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Dinh S, Malmström S, Möller IK, Yilmaz A, Svedhem V, Carlander C. Extracutaneous Kaposi sarcoma risk remains higher in people with HIV in the post-ART era. AIDS 2023; 37:2041-2048. [PMID: 37451428 PMCID: PMC10552821 DOI: 10.1097/qad.0000000000003658] [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: 05/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To assess Kaposi sarcoma (KS) by HIV-status in Sweden 1983-2017, with particular focus on extracutaneous KS. DESIGN Population-based study linking the Total Population Registry, the Swedish HIV Registry InfCareHIV, and the Swedish Cancer Registry. METHODS We included all Swedish residents, born in or outside Sweden between 1940 and 2000 ( n = 8 587 829), assessing the annual incidence of KS, adjusted hazard ratios (adjHR), and odds ratios (adjOR) in the pre and postcombination antiretroviral therapy (ART) eras. RESULTS KS was found in 324 individuals of whom 202 (62%) were people with HIV (PWH). While the incidence of KS decreased in PWH, it remained higher compared to HIV-negative at end of follow-up (28 vs. 0.09 per 100 000 person-years, P < 0.001). In the post-ART era, PWH still had an increased risk of both cutaneous [adjHR 616, 95% confidence interval (CI) 410-926] and extracutaneous KS (adjHR 2068, 95% CI 757-5654), compared to HIV-negative individuals, although there were no cases of extracutaneous disease among virally suppressed PWH. In the post-ART era, the relative risk for KS remained higher in men, particularly men who have sex with men, and viral suppression was associated with lower odds of KS (adjOR 0.05, 95% CI 0.03-0.09). CONCLUSIONS KS remained increased in PWH in the post-ART era, with a particularly high risk for extracutaneous disease compared to HIV-negative individuals. Notably, there were no cases of extracutaneous disease among virally suppressed PWH, suggesting a less aggressive disease in this population. Further studies on KS in virally suppressed PWH are warranted.
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Affiliation(s)
- Sofia Dinh
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Stina Malmström
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | | | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Veronica Svedhem
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Christina Carlander
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Department of Infectious Diseases, Karolinska University Hospital
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Patel R, Lurain K, Yarchoan R, Ramaswami R. Clinical management of Kaposi sarcoma herpesvirus-associated diseases: an update on disease manifestations and treatment strategies. Expert Rev Anti Infect Ther 2023; 21:929-941. [PMID: 37578202 PMCID: PMC10529793 DOI: 10.1080/14787210.2023.2247161] [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: 04/11/2023] [Revised: 07/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Kaposi sarcoma herpes virus (KSHV) is associated with several diseases including Kaposi sarcoma, a form of multicentric Castleman's disease, primary effusion lymphoma, and an inflammatory cytokine syndrome. These KSHV-associated diseases (KAD) can present with heterogenous signs and symptoms that are often associated with cytokine dysregulation that may result in multiorgan dysfunction. The inability to promptly diagnose and treat these conditions can result in long-term complications and mortality. AREAS COVERED Existing epidemiological subtypes of existing KSHV-associated diseases, specifically Kaposi sarcoma as well as the incidence of several KSHV-associated disorders are described. We review the KSHV latent and lytic phases as they correlate with KSHV-associated diseases. Given the complicated presentations, we discuss the clinical manifestations, current diagnostic criteria, existing treatment algorithms for individual KAD, and when they occur concurrently. With emerging evidence on the virus and host interactions, we evaluate novel approaches for the treatment of KAD. An extensive literature search was conducted to support these findings. EXPERT OPINION KSHV leads to complex and concurrent disease processes that are often underdiagnosed both in the United States and worldwide. New therapies that exist for many of these conditions focus on chemotherapy-sparing options that seek to target the underlying viral pathogenesis or immunotherapy strategies.
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Affiliation(s)
- Roshani Patel
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Gothland A, Jary A, Grange P, Leducq V, Beauvais-Remigereau L, Dupin N, Marcelin AG, Calvez V. Harnessing Redox Disruption to Treat Human Herpesvirus 8 (HHV-8) Related Malignancies. Antioxidants (Basel) 2022; 12:antiox12010084. [PMID: 36670946 PMCID: PMC9854560 DOI: 10.3390/antiox12010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Reprogrammed metabolism is regarded as a hallmark of cancer and offers a selective advantage to tumor cells during carcinogenesis. The redox equilibrium is necessary for growth, spread and the antioxidant pathways are boosted following Reactive Oxygen Species (ROS) production to prevent cell damage in tumor cells. Human herpesvirus 8 (HHV-8), the etiologic agent of Kaposi sarcoma KS and primary effusion lymphoma (PEL), is an oncogenic virus that disrupts cell survival-related molecular signaling pathways leading to immune host evasion, cells growths, angiogenesis and inflammatory tumor-environment. We recently reported that primaquine diphosphate causes cell death by apoptosis in HHV-8 infected PEL cell lines in vivo and exhibits therapeutic anti-tumor activity in mice models and advanced KS. Our findings also suggest that the primaquine-induced apoptosis in PEL cells is mostly influenced by ROS production and targeting the redox balance could be a new approach to treat HHV-8 related diseases. In this review, we summarized the knowledge about the influence of ROS in cancer development; more specifically, the proof of evidence from our work and from the literature that redox pathways are important for the development of HHV-8 pathologies.
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Affiliation(s)
- Adélie Gothland
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Department of Virology, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Aude Jary
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Department of Virology, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
- Correspondence: (A.J.); (V.C.); Tel.: +33-1-42-17-74-01 (A.J.)
| | - Philippe Grange
- Cutaneous Biology Lab, INSERM U1016, UMR8104, Institut Cochin, Université de Paris, 24 Rue du Faubourg St Jacques, 75014 Paris, France
- Department of Dermatology, CeGGID et CNR IST Bactériennes, Hôpital Cochin Site Port Royale, AP-HP, Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Valentin Leducq
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Department of Virology, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | | | - Nicolas Dupin
- Cutaneous Biology Lab, INSERM U1016, UMR8104, Institut Cochin, Université de Paris, 24 Rue du Faubourg St Jacques, 75014 Paris, France
- Department of Dermatology, CeGGID et CNR IST Bactériennes, Hôpital Cochin Site Port Royale, AP-HP, Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Anne-Geneviève Marcelin
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Department of Virology, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Vincent Calvez
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Department of Virology, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
- Correspondence: (A.J.); (V.C.); Tel.: +33-1-42-17-74-01 (A.J.)
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Fahrni ML, Misran NFL, Abidin ZZ, Chidambaram SK, Lazzarino AI. Clinical predictors of efavirenz-based regimen treatment durability: A two-year case-control study of antiretroviral-naïve patients. J Infect Public Health 2022; 16:96-103. [PMID: 36508946 DOI: 10.1016/j.jiph.2022.12.001] [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: 09/01/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND While efavirenz-associated adverse drug events (ADEs) were widely established, the clinical relevance is uncertain. OBJECTIVES We aimed to assess the extent of treatment interruption caused by efavirenz-associated ADEs. METHODS A case-control study of efavirenz recipients who did, versus did not (control) develop adverse drug events (ADE), and who were matched for baseline CD4 + at a ratio of 1:1.3 was conducted. Antiretroviral -naïve patients who were started on efavirenz were followed up retrospectively, and their records scrutinized every month for 2 years. Demographic and clinical predictors of treatment interruption were computed using Cox proportional hazard models. Kaplan- Meier curves were plotted to assess time to treatment interruption for the two groups. Clinical endpoints were: i) efficacy -improved CD4 + counts and/or viral load (VL) suppression, ii) safety -absence of treatment-limiting toxicities, and iii) durability - no interruption until follow-up ended. RESULTS Both groups had comparable CD4 + counts at baseline (p = 0.15). At t = 24-months, VL in both groups were suppressed to undetectable levels (<20 copies/mL) while median CD4 + was 353 cells/µL (IQR: 249-460). The mean time on treatment was 23 months (95% CI, 22.3 -23.4) in the control group without ADE and 20 months (95% CI, 18.9 - 21.6) in the ADE group (p = 0.001). Kaplan-Meier plots demonstrated that 59.5% of patients who experienced > 1 ADE versus 81% of those who did not experience any ADE were estimated to continue treatment for up to 24 months with no interruption (p = 0.001). Most interruptions to EFV treatment occurred in the presence of opportunistic infections and these were detected within the first 5 months of treatment initiation. Independent predictors which negatively impacted the dependent variable i.e., treatment durability, were intravenous drug use (adjusted hazard ratio, aHR 2.17, 95% CI, 1.03-4.61, p = 0.043), presence of > 1 opportunistic infection(s) (aHR 2.2, 95% CI, 1.13-4.21, p = 0.021), and presence of > 1 serious ADE(s) (aHR 4.18, 95% CI, 1.98-8.85, p = 0.00). CONCLUSION Efavirenz' role as the preferred first-line regimen for South-East Asia's resource-limited regions will need to be carefully tailored to suit the regional population. Findings have implications to policy-makers and clinicians, particularly for the treatment of patients who develop ADEs and opportunistic infections, and for intravenous drug user subgroups.
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Affiliation(s)
- Mathumalar Loganathan Fahrni
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Selangor Darul Ehsan, Malaysia; Collaborative Drug Discovery Research (CDDR) Group, Communities of Research (Pharmaceutical and Life Sciences), Universiti Teknologi MARA (UiTM), Selangor Darul Ehsan, Malaysia.
| | - Nurul Fatin Laila Misran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Selangor Darul Ehsan, Malaysia
| | - Zarena Zainul Abidin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Selangor Darul Ehsan, Malaysia
| | - Suresh Kumar Chidambaram
- Infectious Disease Unit, Medical Department, Sungai Buloh Hospital, Ministry of Health Malaysia, Malaysia
| | - Antonio Ivan Lazzarino
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
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Htet KZ, Waul MA, Leslie KS. Topical treatments for Kaposi sarcoma: A systematic review. SKIN HEALTH AND DISEASE 2022; 2:e107. [PMID: 35677916 PMCID: PMC9168015 DOI: 10.1002/ski2.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/13/2022]
Abstract
Background While treatment options exist for solitary or disseminated Kaposi sarcoma (KS) disease, there are currently no standardized clinical treatment guidelines for cutaneous KS. Objective This systematic review seeks to identify safe and effective topical treatments for cutaneous KS lesions. Methods We conducted a systematic review using peer-reviewed articles from January 1970 to September 2021 published in the PubMed/MEDLINE and EMBASE databases. Results From the initial search that yielded 590 studies, 34 met the inclusion criteria and were selected. Of the 34 studies, seven were clinical trials, 26 were case reports/series and one was a multicentre study. A total of 634 patients were included in our review. The three most common topical treatments used for cutaneous KS were imiquimod, alitretinoin and timolol. Topical alitretinoin was used in three case reports and three clinical trials. Topical imiquimod was used in eight case reports, one prospective phase II cohort study and one comparative single-blinded non-controlled clinical study. Topical timolol was used in nine case reports/series. Our review also identified reports of less widely used topical treatments for cutaneous KS. These include topical diphencyprone (DPCP), all-trans-retinoic-acid, rapamycin and bleomycin-dimethylsulfoxide (BLM-DMSO) which achieved variable response rates but have not been widely studied. Conclusion Topical alitretinoin, imiquimod and timolol demonstrated positive responses for cutaneous KS and the treatments were well tolerated. These three topical treatment modalities could be considered by clinicians when treating cutaneous KS.
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Affiliation(s)
- Kyaw Zin Htet
- Tulane University School of MedicineNew OrleansLouisianaUSA
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Poizot-Martin I, Brégigeon S, Palich R, Marcelin AG, Valantin MA, Solas C, Veyri M, Spano JP, Makinson A. Immune Reconstitution Inflammatory Syndrome Associated Kaposi Sarcoma. Cancers (Basel) 2022; 14:cancers14040986. [PMID: 35205734 PMCID: PMC8869819 DOI: 10.3390/cancers14040986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
People living with HIV (PLWH) with advanced immunosuppression who initiate antiretroviral therapy (ART) are susceptible to the occurrence of an immune reconstitution inflammatory syndrome (IRIS). Although ART is responsible for AIDS- associated Kaposi sarcoma (KS) improvement and resolution, new onset (unmasking KS-IRIS) or sudden progression of preexisting KS (paradoxical KS-IRIS) can occur after a time delay of between a few days and 6 months after the initiation or resumption of ART, even in patients with a low degree of immunocompromise. KS-IRIS incidence varies from 2.4% to 39%, depending on study design, populations, and geographic regions. Risk factors for developing KS-IRIS include advanced KS tumor stage (T1), pre-treatment HIV viral load >5 log10 copies/mL, detectable pre-treatment plasma-KSHV, and initiation of ART alone without concurrent chemotherapy. Both paradoxical and unmasking KS-IRIS have been associated with significant morbidity and mortality, and thrombocytopenia (<100,000 platelets/mm3 at 12 weeks) has been associated with death. KS-IRIS is not to be considered as ART failure, and an ART regimen must be pursued. Systemic chemotherapy for KS in conjunction with ART is recommended and, in contrast with management of IRIS for other opportunistic infections, glucocorticoids are contra-indicated. Despite our preliminary results, the place of targeted therapies in the prevention or treatment of KS-IRIS needs further assessment.
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Affiliation(s)
- Isabelle Poizot-Martin
- Assistance Publique-Hôpitaux de Marseille (APHM), Inserm, Institut de Recherche pour le Développement (IRD), SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, APHM Sainte-Marguerite, Service D’immuno-Hématologie Clinique, Aix-Marseille Université, 13009 Marseille, France
- Correspondence: ; Tel.: +33-4-9174-4966 or +33-4-9174-6163; Fax: +33-4-9174-4962
| | - Sylvie Brégigeon
- Assistance Publique-Hôpitaux de Marseille (APHM) Sainte-Marguerite, Service D’immuno-Hématologie Clinique, Aix-Marseille Université, 13009 Marseille, France;
| | - Romain Palich
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France; (R.P.); (M.-A.V.)
| | - Anne-Geneviève Marcelin
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Sorbonne Université, 75013 Paris, France;
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France; (R.P.); (M.-A.V.)
| | - Caroline Solas
- Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital La Timone, Laboratoire de Pharmacocinétique et Toxicologie, INSERM 1207, IRD 190, Unité des Virus Emergents, Aix-Marseille Université, 13005 Marseille, France;
| | - Marianne Veyri
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Institut Universitaire de Cancérologie (IUC), CLIP2 Galilée, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne Université, 75013 Paris, France; (M.V.); (J.-P.S.)
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Institut Universitaire de Cancérologie (IUC), CLIP2 Galilée, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne Université, 75013 Paris, France; (M.V.); (J.-P.S.)
| | - Alain Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, 34000 Montpellier, France;
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Valantin MA, Royston L, Hentzien M, Jary A, Makinson A, Veyri M, Ronot-Bregigeon S, Isnard S, Palich R, Routy JP. Therapeutic Perspectives in the Systemic Treatment of Kaposi’s Sarcoma. Cancers (Basel) 2022; 14:cancers14030484. [PMID: 35158752 PMCID: PMC8833559 DOI: 10.3390/cancers14030484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Alternative systemic treatments are needed for patients who develop chemotherapy-refractory KS. Anti-angiogenic therapies constitute interesting therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis, and could represent attractive alternatives. Immune checkpoints blockade could also be an interesting therapeutic approach in order to restore anti-HHV-8 immunity and tumor control. Abstract In patients with Kaposi’s sarcoma (KS), the therapeutic goal is to achieve a durable remission in the size and number of skin and visceral lesions. Although most patients show tumor regression in response to standard systemic chemotherapy regimens, alternative systemic treatments are needed for patients who develop refractory KS. Anti-angiogenic therapies represent attractive therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis. Pomalidomide, which exhibits such anti-angiogenic activity through inhibition of VEGF, currently constitutes the most promising agent of this class and has been recently approved by the FDA. In addition, immune checkpoint blockade also represents an interesting alternative therapeutic approach through the restoration of immunity against HHV-8, the causative agent of KS, and improvement of tumor control. Although small series of cases treated successfully with these drugs have been reported, there is no marketing approval for anti-immune checkpoint antibodies for KS to date. In the present review, we will discuss potential therapeutic options for patients with recurrent or refractory KS, including systemic chemotherapies, immune checkpoint inhibitors, anti-herpesvirus agents, and anti-angiogenic drugs. Well-conducted clinical trials in this population are urgently needed to correctly address the efficacy of targeted agents and immunomodulators, while monitoring for adverse effects.
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Affiliation(s)
- Marc-Antoine Valantin
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
- Correspondence: (M.-A.V.); (L.R.); Tel.: +33-142-160-144 (M.-A.V.); +15-14-934-1934 (ext. 76487) (L.R.); Fax: +33-142-1601 (M.-A.V.)
| | - Léna Royston
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Infectious Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: (M.-A.V.); (L.R.); Tel.: +33-142-160-144 (M.-A.V.); +15-14-934-1934 (ext. 76487) (L.R.); Fax: +33-142-1601 (M.-A.V.)
| | - Maxime Hentzien
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, CHU Robert Debré, 51090 Reims, France;
| | - Aude Jary
- Service de Virologie, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Alain Makinson
- Infectious Diseases Department, INSERM U1175, University Hospital of Montpellier, 34000 Montpellier, France;
| | - Marianne Veyri
- Service d’Oncologie Médicale, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Sorbonne University, 75013 Paris, France;
| | - Sylvie Ronot-Bregigeon
- Service d’Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Aix Marseille Université, 13009 Marseille, France;
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Hematology, McGill University Health Centre, Montréal, QC H4A3J1, Canada
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Jary A, Veyri M, Gothland A, Leducq V, Calvez V, Marcelin AG. Kaposi's Sarcoma-Associated Herpesvirus, the Etiological Agent of All Epidemiological Forms of Kaposi's Sarcoma. Cancers (Basel) 2021; 13:cancers13246208. [PMID: 34944828 PMCID: PMC8699694 DOI: 10.3390/cancers13246208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Kaposi’s sarcoma-associated herpesvirus (KSHV) is one of the seven oncogenic viruses currently recognized by the International Agency for Research on Cancer. Its presence for Kaposi’s sarcoma development is essential and knowledge on the oncogenic process has increased since its discovery in 1994. However, some uncertainties remain to be clarified, in particular on the exact routes of transmission and disparities in KSHV seroprevalence and the prevalence of Kaposi’s sarcoma worldwide. Here, we summarized the current data on the KSHV viral particle’s structure, its genome, the replication, its seroprevalence, the viral diversity and the lytic and latent oncogenesis proteins involved in Kaposi’s sarcoma. Lastly, we reported the environmental, immunological and viral factors possibly associated with KSHV transmission that could also play a role in the development of Kaposi’s sarcoma. Abstract Kaposi’s sarcoma-associated herpesvirus (KSHV), also called human herpesvirus 8 (HHV-8), is an oncogenic virus belonging to the Herpesviridae family. The viral particle is composed of a double-stranded DNA harboring 90 open reading frames, incorporated in an icosahedral capsid and enveloped. The viral cycle is divided in the following two states: a short lytic phase, and a latency phase that leads to a persistent infection in target cells and the expression of a small number of genes, including LANA-1, v-FLIP and v-cyclin. The seroprevalence and risk factors of infection differ around the world, and saliva seems to play a major role in viral transmission. KSHV is found in all epidemiological forms of Kaposi’s sarcoma including classic, endemic, iatrogenic, epidemic and non-epidemic forms. In a Kaposi’s sarcoma lesion, KSHV is mainly in a latent state; however, a small proportion of viral particles (<5%) are in a replicative state and are reported to be potentially involved in the proliferation of neighboring cells, suggesting they have crucial roles in the process of tumorigenesis. KSHV encodes oncogenic proteins (LANA-1, v-FLIP, v-cyclin, v-GPCR, v-IL6, v-CCL, v-MIP, v-IRF, etc.) that can modulate cellular pathways in order to induce the characteristics found in all cancer, including the inhibition of apoptosis, cells’ proliferation stimulation, angiogenesis, inflammation and immune escape, and, therefore, are involved in the development of Kaposi’s sarcoma.
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Affiliation(s)
- Aude Jary
- Service de Virologie, Hôpital Pitié-Salpêtrière, AP-HP, Institut Pierre Louis d’Épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (A.G.); (V.L.); (V.C.); (A.-G.M.)
- Correspondence: ; Tel.: +33-1-4217-7401
| | - Marianne Veyri
- Service d’Oncologie Médicale, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Institut Pierre Louis d’Épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France;
| | - Adélie Gothland
- Service de Virologie, Hôpital Pitié-Salpêtrière, AP-HP, Institut Pierre Louis d’Épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (A.G.); (V.L.); (V.C.); (A.-G.M.)
| | - Valentin Leducq
- Service de Virologie, Hôpital Pitié-Salpêtrière, AP-HP, Institut Pierre Louis d’Épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (A.G.); (V.L.); (V.C.); (A.-G.M.)
| | - Vincent Calvez
- Service de Virologie, Hôpital Pitié-Salpêtrière, AP-HP, Institut Pierre Louis d’Épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (A.G.); (V.L.); (V.C.); (A.-G.M.)
| | - Anne-Geneviève Marcelin
- Service de Virologie, Hôpital Pitié-Salpêtrière, AP-HP, Institut Pierre Louis d’Épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (A.G.); (V.L.); (V.C.); (A.-G.M.)
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9
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Kaposi's Sarcoma in Virally Suppressed People Living with HIV: An Emerging Condition. Cancers (Basel) 2021; 13:cancers13225702. [PMID: 34830857 PMCID: PMC8616070 DOI: 10.3390/cancers13225702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Kaposi’s sarcoma (KS) in people living with HIV (PLHIV) occurs in the vast majority of cases when viral replication is not controlled and when CD4 immunosuppression is important. However, clinicians are observing more and more cases of KS in PLHIV with suppressed viremia on antiretroviral treatment. These clinical forms seem less aggressive, but cause therapeutic dead ends. Indeed, despite repeated chemotherapy, recurrences are frequent. Immunotherapy and specific treatment regimens should be evaluated in this population. Abstract Since the advent of highly effective combined antiretroviral treatment (cART), and with the implementation of large HIV testing programs and universal access to cART, the burden of AIDS-related comorbidities has dramatically decreased over time. The incidence of Kaposi’s sarcoma (SK), strongly associated with HIV replication and CD4 immunosuppression, was greatly reduced. However, KS remains the most common cancer in patients living with HIV (PLHIV). HIV physicians are increasingly faced with KS in virally suppressed HIV-patients, as reflected by increasing description of case series. Though SK seem less aggressive than those in PLHIV with uncontrolled HIV-disease, some may require systemic chemotherapy. Persistent lack of specific anti-HHV-8 cellular immunity could be involved in the physiopathology of these KS. These clinical forms are a real therapeutic challenge without possible short-term improvement of anti-HHV-8 immunity, and no active replication of HIV to control. The cumulative toxicity of chemotherapies repeatedly leads to a therapeutic dead end. The introduction or maintenance of protease inhibitors in cART does not seem to have an impact on the evolution of these KS. Research programs in this emerging condition are important to consider new strategies.
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10
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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: 15] [Impact Index Per Article: 5.0] [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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11
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Lajaunie R, Cuzin L, Palich R, Makinson A, Bani-Sadr F, Duvivier C, Arvieux C, Rey D, Poizot-Martin I, Delpierre C, Delobel P, Martin-Blondel G. No increased risk of Kaposi sarcoma relapse in patients with controlled HIV-1 infection after switching protease inhibitor-based antiretroviral therapy. HIV Med 2021; 23:301-306. [PMID: 34668293 DOI: 10.1111/hiv.13168] [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] [Received: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Our aim was to assess if switching from a protease inhibitors (PI)-based regimen to a PI-free one is associated with an increased risk of Kaposi Sarcoma (KS) relapse among patients living with HIV (PLHIV) with history of KS and controlled HIV replication. METHODS In a retrospective analysis of the prospectively collected Dat'AIDS database we selected patients who both had a past KS history and a HIV-1 viral load below 200 copies/mL while being PI-treated. We searched for KS relapses while persistent virological success was maintained for at least 6 months, whether patients kept taking the PI, or switched to PI-free regimen. RESULTS Among the 216 patients with past KS event and a history of HIV-1 infection efficiently treated by a PI-based regimen, 148 patients (68.5%) later switched to a PI-sparing regimen. Their baseline characteristics were not different from non-switching patients. We described 7 cases of relapse (3.2% of the 216 patients). Five cases of relapse occurred in switching patients (3.4%). The remaining two relapses occurred in PI-treated patients (2.9%). At KS relapse, CD4 cell count was 459 cells/μL (range 225-560) for switching patients, compared with 362 and 136 cells/μL for the other two patients. CONCLUSIONS In this large cohort of PLHIV with a history of KS and ART-controlled HIV replication, KS relapses were described in 3.2% of the patients, and were not more frequent when a PI-containing ART regimen has been switched to a PI-free regimen. Our results do not support a specific effect of PI on KS.
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Affiliation(s)
- Rébecca Lajaunie
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Lise Cuzin
- Department of Infectious and Tropical Diseases, Martinique University Hospital, Fort de France, FWI and INSERM UMR 1027 Toulouse III University, Toulouse, France
| | - Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Alain Makinson
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, InsermU1175, Montpellier, France
| | - Firouzé Bani-Sadr
- Department of Infectious and Tropical Diseases, Reims University Hospital, 45, rue Cognacq-Jay - 51092 Reims Cedex, Reims, France
| | - Claudine Duvivier
- AP-HP, Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center; IHU Imagine; Université de Paris; INSERM, U1016, Institut Cochin; CNRS, UMR8104; Institut Pasteur, Medical Center of Institut Pasteur, Necker-Pasteur Infectiology Center, Paris, France
| | - Cedric Arvieux
- Department of Infectious and Tropical Diseases, Rennes University Hospital, 2 Rue Henri le Guilloux, Rennes, France
| | - David Rey
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Isabelle Poizot-Martin
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Cyril Delpierre
- Toulouse University, Faculté de Médecine 37 Allées Jules Guesde, Toulouse, France
| | - Pierre Delobel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital and INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital and INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Toulouse, France
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12
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Royston L, Isnard S, Calmy A, Routy JP. Kaposi sarcoma in antiretroviral therapy-treated people with HIV: a wake-up call for research on human herpesvirus-8. AIDS 2021; 35:1695-1699. [PMID: 33966030 DOI: 10.1097/qad.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Léna Royston
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre
- Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- CIHR Canadian HIV Trials Network, Vancouver, BC
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre
- Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre
- Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada
- Division of Hematology, McGill University Health Centre, Montréal, QC, Canada
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13
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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: 1.7] [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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14
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Viral and Immunological Analytes are Poor Predictors of the Clinical Treatment Response in Kaposi's Sarcoma Patients. Cancers (Basel) 2020; 12:cancers12061594. [PMID: 32560243 PMCID: PMC7352224 DOI: 10.3390/cancers12061594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/07/2020] [Accepted: 06/12/2020] [Indexed: 12/26/2022] Open
Abstract
Kaposi’s sarcoma-associated herpes virus (KSHV) is the etiologic agent for Kaposi’s sarcoma (KS). The prognostic utility of KSHV and HIV-1 (human immunodeficiency virus) viremia as well as immunological parameters in clinical management of participants with KS is unclear. The objective of this study was to investigate viral and immunological parameters as predictors of KS treatment responses in participants with KS from sub-Saharan Africa (SSA). Plasma KSHV-DNA, HIV-1 viral load, total anti-KSHV antibody, KSHV-neutralizing antibody (nAb), cytokine/chemokine levels, and T-cell differentiation subsets were quantified before and after KS treatment in 13 participants with KS and in 13 KSHV-infected asymptomatic control individuals. One-way analysis of variance and the Mann-Whitney t-test were used to assess differences between groups where p-values < 0.05 were considered significant. Subjects with patch and plaque KS lesions responded more favorably to treatment than those with nodular lesions. Pre-treatment and post-treatment levels of plasma KSHV-DNA, HIV-1 viral load, KSHV-Ab responses, cytokines, and T-cell populations did not predict the KS treatment response. Elevated KSHV-humoral and cytokine responses persisted in participants with KS despite a clinical KS response. While patch and plaque KS lesions were more common among treatment responders, none of the analyzed viral and immunological parameters distinguished responders from non-responders at baseline or after treatment.
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15
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Poizot-Martin I, Obry-Roguet V, Duvivier C, Lions C, Huleux T, Jacomet C, Ferry T, Cheret A, Allavena C, Bani-Sadr F, Palich R, Cabié A, Fresard A, Pugliese P, Delobel P, Lamaury I, Hustache-Mathieu L, Brégigeon S, Makinson A, Rey D. Kaposi sarcoma among people living with HIV in the French DAT'AIDS cohort between 2010 and 2015. J Eur Acad Dermatol Venereol 2020; 34:1065-1073. [PMID: 31953902 PMCID: PMC7318618 DOI: 10.1111/jdv.16204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023]
Abstract
Background Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV‐infected people. Objective To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage. Methods Retrospective study using longitudinal data from 44 642 patients in the French Dat’AIDS multicenter cohort. Patients’ characteristics were described at KS diagnosis according to ART exposure and to HIV‐plasma viral load (HIV‐pVL) (≤50 or >50) copies/mL. Results Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART‐experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV‐pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted‐PI‐based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis. Limitations Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected. Conclusion Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV‐pVL ≤50 cp/mL remain to be explored.
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Affiliation(s)
- I Poizot-Martin
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - V Obry-Roguet
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - C Duvivier
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, APHP-Hôpital Necker-Enfants Malades, Paris, France.,IHU Imagine, Paris, France.,Institut Cochin - CNRS 8104 - INSERM U1016 - RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France.,Centre Médical de l'Institut Pasteur, Institut Pasteur, Paris, France
| | - C Lions
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - T Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur - Centre Hospitalier G. DRON, Tourcoing, France
| | - C Jacomet
- Centre Hospitalier Universitaire de Clermont-Ferrand, Département des Maladies Infectieuses et Tropicales, Clermont Ferrand, France
| | - T Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - A Cheret
- Sorbonne Paris Cité, EA7327, Université Paris Descartes, Paris, France.,Service de Médecine Interne - Immunologie Clinique - Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - C Allavena
- Service des Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, Nantes, France
| | - F Bani-Sadr
- Département de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hêpital Robert Debré, Centre Hospitalier Universitaire, Reims, France
| | - R Palich
- Service des Maladies Infectieuses et Tropicales, GHPS Pitié Salpêtrière APHP, Paris, France.,UMR 1136, Sorbonne Universités UPMC Université Paris 6-INSERM-IPLESP, Paris, France
| | - A Cabié
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, France.,EA 4537 Maladies Infectieuses et Tropicales dans la Caraï be, Université des Antilles, Pointe-à-Pitre, France.,INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier Andrée Rosemon, Cayenne, France
| | - A Fresard
- Centre Hospitalier Universitaire de Saint-Étienne, Département des Maladies Infectieuses et Tropicales, Saint-Etienne, France
| | - P Pugliese
- CHU de Nice, Universite Côte d'Azur, Nice, France
| | - P Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales-INSERM, UMR1043-Université Toulouse III Paul Sabatier, Toulouse, France
| | - I Lamaury
- Département d'Infectiologie, Dermatologie et Immunologie Clinique, Pointe-à-Pitre Cedex, France
| | - L Hustache-Mathieu
- Service des Maladies Infectieuses et Tropicales, CHRU de Besançon - Hôpital Jean Minjoz, Besançon, France
| | - S Brégigeon
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - A Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, Montpellier, France
| | - D Rey
- Le Trait d'Union, Centre de Soins de l'infection par le VIH, Hôpitaux Universitaires, Strasbourg, France
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