Early Progression and Immune Reconstitution Inflammatory Syndrome During Treatment of Mild-To-Moderate Kaposi Sarcoma in Sub-Saharan Africa and South America: Incidence, Long-Term Outcomes, and Effects of Early Chemotherapy

作者：Mulinda Nyirenda, McNeil Ngongondo, Minhee Kang, Triin Umbleja, Susan E. Krown, Catherine Godfrey, Wadzanai Samaneka, Rosie Mngqibisa, Brenda Hoagland, Noluthando Mwelase, Stephanie Caruso, Oto Martinez-Maza, Dirk P. Dittmer, Margaret Borok, Mina C. Hosseinipour, Thomas Campbell, for the A5264/AMC-067 team · 发表于：JAIDS Journal of Acquired Immune Deficiency Syndromes · 年份：2020 · DOI：10.1097/qai.0000000000002361 · 被引用次数：15 · 研究领域：Viral-associated cancers and disorders、CNS Lymphoma Diagnosis and Treatment、Infectious Diseases and Tuberculosis

BACKGROUND: Early progression of AIDS-associated Kaposi sarcoma (KS-PD) and immune reconstitution inflammatory syndrome (KS-IRIS) sometimes occur after the initiation of antiretroviral therapy (ART). METHODS: Early KS-PD and KS-IRIS were assessed in the A5264/AMC-067 trial in which participants with mild-to-moderate AIDS-KS were randomized to initiate ART with either immediate or as-needed oral etoposide. Early KS-PD was defined as tumor progression within 12 weeks of ART initiation. When investigators had concern that early KS-PD was KS-IRIS, additional evaluations were performed. Suspected KS-IRIS was defined as early KS-PD accompanied by a CD4 count increase of ≥50 cells per cubic millimeter or plasma HIV-1 RNA decrease of ≥0.5 log10 copies/mL. Clinical outcome was a composite end point categorized as failure, stable, and response at 48 and 96 weeks compared with baseline. RESULTS: Fifty of 190 participants had early KS-PD (27%): 28 had KS-IRIS and 22 were not evaluated for KS-IRIS. Early KS-PD and KS-IRIS incidences with immediate etoposide versus ART alone were 16% versus 39%, and 7% versus 21%, respectively. Week 48 clinical outcome was 45% failure, 18% stable, and 37% response for no early KS-PD; 82% failure, 2% stable, and 16% response for early KS-PD; and 88% failure, 0% stable, and 12% response for KS-IRIS. Cumulative incidence of KS tumor response by week 96 was 64% for no early KS-PD, 22% with early KS-PD, and 18% with KS-IRIS. CONCLUSIONS: Early KS-PD, including ...