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Pantke A, Kollan C, Gunsenheimer-Bartmeyer B, Jensen BEO, Stephan C, Degen O, Schürmann D, Kurth T, Bremer V, Koppe U. AIDS-defining events among people living with HIV who have been under continuous antiretroviral therapy for more than one year, a German cohort study 1999-2018. Infection 2024; 52:637-648. [PMID: 38381307 PMCID: PMC10954987 DOI: 10.1007/s15010-024-02188-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE This study examined the characteristics, incidence and prognostic factors of the first AIDS-defining condition developed after more than one year of continuous antiretroviral therapy (ART) among people living with HIV (PLHIV). METHODS We used data from two multicentre observational cohorts of PLHIV in Germany between 1999 and 2018. Our outcome was the first AIDS-defining event that occurred during follow-up after more than one year of continuous ART. Descriptive analyses at ART initiation, at the time of the AIDS event and of the most frequently observed types of AIDS-defining illnesses were performed. We calculated the incidence rate (IR) per 1000 person-years (PY) and used a bootstrap stepwise selection procedure to identify predictors of the outcome. RESULTS A total of 12,466 PLHIV were included in the analyses. 378 developed the outcome, constituting an overall IR of 5.6 (95% CI 5.1-6.2) AIDS events per 1000 PY. The majority of PLHIV was virally suppressed at the time of the event. Oesophageal candidiasis and wasting syndrome were the most frequently diagnosed AIDS-defining illnesses. We found a low CD4 count at ART initiation, a previous AIDS-defining condition and transmission through intravenous drug use to be meaningful prognostic factors of the outcome. CONCLUSION The overall rate of AIDS-defining events among PLHIV under long-term ART was low, highlighting the importance of continuous treatment. PLHIV who started ART with indicators of impaired immune functioning were more susceptible to disease progression, suggesting that the public health response should continue to focus on early and sustained treatment for all PLHIV.
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Affiliation(s)
- Annemarie Pantke
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | | | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christoph Stephan
- Medical Department 2, Infectious Diseases Unit, University Hospital of Frankfurt, Frankfurt, Germany
| | - Olaf Degen
- Clinic for Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Schürmann
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Uwe Koppe
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
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Dalu D, Fasola C, Ammoni L, De Francesco D, Cona MS, Rota S, Ferrario S, Gambaro A, Tosca N, Piva S, La Verde N. Pegylated liposomal doxorubicin as first line treatment in aids-related Kaposi's sarcoma: a real-life study. J Chemother 2021; 33:342-347. [PMID: 34060438 DOI: 10.1080/1120009x.2021.1920248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite the introduction of effective combination antiretroviral therapy (cART) AIDS-related Kaposi Sarcoma (AIDS-KS) remains the most common malignancy in HIV positive patients. In advanced stage or progressive forms, chemotherapy (CT) in combination with cART is the treatment of choice. The aim of the study is to evaluate efficacy and tolerability of Pegylated Liposomal Doxorubicin (PLD) as first line CT in AIDS-KS. In this single institution retrospective study PLD (20 mg/m2 IV every 2 weeks for 6 or 12 cycles) in combination with cART was administered in poor risk and some cases of good prognosis or limited cutaneous disease. Response rate and adverse events to treatment was evaluated. We enrolled 33 patients with AIDS-KS: median age 44ys, male 90.9%, Caucasian 72.7%, cART-naïve (simultaneous diagnosis of HIV infection and KS) 84.4%, median lymphocyte CD4+ count 134cells, median HIV viral load 4.9 log10 copies/ml. 32 patients were assigned to a Poor Risk KS stage. Grade 3-4 toxicity was reported in 9 patients. No cardiovascular events or severe sepsis were described. Complete response was reported in 25 of 31 patients evaluable for efficacy. After a median follow-up of 52 months the 3-years PFS was 68.6%. PLD associated with cART is an effective, feasible and well tolerated first-line CT in advanced AIDS-KS.
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Affiliation(s)
- Davide Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Cinzia Fasola
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Luca Ammoni
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Maria Silvia Cona
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Selene Rota
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Sabrina Ferrario
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Anna Gambaro
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Nicoletta Tosca
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Sheila Piva
- Department of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Nicla La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
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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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Abstract
Kaposi sarcoma (KS) is a mesenchymal tumour caused by KS-associated herpesvirus and is an AIDS-defining illness. Despite a decline in incidence since the introduction of combination anti-retroviral therapy, KS remains the most common cancer in people living with HIV in sub-Saharan Africa, where it causes significant morbidity and mortality. This review reflects on recent epidemiological data as well as current management, unmet needs and future perspectives in the treatment of HIV-associated KS with particular emphasis on the potential role of immune checkpoint inhibitors.
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Affiliation(s)
- Alessia Dalla Pria
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
| | - David J. Pinato
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
| | | | - Mark Bower
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
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Mletzko S, Pinato DJ, Robey RC, Dalla Pria A, Benson P, Imami N, Bower M. Programmed death ligand 1 (PD-L1) expression influences the immune-tolerogenic microenvironment in antiretroviral therapy-refractory Kaposi's sarcoma: A pilot study. Oncoimmunology 2017; 6:e1304337. [PMID: 28919987 DOI: 10.1080/2162402x.2017.1304337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/31/2022] Open
Abstract
Upregulation of programmed death ligand 1 (PD-L1) is a mechanism of immune escape utilized by a variety of tumors. PD-L1 expression in tumor cells or in the surrounding infiltrate correlates with clinical responsiveness to novel therapies targeting the PD-1/PD-L1 immune checkpoint. In the context of HIV-1 infection, Kaposi's sarcoma (KS) is largely responsive to restoration of immunity following combination antiretroviral therapy (cART), but there is a subset that is not. We hypothesized that this subset of cART-refractory KS may utilize the PD-L1 pathway of immune escape. We found that PD-L1 expressing KS had a denser CD8+ T cell (p = 0.03) and PD-L1 positive macrophage peritumoral infiltrate (p = 0.04) to suggest the involvement of PD-L1 in shaping an immune-tolerogenic microenvironment in cART-refractory KS. The presence of PD-L1 expression in association with immune-infiltrating cells provides rationale for the clinical development PD-1/PD-L1-targeted checkpoint inhibitors in cART-refractory KS.
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Affiliation(s)
| | | | | | | | | | | | - Mark Bower
- Imperial College London, London, UK.,Chelsea and Westminster Hospital, London, UK
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Thakker S, Verma SC. Co-infections and Pathogenesis of KSHV-Associated Malignancies. Front Microbiol 2016; 7:151. [PMID: 26913028 PMCID: PMC4753363 DOI: 10.3389/fmicb.2016.00151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/27/2016] [Indexed: 12/25/2022] Open
Abstract
Kaposi’s sarcoma-associated herpesvirus (KSHV), also known as human herpes virus 8 (HHV-8) is one of the several carcinogenic viruses that infect humans. KSHV infection has been implicated in the development of Kaposi’s sarcoma (KS), primary effusion lymphoma, and multicentric Castleman’s Disease. While KSHV infection is necessary for the development of KSHV associated malignancies, it is not sufficient to induce tumorigenesis. Evidently, other co-factors are essential for the progression of KSHV induced malignancies. One of the most important co-factors, necessary for the progression of KSHV induced tumors, is immune suppression that frequently arises during co-infection with HIV and also by other immune suppressants. In this mini-review, we discuss the roles of co-infection with HIV and other pathogens on KSHV infection and pathogenesis.
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Melé-Ninot G, Sola-Ortigosa J, Iglesias-Sancho M, Delás-Amat J. [Fatal outcome of immune reconstitution inflammatory síndrome in a patient with AIDS-associated Kaposi sarcoma]. Med Clin (Barc) 2015; 145:551-2. [PMID: 25865611 DOI: 10.1016/j.medcli.2015.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/07/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gemma Melé-Ninot
- Servicio de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, España.
| | | | | | - Jordi Delás-Amat
- Servicio de Medicina Interna, Hospital Universitari Sagrat Cor, Barcelona, España
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von Braun A, Braun DL, Kamarachev J, Günthard HF. New onset of kaposi sarcoma in a human immunodeficiency virus-1-infected homosexual man, despite early antiretroviral treatment, sustained viral suppression, and immune restoration. Open Forum Infect Dis 2014; 1:ofu005. [PMID: 25734079 PMCID: PMC4324193 DOI: 10.1093/ofid/ofu005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/03/2014] [Indexed: 12/02/2022] Open
Abstract
This is a rare case of new onset Kaposi sarcoma in a man infected with human immunodeficiency virus (HIV) and receiving antiretroviral treatment since primary HIV infection, with normal CD4+ cell count and suppressed viral load. The presentation questions the general understanding of Kaposi sarcoma as an acquired immune deficiency syndrome-defining disease occurring predominantly in severely immunocompromised patients infected with HIV.
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Affiliation(s)
| | | | - Jivko Kamarachev
- Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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