10.1136/bcr-2020-240849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old African American man with no medical history presented with a recent history of cough and dyspnoea. Initial chest imaging revealed diffuse bilateral lung infiltrates. A subsequent HIV test resulted positive, and he was presumptively diagnosed with AIDS, later confirmed by a CD4 of 88 cells/mm3 Empiric therapy with trimethoprim-sulfamethoxazole was initiated for presumed Pneumocystis jirovecii pneumonia. The patient's clinical status deteriorated despite treatment. Further workup with chest CT, bronchoscopy and skin biopsy led to a diagnosis of Kaposi sarcoma with pulmonary involvement. Highly active antiretroviral therapy therapy was initiated, along with plans to start chemotherapy. However, the patient's clinical status rapidly declined, leading to respiratory failure and eventual death. This case underlines the importance of maintaining a broad differential in immunocompromised patients presenting with respiratory symptoms.
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Affiliation(s)
- Naji Maaliki
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Aleem Azal Ali
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Carmen Liliana Isache
- Infectious Diseases, University of Florida Health at Jacksonville, Jacksonville, Florida, USA
| | - Win Aung
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
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20
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Séverin D, Bessaoud F, Meftah N, Du Thanh A, Tretarre B, Guillot B, Makinson A. A comparative study of classic and HIV-viremic and aviremic AIDS Kaposi sarcoma. AIDS 2021; 35:399-405. [PMID: 33181532 DOI: 10.1097/qad.0000000000002744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Kaposi sarcoma in people living with HIV (PLHIV) is the most common AIDS-associated malignancy. There is increased interest in Kaposi sarcoma in PLHIV with controlled HIV viremia. OBJECTIVES To describe Kaposi sarcoma occurring in PLHIV despite virological control and to compare their clinical presentations with viremic AIDS-Kaposi sarcoma (AIDS-KS) and classic Kaposi sarcoma (CKS). METHODS This was a monocentric retrospective study, including all Kaposi sarcoma patients registered between the 1 January of 2000 and 31 December 2017 in a comprehensive data bank for all cancers in the Hérault region, South of France. AIDS-KS were also described using chart reviews from the Infectious diseases Department, which followed more than 90% of PLHIV from the same region. We defined aviremic AIDS-KS as Kaposi sarcoma occurring in persons taking HAART with a HIV viral load less than 50 copies for more than 12 months. We compared clinical characteristics of persons with aviremic AIDS-KS, viremic AIDS-KS and CKS, using the Kriegel score and number and topography of skin lesions, and presence of lymphedema. RESULTS We retrieved 187 Kaposi sarcoma cases, of which 12 occurred in PLHIV with aviremic AIDS-KS. Kriegel score stage I was found in 10 (83%) of the aviremic AIDS-KS, 34 (68%) of CKS and 38 (58.4%) of viremic AIDS-KS cases, with similar clinical presentations between aviremic AIDS-KS and CKS groups, and viremic AIDS-KS persons having more aggressive presentations. One person with aviremic AIDS-KS had visceral involvement. CONCLUSION We showed that Kaposi sarcoma in PLHIV with controlled viremia were generally indolent, similarly to CKS. Visceral involvement is, however, possible.
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Affiliation(s)
| | | | - Nadia Meftah
- COREVIH, Saint Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | | | | | | | - Alain Makinson
- Department of Infectiology, Inserm U1175, Saint Eloi Hospital and Montpellier University Hospital
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21
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Guan C, Shi Y, Liu J, Yang Y, Zhang Q, Lu Z, Zheng G, Ye W, Xue M, Zhou X, Zhang N, Li H, Xie R, Chen B, Lu P. Pulmonary involvement in acquired immunodeficiency syndrome-associated Kaposi's sarcoma: a descriptive analysis of thin-section manifestations in 29 patients. Quant Imaging Med Surg 2021; 11:714-724. [PMID: 33532271 DOI: 10.21037/qims-20-284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (AIDS-KS) was the first malignant neoplasm to be described as being related to AIDS. The lungs are the most common visceral site of AIDS-KS. This study aimed to analyze the computed tomography (CT) manifestations of pulmonary involvement in AIDS-KS. Methods Twenty-nine male patients were enrolled in this retrospective study. Imaging evaluation parameters included lesion distribution, the flame sign, interlobular septal thickening, peribronchovascular interstitium thickening, ground-glass opacity (GGO), dilated blood vessels in lesions, and pleural effusion. Results A peribronchovascular distribution was observed in all patients, predominantly in the lower lobes. Of the patients, 58.62% (17/29) exhibited the flame sign, 75.86% (22/29) had interlobular septal thickening, 72.41% (21/29) had peribronchovascular interstitium thickening, 82.76% (24/29) had GGO, and 34.48% (10/29) had pleural effusion. Enlarged lymph nodes with a short-axis diameter >1.0 cm were found in 41.38% (12/29) of the patients. Of the 12 patients who underwent contrast-enhanced CT (CECT), 90.91% (11/12) had dilated blood vessels, and nodules, consolidations, and lymph nodes were observed to be strongly enhanced. Intrapulmonary lesions decreased in size or number after appropriate treatment during follow-up. Conclusions Common CT manifestations of pulmonary AIDS-KS include the flame sign, peribronchovascular distribution, peribronchovascular interstitium thickening, interlobular septa thickening, GGO, dilated blood vessel, and strong enhancement of nodules, consolidations, and lymph nodes. It is helpful to follow up the therapeutic effect of pulmonary AIDS-KS by chest CT.
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Affiliation(s)
- Chunshuang Guan
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jinxin Liu
- Department of Radiology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuxin Yang
- Department of Radiology, The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qianqian Zhang
- Department of Radiology, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiyan Lu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guangping Zheng
- Department of Radiology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Wen Ye
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Ming Xue
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xingang Zhou
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Na Zhang
- Department of Radiology, Chengdu Public Health Clinical Center, Chengdu, China
| | - Hongjun Li
- Department of Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Ruming Xie
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Budong Chen
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Puxuan Lu
- Department of Radiology, Shenzhen Center for Chronic Disease Control, Shenzhen, China
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22
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Moharer OA, Vrcek IM. Eyelid margin Kaposi sarcoma leading to AIDS diagnosis. Proc (Bayl Univ Med Cent) 2020; 34:102-103. [PMID: 33456161 DOI: 10.1080/08998280.2020.1799132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A wide variety of eyelid lesions are routinely encountered in standard medical practice. Most commonly, these lesions are benign; however, malignant etiologies may present on the eyelid and require further attention. In this case, we present a 51-year-old man with no known medical history who presented to an ophthalmologist for treatment of a lesion on the left lower eyelid, which was presumed to be an inflamed chalazion. Incisional biopsy of the lesion revealed it to be Kaposi sarcoma, and the patient was subsequently diagnosed with HIV/AIDS. While uncommon, Kaposi sarcoma in the eyelid region should be considered in the differential diagnosis, as early detection could have significant impact on patient mortality.
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Affiliation(s)
| | - Ivan M Vrcek
- Oculoplastic Surgery, Texas Eye Plastics, Dallas, Texas
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23
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Giardina F, Romero-Severson EO, Axelsson M, Svedhem V, Leitner T, Britton T, Albert J. Getting more from heterogeneous HIV-1 surveillance data in a high immigration country: estimation of incidence and undiagnosed population size using multiple biomarkers. Int J Epidemiol 2020; 48:1795-1803. [PMID: 31074780 PMCID: PMC6929534 DOI: 10.1093/ije/dyz100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2019] [Indexed: 01/08/2023] Open
Abstract
Background Most HIV infections originate from individuals who are undiagnosed and unaware of their infection. Estimation of this quantity from surveillance data is hard because there is incomplete knowledge about (i) the time between infection and diagnosis (TI) for the general population, and (ii) the time between immigration and diagnosis for foreign-born persons. Methods We developed a new statistical method for estimating the incidence of HIV-1 and the number of undiagnosed people living with HIV (PLHIV), based on dynamic modelling of heterogeneous HIV-1 surveillance data. The methods consist of a Bayesian non-linear mixed effects model using multiple biomarkers to estimate TI of HIV-1-positive individuals, and a novel incidence estimator which distinguishes between endogenous and exogenous infections by modelling explicitly the probability that a foreign-born person was infected either before or after immigration. The incidence estimator allows for direct calculation of the number of undiagnosed persons. The new methodology is illustrated combining heterogeneous surveillance data from Sweden between 2003 and 2015. Results A leave-one-out cross-validation study showed that the multiple-biomarker model was more accurate than single biomarkers (mean absolute error 1.01 vs ≥1.95). We estimate that 816 [95% credible interval (CI) 775-865] PLHIV were undiagnosed in 2015, representing a proportion of 10.8% (95% CI 10.3-11.4%) of all PLHIV. Conclusions The proposed methodology will enhance the utility of standard surveillance data streams and will be useful to monitor progress towards and compliance with the 90–90-90 UNAIDS target.
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Affiliation(s)
- Federica Giardina
- Department of Mathematics, Stockholm University, Stockholm, Sweden.,Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ethan O Romero-Severson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Maria Axelsson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Veronica Svedhem
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Leitner
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Tom Britton
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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24
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Kerkemeyer KLS, Mar A, Lai FYX. Kaposi's Sarcoma Occurring in HIV Infection Controlled on HAART. Am J Med 2020; 133:e294-e295. [PMID: 31751529 DOI: 10.1016/j.amjmed.2019.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Adrian Mar
- Department of Dermatology, Monash Health, Clayton, Victoria, Australia
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25
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Bhattarai B, Lamichhane J, Mandal A, Datar P, Mukhtar O, Alhafidh O, Lixon A, Enriquez D, Quist J, Schmidt F. Pulmonary Kaposi Sarcoma: an uncommon presentation in HIV heterosexual female on antiretroviral therpay. J Community Hosp Intern Med Perspect 2020; 10:158-161. [PMID: 32850055 PMCID: PMC7425620 DOI: 10.1080/20009666.2020.1742502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Kaposi sarcoma (KS) is caused by Human Herpesvirus 8 (HHV-8), and it affects 15 times more common in men than women. It has varied clinical presentation from classic, endemic, organ transplant-related, and acquired immunodeficiency syndrome (AIDS)-related. Clinical features of pulmonary KS might be challenging to distinguish from pneumonia in immunocompromised patients and could lead to diagnostic challenges. Hence Pulmonary KS should also be considered in the differential when HIV-infected patients develop rapidly progressive respiratory symptoms after the initiation of glucocorticoid therapy and immunocompromised not responding to antibiotic treatment for pneumonia, especially when CD4 < 100 and viral load >10,000. Early diagnosis and treatment are essential for a better outcome and prevent morbidity and mortality. Highly active antiretroviral therapy (HAART) is the only proven therapy to prevent Kaposi sarcoma. We report the case of a young woman who presented with symptoms of pneumonia and was later found to have pulmonary KS (PKS).
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Affiliation(s)
- Bikash Bhattarai
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jenny Lamichhane
- Department of Medicine, St. John's Riverside Hospital, Yonkers, NY, USA
| | - Amrendra Mandal
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Praveen Datar
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
| | - Osama Mukhtar
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
| | - Oday Alhafidh
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
| | - Anton Lixon
- Department of Pulmonary and Sleep Medicine, NYU Winthrop, Mineola, NY, USA
| | - Danilo Enriquez
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
| | - Joseph Quist
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
| | - Frances Schmidt
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, NY, USA
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26
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Shmakova A, Germini D, Vassetzky Y. HIV-1, HAART and cancer: A complex relationship. Int J Cancer 2020; 146:2666-2679. [PMID: 31603989 DOI: 10.1002/ijc.32730] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
Abstract
HIV infected people are at higher risk of developing cancer, although it is globally diminished in the era of highly active antiretroviral treatment (HAART). Recently, antioncogenic properties of some HAART drugs were discovered. We discuss the role of HAART in the prevention and improvement of treatment outcomes of cancers in HIV-infected people. We describe different trends in HAART-cancer relationships: cancer-predisposing as well as cancer-preventing. We cover the roles of particular drug regimens in cancer prevention. We also describe the causes of cancer treatment with HAART drugs in HIV-negative people, including ongoing clinical studies that may directly point to a possible independent anti-oncogenic activity of HAART drugs. We conclude that despite potent antioncogenic activities of every class of HAART drugs reported in preclinical models, the evidence to date indicates that their independent clinical impact in HIV-infected people is limited. Improved cancer prevention strategies besides HAART are needed to reduce HIV-cancer-related mortality.
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Affiliation(s)
- Anna Shmakova
- UMR 8126, CNRS, Univ. Paris-Sud, Institut Gustave Roussy, Université Paris Saclay, Édouard-Vaillant, Villejuif, France
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, Édouard-Vaillant, Villejuif, France
- Laboratory of Gene and Cell Technologies, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Diego Germini
- UMR 8126, CNRS, Univ. Paris-Sud, Institut Gustave Roussy, Université Paris Saclay, Édouard-Vaillant, Villejuif, France
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, Édouard-Vaillant, Villejuif, France
| | - Yegor Vassetzky
- UMR 8126, CNRS, Univ. Paris-Sud, Institut Gustave Roussy, Université Paris Saclay, Édouard-Vaillant, Villejuif, France
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, Édouard-Vaillant, Villejuif, France
- Koltzov Institute of Developmental Biology, Moscow, Russia
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27
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Kaposi sarcoma in people living with HIV: incidence and associated factors in a French cohort between 2010 and 2015. AIDS 2020; 34:569-577. [PMID: 31764070 DOI: 10.1097/qad.0000000000002450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Kaposi sarcoma is still observed among people living with HIV (PLHIV) including those on ART with undetectable HIV viral load (HIV-VL). We aimed to assess Kaposi sarcoma incidence and trends between 2010 and 2015 in France and to highlight associated factors. DESIGN Retrospective study using longitudinal data from the Dat'AIDS cohort including 44 642 PLWH. For the incidence assessment, Kaposi sarcoma cases occurring within 30 days of cohort enrollment were excluded. METHODS Demographic, immunological, and therapeutic characteristics collected at time of Kaposi sarcoma diagnosis or at last visit for patients without Kaposi sarcoma. RESULTS Among 180 216.4 person-years, Kaposi sarcoma incidence was 76 (95% CI 64.3-89.9)/10 person-years. Multivariate analysis (Poisson regression) revealed the positive association with male sex, MSM transmission route, lower CD4 T-cell count, higher CD8 T-cell count, not to be on ART, whereas HIV follow-up time, duration with an HIV-VL 50 copies/ml or less were negatively associated with Kaposi sarcoma. According to the different models tested, HIV-VL, CD4 : CD8 ratio and nadir CD4 cell count were associated with Kaposi sarcoma. Moreover, stratified analysis showed that patients with a CD4 : CD8 ratio 0.5 or less or a CD8 T-cell count greater than 1000 cells/μl were at higher risk of Kaposi sarcoma regardless of the CD4 T-cell count. CONCLUSION This study showed that in a resource-rich country setting with high ART coverage, Kaposi sarcoma still occurred among PLWH. CD8 hyperlymphocytosis and CD4 : CD8 ratio should be now considered as two useful markers to better identify patients at increased Kaposi sarcoma risk, including those with a CD4 T-cell count greater than 500 cells/μl.
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Hamel R, Schneider SL, Hurst EA. Cells to Surgery Quiz: January 2020. J Invest Dermatol 2020; 140:e7-e11. [PMID: 34643508 DOI: 10.1016/j.jid.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Remi Hamel
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Eva A Hurst
- Washington University School of Medicine, St. Louis, Missouri.
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29
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Benson TA, Mulvaney PM, Hoang MP, Kroshinsky D. A 63-Year-Old Male with AIDS and Diffuse Violaceous Plaques. Dermatopathology (Basel) 2019; 6:195-200. [PMID: 31616660 PMCID: PMC6787420 DOI: 10.1159/000502371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/28/2019] [Indexed: 11/19/2022] Open
Abstract
Hyperkeratotic Kaposi's sarcoma (KS) is a rare clinicopathologic variant of AIDS-related KS that typically presents with chronic lymphedema and diffuse hyperkeratotic plaques of the lower extremities. Histopathologically, this variant is defined by epidermal hyperplasia, thickened lymphatic walls, and increased numbers of dermal fibroblasts and vascular spaces. Herein, we report the case of a 63-year-old HIV-positive male who presented with this rare hyperkeratotic variant of AIDS-related KS.
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Affiliation(s)
| | - Patrick M Mulvaney
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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30
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Olanipekun T, Kagbo-Kue S, Egwakhe A, Mayette M, Fransua M, Flood M. Lower Gastrointestinal Kaposi Sarcoma in HIV/AIDS: A Diagnostic Challenge. Gastrointest Tumors 2019; 6:51-55. [PMID: 31602377 DOI: 10.1159/000500140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Indexed: 11/19/2022] Open
Abstract
Gastrointestinal Kaposi sarcoma (GI-KS) is the most common extra-cutaneous site of KS in HIV/AIDS, and the majority (75%) of affected patients are asymptomatic. GI-KS rarely occurs in the absence of cutaneous lesions. Opportunistic GI infections in HIV/AIDS and GI-KS can present with similar symptoms especially diarrhea, creating a diagnostic challenge. We present a 46-year-old homosexual male with a medical history of HIV/AIDS and neurosyphilis, who presented with 2 weeks of nonbloody diarrhea and abdominal discomfort. He was initially worked up for infectious diarrhea, initiated on highly active anti-retroviral (HAART) and supportively managed with rehydration therapy and analgesia. However, his clinical symptoms did not improve, necessitating abdomen/pelvic CT scan which revealed extensive recto-sigmoid colon thickening and pelvic lymphadenopathy. Due to a high suspicion of malignancy, diagnostic endoscopy and biopsy were done which showed colonic KS. He was treated with intravenous pegylated doxorubicin in addition to HAART which evidently resulted in significant clinical and radiological improvement. The diagnosis of GI-KS could be challenging in the presence of overlapping features with opportunistic GI infections and the absence of cutaneous manifestations of KS because clinicians tend to focus more on infectious etiology. We suggest that clinicians should consider GI-KS in the differential diagnosis of patients with HIV/AIDS that present with diarrhea and other nonspecific abdominal symptoms. Early endoscopic evaluation with biopsy could help to ensure the timely diagnosis and management of GI-KS and ultimately improve outcomes.
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Affiliation(s)
- Titilope Olanipekun
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Suaka Kagbo-Kue
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Adekunbi Egwakhe
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Maxi Mayette
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mesfin Fransua
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Michael Flood
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA.,Division of Gastroenterology, Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
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Impact of Protease Inhibitors on HIV-Associated Kaposi Sarcoma Incidence: A Systematic Review. J Acquir Immune Defic Syndr 2019; 79:141-148. [PMID: 29985803 DOI: 10.1097/qai.0000000000001798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Protease inhibitors (PIs) may inhibit Kaposi sarcoma (KS) carcinogenesis. However, PI-based antiretroviral therapy (ART) is rarely a first-line choice in people living with HIV (PLWH) because of cost and toxicities. This is the first systematic review to assess KS incidence stratified by ART type. METHODS We searched PubMed to identify original, full research reports of KS incidence in ART-treated adult PLWH, stratified by ART class, published between 1996 and 2017. For overlapping cohorts, we included only the most recent study and supplemented data with earlier relevant analyses. We described study design, sociodemographic characteristics, statistical adjustment factors, and KS incidence. RESULTS We identified 3 unique retrospective cohort studies, and supplemented one of the studies with results from 6 previous subgroup reports, which included 242,309 PLWH and 3570 incident KS cases. Overall, KS crude incidence decreased by a factor of 10 between untreated and ART-treated PLWH; CD4-adjusted KS incidence decreased by ∼50%, with either non-nucleoside reverse transcriptase inhibitor- or PI-based ART. A single study measured a cumulative dose-/time-dependent effect of ART, which reported a relative risk reduction in only the cohort receiving boosted PI-based ART. Other studies defined ART categories by first-line therapy only. CONCLUSIONS The risk of incident KS was significantly reduced, regardless of ART class even after adjusting for CD4 count. The quality of evidence (ie, most studies categorizing users by first-line ART) does not permit KS risk reduction comparisons across ART types. Given the limited number and retrospective nature of these studies, prospective data are indicated.
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Abstract
Kaposi sarcoma (KS) is an angioproliferative mesenchymal neoplasm caused by Kaposi sarcoma-related herpesvirus. This review outlines our current understanding of the epidemiology, pathogenesis, clinical presentation, and staging for this disease. Recent research has informed a more comprehensive understanding of the epidemiology of KS in the post-antiretroviral therapy era, and highlights the continued need to better characterize the African endemic subtype. Advances in clinical oncology, including checkpoint inhibitors and new skin-directed therapies, have translated into exciting new developments for the future of KS treatment options.
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Chelidze K, Thomas C, Chang AY, Freeman EE. HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management. Am J Clin Dermatol 2019; 20:423-442. [PMID: 30806959 PMCID: PMC6581453 DOI: 10.1007/s40257-019-00422-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Antiretroviral therapy (ART) has revolutionized the treatment and prognosis of people living with HIV (PLHIV). With increased survival and improved overall health, PLHIV are experiencing dermatologic issues both specific to HIV and common to the general population. In this new era of ART, it is crucial for dermatologists to have a strong understanding of the broad range of cutaneous disease and treatment options in this unique population. In this review, we outline the most common skin diseases in PLHIV, including HIV-associated malignancies, inflammatory conditions, and infections, and focus on the role of ART in altering epidemiology, clinical features, diagnosis, and treatment of cutaneous conditions.
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Affiliation(s)
- Khatiya Chelidze
- Weill Cornell Medical College, Massachusetts General Hospital, 1300 York Avenue, New York, NY, 10021, USA
| | - Cristina Thomas
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA
| | - Aileen Yenting Chang
- Department of Dermatology, University of California, San Francisco, 505 Paranassus Avenue, San Francisco, CA, 94143, USA
| | - Esther Ellen Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA.
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
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34
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Lebbe C, Garbe C, Stratigos AJ, Harwood C, Peris K, Marmol VD, Malvehy J, Zalaudek I, Hoeller C, Dummer R, Forsea AM, Kandolf-Sekulovic L, Olah J, Arenberger P, Bylaite-Bucinskiene M, Vieira R, Middleton M, Levy A, Eggermont AM, Battistella M, Spano JP, Grob JJ, Pages C. Diagnosis and treatment of Kaposi's sarcoma: European consensus-based interdisciplinary guideline (EDF/EADO/EORTC). Eur J Cancer 2019; 114:117-127. [DOI: 10.1016/j.ejca.2018.12.036] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 01/28/2023]
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35
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Kaposi Sarcoma in HIV-positive Solid-Organ Transplant Recipients: A French Multicentric National Study and Literature Review. Transplantation 2019; 103:e22-e28. [PMID: 30273235 DOI: 10.1097/tp.0000000000002468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kaposi sarcoma is a vascular tumor related to herpesvirus-8 and is promoted by immunosuppression. For the last 15 years, human immunodeficiency virus (HIV) patients have had access to organ transplantation. The dual immunosuppression of HIV and immunosuppressive treatments might increase the risk and severity of Kaposi sarcoma. METHODS We conducted a multicentric retrospective study by collecting cases from French databases and society members of transplanted patients, among which 7 HIV-infected patients who subsequently developed Kaposi sarcoma were included. RESULTS In the CRISTAL database (114 511 patients) and the DIVAT (Données Informatisées et VAlidées en Transplantation) database (19 077 patients), the prevalence of Kaposi sarcoma was 0.18% and 0.46%, respectively, in transplanted patients; these values compare with 0.66% and 0.50%, respectively, in transplanted patients with HIV. The median time from HIV infection to Kaposi sarcoma was 20 years. Kaposi sarcoma occurred during the first year after transplantation in most cases, whereas HIV viral load was undetectable. Only 2 patients had visceral involvement. Five patients were treated with conversion of calcineurin inhibitor to mammalian target of rapamycin inhibitor, and 5 patients were managed by decreasing immunosuppressive therapies. At 1 year, 4 patients had a complete response, and 3 had a partial response. CONCLUSIONS In our study, Kaposi sarcoma in transplanted patients with HIV did not show any aggressive features and was treated with the usual posttransplant Kaposi sarcoma management protocol.
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36
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Klingenberg RE, Esser S, Brockmeyer NH, Michalik C, Skaletz-Rorowski A, Potthoff A. [Profile of Kaposi sarcoma patients in the competence network HIV/AIDS]. Hautarzt 2019; 69:143-148. [PMID: 29101417 DOI: 10.1007/s00105-017-4062-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Kaposi's sarcoma (KS) represents the most common AIDS-defining neoplasm. Only very few studies regarding the course and treatment of human immunodeficiency virus (HIV)-associated KS have been carried out in Germany. OBJECTIVE In this study the course of HIV-associated KS was observed in patients from the cohort database of the competence network for HIV/AIDS. MATERIAL AND METHODS Data from HIV-associated KS patients from 9 German core centers from 1987 to 2011 were retrospectively collected. Kaplan-Meier curves for the recurrence and survival probability were calculated. RESULTS In 222 patients KS was diagnosed at a median age of 38.5 ± 10.1 years. Men were almost exclusively affected (97.7%). The HIV viral load at the time of diagnosis was in 7.4% <50 copies/ml. Of the patients 55.5% developed KS with a CD4 cell count of <200 cells/μl and 9.5% with >500 cells/μl. In 68 patients KS therapy consisted exclusively of the optimization or initiation of antiretroviral therapy (ART). In addition, 71 patients were treated with pegylated liposomal doxorubicin. During the median follow-up period of 8.9 ± 4.9 years, 80.2% of the patients were free of KS recurrence. Survival rates after 5 and 10 years were 96.8% and 91.3%, respectively. CONCLUSION Even with a good immune status HIV-associated KS occurred. An effective ART was the most important mainstay of therapy. With appropriate therapy, HIV-positive patients with KS showed a good survival rate.
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Affiliation(s)
- R-E Klingenberg
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
| | - S Esser
- Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - N H Brockmeyer
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
| | - C Michalik
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
- Zentrum für klinische Studien, Köln, Deutschland
| | - A Skaletz-Rorowski
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
| | - A Potthoff
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland.
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Hwang A, Iskandar AS, Kerr WT, Farrell S, Plaxe SC, Dasanu CA. Clinico-epidemiologic characteristics and patterns of care in Kaposi's sarcoma: Data from a single-institution series. J Oncol Pharm Pract 2019; 25:1719-1721. [PMID: 30940048 DOI: 10.1177/1078155219838614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the late 20th to early 21st century, most new Kaposi's sarcoma cases were associated with HIV coinfection and low CD4 T-cell counts. After introduction of effective antiretroviral therapy, the clinical and epidemiologic characteristics of Kaposi's sarcoma may have changed. We analyzed and now report on 27 consecutive Kaposi's sarcoma patients treated at our institution from 2007 to 2017. Most patients were HIV-positive Caucasian men on antiretroviral therapy; the average CD4 T-cell count was above the AIDS-defining level of 200 cells/mm3. Seven patients had Kaposi's sarcoma with mucosal involvement, and 20 had skin-only Kaposi's sarcoma. Mucosal Kaposi's sarcoma patients had a mean CD4 T-cell count of 83 cells/mm3 as opposed to 381 cells/mm3 for patients with skin-only involvement (p = 0.005). Survival was significantly compromised in both groups but even more so in Kaposi's sarcoma patients with mucosal involvement (306 vs. 609 days). Along with other reports, our findings suggest that Kaposi's sarcoma may develop in HIV patients in the modern era despite well-controlled HIV disease. This is significant since Kaposi's sarcoma remains an important contributor to morbidity and mortality in HIV-infected patients.
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Affiliation(s)
- Andrew Hwang
- 1 Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA
| | - Andrew S Iskandar
- 1 Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA
| | - Wesley T Kerr
- 2 Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephanie Farrell
- 3 Department of Hematology/Oncology, Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA, USA
| | - Steven C Plaxe
- 3 Department of Hematology/Oncology, Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA, USA.,4 Department of Hematology/Oncology, University of California San Diego Health, La Jolla, CA, UCA
| | - Constantin A Dasanu
- 3 Department of Hematology/Oncology, Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA, USA.,4 Department of Hematology/Oncology, University of California San Diego Health, La Jolla, CA, UCA
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Lazăr DC, Avram MF, Romoșan I, Văcariu V, Goldiș A, Cornianu M. Malignant hepatic vascular tumors in adults: Characteristics, diagnostic difficulties and current management. World J Clin Oncol 2019; 10:110-135. [PMID: 30949442 PMCID: PMC6441663 DOI: 10.5306/wjco.v10.i3.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation (LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma (HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation Association-European Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma (HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient. Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches, alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.
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Affiliation(s)
- Daniela Cornelia Lazăr
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mihaela Flavia Avram
- Department of Surgery X, 1st Surgery Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Ioan Romoșan
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Violetta Văcariu
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Adrian Goldiș
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mărioara Cornianu
- Department of Pathology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
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Castrejón N, Nicolau C, González-Cordón A, Archilla I, Solé M. Sclerosing Kaposi's sarcoma of the adrenal gland in an HIV-infected patient under antiretroviral therapy. Ann Diagn Pathol 2018; 38:123-125. [PMID: 30580154 DOI: 10.1016/j.anndiagpath.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Natàlia Castrejón
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Ana González-Cordón
- Infectious Diseases Service, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Iván Archilla
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Manel Solé
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.
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40
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Galanina N, Goodman AM, Cohen PR, Frampton GM, Kurzrock R. Successful Treatment of HIV-Associated Kaposi Sarcoma with Immune Checkpoint Blockade. Cancer Immunol Res 2018; 6:1129-1135. [PMID: 30194084 DOI: 10.1158/2326-6066.cir-18-0121] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/03/2018] [Accepted: 07/20/2018] [Indexed: 12/31/2022]
Abstract
Kaposi sarcoma (KS) is an incurable, human immunodeficiency virus (HIV)-associated malignancy. We reviewed 320 immunotherapy-treated patient records. Seventeen had HIV-associated malignancies, including nine men with KS. Median viral load was 20 copies/mL (range, undetectable to 549,704) and median CD4 count was 256 cells/μL (range, 10-603). Eight patients received nivolumab and one received pembrolizumab. Six patients (67%) achieved partial (N = 5) or complete remission (N = 1). No drug-related grade >2 toxicities occurred. In seven patients, CD4 counts increased (P = 0.09). Tissue and/or blood-derived circulating tumor DNA (ctDNA) was evaluated by next-generation sequencing. Four evaluable patients each showed anomalies in distinct genes: TP53, KRAS, TLL2, PTPN6 (tissue and/or ctDNA), and NF1 (ctDNA). Tumor mutational burden was low, and PD-L1 immunohistochemistry was negative (three and four assessable patients, respectively). Responders included patients with low CD4 counts, high HIV load, and/or visceral disease. In summary, checkpoint blockade demonstrated significant antitumor activity and low toxicity in patients with HIV-associated KS. Cancer Immunol Res; 6(10); 1129-35. ©2018 AACR.
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Affiliation(s)
- Natalie Galanina
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California. .,Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, California
| | - Aaron M Goodman
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California.,Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, California.,Department of Medicine, Division of Blood and Marrow Transplantation, University of California San Diego, La Jolla, California
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, California
| | | | - Razelle Kurzrock
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California.,Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, California
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Chhetri M, Miaskiewicz S, Lawrence TA, Kapetanos A. Unexpected cause of fever in a patient with untreated HIV. BMJ Case Rep 2018; 2018:bcr-2018-225087. [PMID: 29970608 DOI: 10.1136/bcr-2018-225087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 27-year-old man with a history of untreated HIV who presented with fever, rash and leg cramps. Initial suspicion was high for an infectious process; however, after an exhaustive evaluation, thyrotoxicosis was revealed as the aetiology of his symptoms. Recent intravenous contrast administration complicated his workup to determine the exact cause of hyperthyroidism. Differentiation between spontaneously resolving thyroiditis and autonomous hyperfunction was paramount in the setting of existing neutropenia and the need for judicious use of antithyroid therapy. The inability to enlist a nuclear scan in the setting of recent iodinated contrast administration prompted alternative testing, including thyroid antibodies and thyroid ultrasound. In this case, we will discuss the diagnostic challenges of thyrotoxicosis in a complex patient, the sequelae of iodine contrast administration, effects of iodine on the thyroid and the predictive value of other available tests.
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Affiliation(s)
- Mamta Chhetri
- Department of Endocrinology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Stasia Miaskiewicz
- Department of Endocrinology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Taylor Abegg Lawrence
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Anastasios Kapetanos
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Liu Z, Fang Q, Zuo J, Minhas V, Wood C, Zhang T. The world‐wide incidence of Kaposi's sarcoma in the
HIV
/
AIDS
era. HIV Med 2018; 19:355-364. [DOI: 10.1111/hiv.12584] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Z Liu
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
| | - Q Fang
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
| | - J Zuo
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
| | - V Minhas
- Nebraska Center of Virology and the School of Biological Sciences University of Nebraska‐Lincoln Lincoln NE USA
| | - C Wood
- Nebraska Center of Virology and the School of Biological Sciences University of Nebraska‐Lincoln Lincoln NE USA
| | - T Zhang
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
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Association of CD4+ T-cell Count, HIV-1 RNA Viral Load, and Antiretroviral Therapy With Kaposi Sarcoma Risk Among HIV-infected Persons in the United States and Canada. J Acquir Immune Defic Syndr 2017; 75:382-390. [PMID: 28394855 DOI: 10.1097/qai.0000000000001394] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) remains common among HIV-infected persons. To better understand KS etiology and to help target prevention efforts, we comprehensively examined a variety of CD4 T-cell count and HIV-1 RNA viral load (VL) measures, as well as antiretroviral therapy (ART) use, to determine independent predictors of KS risk. SETTING North American AIDS Cohort Collaboration on Research and Design. METHODS We followed HIV-infected persons during 1996-2009 from 18 cohorts. We used time-updated Cox regression to model relationships between KS risk and recent, lagged, trajectory, and cumulative CD4 count or VL measures, as well as ART use. We used Akaike's information criterion and global P values to derive a final model. RESULTS In separate models, the relationship between each measure and KS risk was highly significant (P < 0.0001). Our final mutually adjusted model included recent CD4 count [hazard ratio (HR) for <50 vs. ≥500 cells/μL = 12.4; 95% confidence interval (CI): 6.5 to 23.8], recent VL (HR for ≥100,000 vs. ≤500 copies/mL = 3.8; 95% CI: 2.0 to 7.3), and cumulative (time-weighted mean) VL (HR for ≥100,000 vs. ≤500 copies/mL = 2.5; 95% CI: 1.0 to 5.9). Each P-trend was <0.0001. After adjusting for these measures, we did not detect an independent association between ART use and KS risk. CONCLUSIONS Our results suggested a multifactorial etiology for KS, with early and late phases of development. The cumulative VL effect suggested that controlling HIV replication promptly after HIV diagnosis is important for KS prevention. We observed no evidence for direct anti-KS activity of ART, independent of CD4 count and VL.
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The AIDS-defining Cancer Project Working Group for IeDEA and COHERE in EuroCoord, Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, et alThe AIDS-defining Cancer Project Working Group for IeDEA and COHERE in EuroCoord, Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Show More Authors] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Puller V, Neher R, Albert J. Estimating time of HIV-1 infection from next-generation sequence diversity. PLoS Comput Biol 2017; 13:e1005775. [PMID: 28968389 PMCID: PMC5638550 DOI: 10.1371/journal.pcbi.1005775] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/12/2017] [Accepted: 09/15/2017] [Indexed: 01/16/2023] Open
Abstract
Estimating the time since infection (TI) in newly diagnosed HIV-1 patients is challenging, but important to understand the epidemiology of the infection. Here we explore the utility of virus diversity estimated by next-generation sequencing (NGS) as novel biomarker by using a recent genome-wide longitudinal dataset obtained from 11 untreated HIV-1-infected patients with known dates of infection. The results were validated on a second dataset from 31 patients. Virus diversity increased linearly with time, particularly at 3rd codon positions, with little inter-patient variation. The precision of the TI estimate improved with increasing sequencing depth, showing that diversity in NGS data yields superior estimates to the number of ambiguous sites in Sanger sequences, which is one of the alternative biomarkers. The full advantage of deep NGS was utilized with continuous diversity measures such as average pairwise distance or site entropy, rather than the fraction of polymorphic sites. The precision depended on the genomic region and codon position and was highest when 3rd codon positions in the entire pol gene were used. For these data, TI estimates had a mean absolute error of around 1 year. The error increased only slightly from around 0.6 years at a TI of 6 months to around 1.1 years at 6 years. Our results show that virus diversity determined by NGS can be used to estimate time since HIV-1 infection many years after the infection, in contrast to most alternative biomarkers. We provide the regression coefficients as well as web tool for TI estimation. HIV-1 establishes a chronic infection, which may last for many years before the infected person is diagnosed. The resulting uncertainty in the date of infection leads to difficulties in estimating the number of infected but undiagnosed persons as well as the number of new infections, which is necessary for developing appropriate public health policies and interventions. Such estimates would be much easier if the time since HIV-1 infection for newly diagnosed cases could be accurately estimated. Three types of biomarkers have been shown to contain information about the time since HIV-1 infection, but unfortunately, they only distinguish between recent and long-term infections (concentration of HIV-1-specific antibodies) or are imprecise (immune status as measured by levels of CD4+ T-lymphocytes and viral sequence diversity measured by polymorphisms in Sanger sequences). In this paper, we show that recent advances in sequencing technologies, i.e. the development of next generation sequencing, enable significantly more precise determination of the time since HIV-1 infection, even many years after the infection event. This is a significant advance which could translate into more effective HIV-1 prevention.
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Affiliation(s)
- Vadim Puller
- Max Planck Institute for Developmental Biology, Tübingen, Germany
- Biozentrum, University of Basel, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
- * E-mail:
| | - Richard Neher
- Max Planck Institute for Developmental Biology, Tübingen, Germany
- Biozentrum, University of Basel, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Sengayi MM, Kielkowski D, Egger M, Dreosti L, Bohlius J. Survival of patients with Kaposi's sarcoma in the South African antiretroviral treatment era: A retrospective cohort study. S Afr Med J 2017; 107:871-876. [PMID: 29022531 PMCID: PMC5913753 DOI: 10.7196/samj.2017.v107i10.12362] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi's sarcoma (KS) patients shifted from symptomatic palliation to potential cure. OBJECTIVE To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. METHODS We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors. RESULTS Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality. CONCLUSIONS Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop.
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Affiliation(s)
- M M Sengayi
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Hussenet C, Calin R, Boussouar S, Londner C, Caby F, Tubiana R, Pourcher V. [Chylothorax as a complication of Kaposi's sarcoma in an AIDS patient]. Med Mal Infect 2017; 48:66-69. [PMID: 28947235 DOI: 10.1016/j.medmal.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- C Hussenet
- Service de maladies infectieuses, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Sorbonne universités, UPMC université, 75013 Paris 06, France
| | - R Calin
- Service de maladies infectieuses, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Sorbonne universités, UPMC université, 75013 Paris 06, France
| | - S Boussouar
- Département d'imagerie cardiovasculaire, thoracique et radiologie interventionnelle, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - C Londner
- Sorbonne universités, UPMC université, 75013 Paris 06, France; Service de pneumologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - F Caby
- Service de maladies infectieuses, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm, UMR S_1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France
| | - R Tubiana
- Service de maladies infectieuses, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm, UMR S_1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France
| | - V Pourcher
- Service de maladies infectieuses, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Sorbonne universités, UPMC université, 75013 Paris 06, France; Laboratoire Inserm « HIV pathogenesis and immune aging », immunity and infectious diseases research center, Inserm U1135, 75013 Paris, France.
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Ramsingh J, Watson C. Adrenal incidentaloma in a patient with HIV/AIDS. J Surg Case Rep 2017; 2017:rjx125. [PMID: 28852452 PMCID: PMC5570053 DOI: 10.1093/jscr/rjx125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/14/2017] [Indexed: 12/27/2022] Open
Abstract
Human immunodeficiency virus (HIV) is well known to be associated with various neoplasms and opportunistic infections. Kaposi sarcoma (KS), associated with human herpes virus 8 (HHV8) infection, is the most common tumour in HIV positive patients and is also an acquired immune deficiency syndrome (AIDS) defining illness. Cutaneous manifestations are the most common presenting symptom; however, visceral involvement is also recognized. We present the case of a 55-year-old male who was diagnosed with AIDS-related KS, who was referred to our surgical unit with an indeterminate left adrenal lesion. He subsequently started antiretroviral therapy and given the indeterminate nature of his adrenal lesion, we performed a laparoscopic left adrenalectomy, with KS of the adrenal gland confirmed on histology.
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Affiliation(s)
- Jason Ramsingh
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Carol Watson
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Alwassia A, Alshathri Z, Khosla R, Spagnolo SV. Pulmonary Kaposi sarcoma presenting as complete lung consolidation. BMJ Case Rep 2017; 2017:bcr-2016-219048. [PMID: 28331023 DOI: 10.1136/bcr-2016-219048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The patient in our case presented with progressive dyspnoea and cough. Chest radiograph reveals complete opacification of the hemithorax. Complete lung consolidation was not seen on chest CT. The patient in this case had extensive pulmonary and endobronchial Kaposi sarcoma (KS) that led to complete consolidation of the right lung that was diagnosed via bronchoscopy. After diagnosis, he was restarted on antiretroviral therapy and single-agent chemotherapy for treatment of pulmonary KS.
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Affiliation(s)
- Ahmad Alwassia
- Department of Pulmonary Critical Care, George Washington University Hospital, Washington, DC, USA
| | - Ziyad Alshathri
- Department of Pulmonary Critical Care, George Washington University Hospital, Washington, DC, USA
| | - Rahul Khosla
- Department of Pulmonary Critical Care, US Department of Veterans Affairs, Washington, DC, USA
| | - Samuel V Spagnolo
- Department of Pulmonary Critical Care, US Department of Veterans Affairs, Washington, DC, USA
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de Lima CT, de Araújo PSR, de Teixeira HM, dos Santos JB, da Silveira VM. Clinical and laboratory characteristics, staging, and outcomes of individuals with AIDS-associated Kaposi's sarcoma at an university hospital. An Bras Dermatol 2017; 92:172-176. [PMID: 28538874 PMCID: PMC5429100 DOI: 10.1590/abd1806-4841.20175377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/06/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. OBJECTIVE: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. METHODS: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. RESULTS: Of the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis. LIMITATION OF THE STUDY: Without a control group, this study cannot be used to generate hypotheses. CONCLUSIONS: Despite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service.
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Affiliation(s)
- Catarina Tenório de Lima
- Commission and Hospital Infection Control Service of the Hospital
Barão de Lucena – Recife (PE), Brazil
| | - Paulo Sérgio Ramos de Araújo
- Department of Tropical Medicine - Universidade Federal de Pernambuco
(UFPE) – Recife (PE), Brazil
- Ageu Magalhães Research Center - Fundação
Oswaldo Cruz (CPqAM-Fiocruz) – Recife (PE), Brazil
| | - Heberton Medeiros de Teixeira
- Department of Clinical Oncology - Real Hospital Português de
Beneficência de Pernambuco – Recife (PE), Brazil
- Department of Clinical Oncology - Hospital Barão de Lucena –
Recife (PE), Brazil
| | - Josemir Belo dos Santos
- Department of Tropical Medicine - Universidade Federal de Pernambuco
(UFPE) – Recife (PE), Brazil
- Dermatology Service of the Hospital das Clínicas of the
Universidade Federal de Pernambuco (HC-UFPE) – Recife (PE), Brazil
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