Kaposi Sarcoma Declines Among HIV Positive Patients
American Cancer Society
Kaposi Sarcoma (KS), a once-rare cancer whose mysterious appearance marked the beginning of the AIDS epidemic, has dropped nearly 40 percent a year in the last decade among HIV-positive patients in Europe. The finding comes from a new study reported in the May 10, 2004 online edition of CANCER, a peer-reviewed journal of the American Cancer Society. The study also finds that the level of immune deficiency as characterized by the CD4 count is the main factor associated with KS and that the longer a patient is on highly active antiretroviral therapy (HAART), the lower the risk of developing KS. The full study will be available online via Wiley InterScience (http://www.interscience.wiley.com/cancer-newsroom), and will also appear in the June 15, 2004 print issue.
KS is a cancer that first appears as a skin lesion but can also develop in the gastrointestinal tract, lungs, spleen and liver. Until the appearance of HIV, KS was rare and predominantly found in elderly Mediterranean men. In the 1980s, KS was one of the first diseases seen in HIV-infected patients and became one of the AIDS-defining illnesses.
The introduction of HAART in the 1990s has led to a decline in all AIDS-defining diseases due to its suppression of HIV. Some studies show that the incidence of KS has also declined but those studies have been small and limited. EuroSIDA is one of the largest studies to date on HIV infection, including HIV positive patients who acquired HIV from various exposures and who come from all across Europe. Led by Dr. A. Mocroft of the Royal Free and University College in London, researchers used data collected from 9803 patients enrolled in EuroSIDA to characterize the changes in the incidence of KS in Europe and the risk factors for KS among patients started on HAART.
The annual incidence of KS decreased 39 percent between 1994 and 2003. This decline started prior to the introduction of HAART but continued after HAART's introduction in Europe. KS still contributes to 6 percent of all annual AIDS defining illnesses. There was a significantly increased incidence among homosexual men compared to other at-risk groups, such as intravenous drug users, and also among patients from Central-Western Europe, possibly reflecting a difference in the prevalence of human herpes virus 8, which has been associated with KS.
Analysis of the data for risk factors showed that patients with a higher current CD4 count or who had been on HAART for a longer period of time had a decreased incidence of KS. "This indicates that the current CD4 count remains one of the most important prognostic factors for KS, and patients who start HAART should experience a reduction in the risk of KS if the CD4 count starts to rise," conclude the authors. That the risk of KS declines as the immune system is reconstituted strongly suggests that KS behaves more like an infection and less like a cancer.
Article: "The Changing Pattern of Kaposi Sarcoma in Patients with HIV, 1994-2003: The EuroSIDA Study," Amanda Mocroft, O. Kirk, N. Clumeck, P. Gargalianos, Hanna Trocha, Nelly Chentsova, F. Antunes, Hans-J. Stellbrink, Andrew N. Phillips, Jens D. Lundgren, CANCER; Published Online: May 10, 2004 (DOI: 10.1002/cncr.20309); Print Issue Date: June 15, 2004.20278); Print Issue Date: June 1, 2004.
For more information, or to contact American Cancer Society, see their website at: www.cancer.org
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