Cattelan Anna Maria, Calabrò Maria Luisa, De Rossi Anita, Aversa Savina Maria Luciana, Barbierato Massimo, Trevenzoli Marco, Gasperini Paola, Zanchetta Marisa, Cadrobbi Paolo, Monfardini Silvio, Chieco-Bianchi Luigi
Department of Infectious Diseases, General Hospital and University of Padova, I-35121 Padova, Italy.
Int J Oncol. 2005 Sep;27(3):779-85.
The long-term impact of highly active antiretroviral therapy (HAART) in AIDS patients with Kaposi's sarcoma (KS) was evaluated in 22 consecutive, HAART-naïve KS patients attending a single Italian referral centre for HIV/AIDS. Clinical, virologic and immunologic responses to HAART were assessed at baseline and every three months during the follow-up. Peripheral blood mononuclear cell (PBMC)-associated human herpesvirus 8 (HHV-8) load was also evaluated by real-time PCR in 13 patients with durable clinical KS complete response (CR). In a median follow-up of 40 months (range 17-78), the KS overall clinical response rate was 91%: 18 complete and 2 partial responses were achieved, and two patients experienced disease progression. CR persisted in all 18 patients, including the 5 poor-risk KS patients in whom CR lasted for > 60 months, and was significantly linked to an increase in CD4+ cell counts and a drop in HIV-1-RNA copies. Compared to baseline levels, a decrease in PBMC HHV-8 load was observed at CR, and a significant further reduction was found at the end of follow-up. In this monocentric study, AIDS-KS patients treated with HAART showed high clinical response rate. Patients with CR showed a prolonged remission, lasting more than 5 years in a group of poor-risk patients, and a persistent reduction in circulating HHV-8-infected cells. These findings highlight that HAART deeply modifies the natural history of this tumour in AIDS patients, and that this long-lasting approach may be considered a first-line treatment for the majority of HIV-1-infected patients developing KS.
在一家意大利单一的HIV/AIDS转诊中心，对22例未接受过高效抗逆转录病毒治疗（HAART）的连续性卡波西肉瘤（KS）艾滋病患者进行了HAART长期影响的评估。在基线时以及随访期间每三个月评估对HAART的临床、病毒学和免疫学反应。还通过实时PCR对13例具有持久临床KS完全缓解（CR）的患者外周血单个核细胞（PBMC）相关的人类疱疹病毒8（HHV-8）载量进行了评估。在中位随访40个月（范围17 - 78个月）时，KS总体临床缓解率为91%：实现了18例完全缓解和2例部分缓解，2例患者疾病进展。所有18例患者均持续保持CR，包括5例高危KS患者，其CR持续时间>60个月，且CR与CD4 + 细胞计数增加和HIV-1-RNA拷贝数下降显著相关。与基线水平相比，CR时PBMC HHV-8载量降低，随访结束时进一步显著降低。在这项单中心研究中，接受HAART治疗的艾滋病KS患者显示出高临床缓解率。CR患者缓解期延长，一组高危患者中缓解期持续超过5年，且循环中感染HHV-8的细胞持续减少。这些发现突出表明，HAART深刻改变了艾滋病患者中这种肿瘤的自然病程，并且这种长期治疗方法可被视为大多数发生KS的HIV-1感染患者的一线治疗方法。
