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Abrupt worsening of Kaposi's sarcoma seen at start of HAART.

BETHESDA, MD. -- Kaposi's sarcoma can flare dramatically when HIV-positive patients initiate or change highly active antiretroviral therapy, or when they resume HAART after an interruption, Dr. David Aboulafia said at an international conference on malignancies in AIDS and other immunodeficiencies.

This abrupt worsening in Kaposi's sarcoma "may represent yet another protean and little-appreciated manifestation of the immune reconstitution syndrome," said Dr. Aboulafia of the University of Washington, Seattle.

He and his associates treated seven patients with rapidly proliferating Kaposi's sarcoma in 2001-2004, and reviewed the cases of another 10 patients that were reported in the literature. Of these patients, 12 had recently initiated HAART, three had recently started a salvage HAART regimen, and two had recently resumed HAART after an interruption in treatment. The median time to onset of the flare in Kaposi's sarcoma was 4 weeks.

At the start of HAART, the mean HIV viral load was 283,000 copies/mL and the mean CD4 count was 142 cells/[micro]L. At the time of the Kaposi's sarcoma flare, the mean viral load had plummeted to 958 copies/mL and the mean CD4 count had risen to 220 cells/[micro]L with HAART.

The Kaposi's sarcomas were treated using a variety of approaches, including chemotherapy, radiotherapy, surgery, cryotherapy, and experimental agents. Of the 17 patients, 6 died soon after the Kaposi's sarcoma flare--4 from progressive pulmonary Kaposi's sarcoma, 1 from a pulmonary embolus, and 1 from concomitant non-Hodgkin's lymphoma.

No predictive factors for the development of Kaposi's sarcoma flares were evident. Researchers and clinicians have yet to identify any predictive factors for the immune reconstitution syndrome as well, Dr. Aboulafia noted at the conference, sponsored by the National Cancer Institute.
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Title Annotation:Infectious Diseases
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Jul 1, 2004
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