Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma
Identifieur interne : 000709 ( Main/Exploration ); précédent : 000708; suivant : 000710Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma
Auteurs : Patricia Volkow [Mexique] ; Gabriela Cesarman-Maus [Mexique] ; Pamela Garciadiego-Fossas [Mexique] ; Enrique Rojas-Marin [Mexique] ; Patricia Cornejo-Juárez [Mexique]Source :
- AIDS Research and Therapy [ 1742-6405 ] ; 2017.
Abstract
To investigate the predictive factors for the development of Kaposi sarcoma-related immune reconstitution inflammatory syndrome (KS-IRIS) and long-term prognosis in patients starting combined antiretroviral therapy (cART).
We studied a retrospective-cohort of consecutive antiretroviral-naïve patients with KS initiating cART from January 2005 to December 2011 and followed through June 2013. KS-IRIS was defined as ≥2 of the following: abrupt increase in number of KS lesions, appearance or exacerbation of lung-opacities or lymphedema, concomitantly with an increase in CD4+ cell-count ≥50 cells/mm3 and a decrease of >1 log in viral-load once started cART. We compared individuals who met KS-IRIS criteria with those that did not and described the long-term follow-up.
We included 89 patients, 88 males; 35 (39%) developed KS-IRIS at a median of 10 weeks (IQR 4–16). KS-IRIS patients had more pulmonary-involvement (60% vs. 16.6% of patients;
Lung-involvement was predictive of IRIS development. Thrombocytopenia in KS-IRIS patients at week 12 follow-up after cART initiation was associated with high mortality. Over a third of patients with KS achieve remission without chemotherapy. Individuals that survive the initial period of KS-IRIS adhere to cART had a good long-term prognosis.
The online version of this article (doi:10.1186/s12981-017-0156-9) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12981-017-0156-9
PubMed: 28558783
PubMed Central: 5450046
Affiliations:
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San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Mexico City, Mexico</nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Mexico City</wicri:regionArea><wicri:noRegion>14080 Mexico City</wicri:noRegion></affiliation></author><author><name sortKey="Cesarman Maus, Gabriela" sort="Cesarman Maus, Gabriela" uniqKey="Cesarman Maus G" first="Gabriela" last="Cesarman-Maus">Gabriela Cesarman-Maus</name><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1777 1207</institution-id><institution-id institution-id-type="GRID">grid.419167.c</institution-id><institution>Hematology Department,</institution><institution>Instituto Nacional de Cancerología (INCan),</institution></institution-wrap>Mexico City, Mexico</nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Mexico City</wicri:regionArea></affiliation></author><author><name sortKey="Garciadiego Fossas, Pamela" sort="Garciadiego Fossas, Pamela" uniqKey="Garciadiego Fossas P" first="Pamela" last="Garciadiego-Fossas">Pamela Garciadiego-Fossas</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1777 1207</institution-id><institution-id institution-id-type="GRID">grid.419167.c</institution-id><institution>Infectious Diseases Department,</institution><institution>Instituto Nacional de Cancerología (INCan),</institution></institution-wrap>Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Mexico City, Mexico</nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Mexico City</wicri:regionArea><wicri:noRegion>14080 Mexico City</wicri:noRegion></affiliation></author><author><name sortKey="Rojas Marin, Enrique" sort="Rojas Marin, Enrique" uniqKey="Rojas Marin E" first="Enrique" last="Rojas-Marin">Enrique Rojas-Marin</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1777 1207</institution-id><institution-id institution-id-type="GRID">grid.419167.c</institution-id><institution>Radiology Department,</institution><institution>Instituto Nacional de Cancerología (INCan),</institution></institution-wrap>Mexico City, Mexico</nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Mexico City</wicri:regionArea></affiliation></author><author><name sortKey="Cornejo Juarez, Patricia" sort="Cornejo Juarez, Patricia" uniqKey="Cornejo Juarez P" first="Patricia" last="Cornejo-Juárez">Patricia Cornejo-Juárez</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1777 1207</institution-id><institution-id institution-id-type="GRID">grid.419167.c</institution-id><institution>Infectious Diseases Department,</institution><institution>Instituto Nacional de Cancerología (INCan),</institution></institution-wrap>Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Mexico City, Mexico</nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Mexico City</wicri:regionArea><wicri:noRegion>14080 Mexico City</wicri:noRegion></affiliation></author></analytic><series><title level="j">AIDS Research and Therapy</title><idno type="eISSN">1742-6405</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To investigate the predictive factors for the development of Kaposi sarcoma-related immune reconstitution inflammatory syndrome (KS-IRIS) and long-term prognosis in patients starting combined antiretroviral therapy (cART).</p></sec><sec><title>Methods</title><p>We studied a retrospective-cohort of consecutive antiretroviral-naïve patients with KS initiating cART from January 2005 to December 2011 and followed through June 2013. KS-IRIS was defined as ≥2 of the following: abrupt increase in number of KS lesions, appearance or exacerbation of lung-opacities or lymphedema, concomitantly with an increase in CD4+ cell-count ≥50 cells/mm<sup>3</sup> and a decrease of >1 log in viral-load once started cART. We compared individuals who met KS-IRIS criteria with those that did not and described the long-term follow-up.</p></sec><sec><title>Results</title><p>We included 89 patients, 88 males; 35 (39%) developed KS-IRIS at a median of 10 weeks (IQR 4–16). KS-IRIS patients had more pulmonary-involvement (60% vs. 16.6% of patients; <italic>p</italic> < 0.0001), eight died attributed to pulmonary-KS. Thrombocytopenia <100,000/mm<sup>3</sup> at follow-up occurred in 36% of KS-IRIS vs. 4% in non-KS-IRIS patients (<italic>p</italic> = 0.0002), 45% KS-IRIS patients with thrombocytopenia died, non without KS-IRIS. Chemotherapy (bleomicyn–vincristine) was more frequently prescribed in KS-IRIS patients (88.6% vs. 29.6%) with no differences in outcome; 80% of all patients achieve KS complete remission, 52% of them never received chemotherapy. No difference between groups in the long-term follow-up (mean 52.4 ± 27.4 months) was found, only one patient developed a secondary malignancy (1.12%).</p></sec><sec><title>Conclusions</title><p>Lung-involvement was predictive of IRIS development. Thrombocytopenia in KS-IRIS patients at week 12 follow-up after cART initiation was associated with high mortality. Over a third of patients with KS achieve remission without chemotherapy. Individuals that survive the initial period of KS-IRIS adhere to cART had a good long-term prognosis.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12981-017-0156-9) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Nakamura, S" uniqKey="Nakamura S">S Nakamura</name></author><author><name sortKey="Salahuddin, Sz" uniqKey="Salahuddin S">SZ Salahuddin</name></author><author><name sortKey="Biberfeld, P" uniqKey="Biberfeld P">P Biberfeld</name></author><author><name sortKey="Ensoli, B" uniqKey="Ensoli B">B Ensoli</name></author><author><name sortKey="Markham, Pd" uniqKey="Markham P">PD Markham</name></author><author><name sortKey="Wong Staal, F" uniqKey="Wong Staal F">F Wong-Staal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ensoli, B" uniqKey="Ensoli 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Weng</name></author><author><name sortKey="Graham, Nm" uniqKey="Graham N">NM Graham</name></author><author><name sortKey="Phair, Jp" uniqKey="Phair J">JP Phair</name></author><author><name sortKey="Detels, R" uniqKey="Detels R">R Detels</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Mexique</li></country></list><tree><country name="Mexique"><noRegion><name sortKey="Volkow, Patricia" sort="Volkow, Patricia" uniqKey="Volkow P" first="Patricia" last="Volkow">Patricia Volkow</name></noRegion><name sortKey="Cesarman Maus, Gabriela" sort="Cesarman Maus, Gabriela" uniqKey="Cesarman Maus G" first="Gabriela" last="Cesarman-Maus">Gabriela Cesarman-Maus</name><name sortKey="Cornejo Juarez, Patricia" sort="Cornejo Juarez, Patricia" uniqKey="Cornejo Juarez P" first="Patricia" last="Cornejo-Juárez">Patricia Cornejo-Juárez</name><name sortKey="Garciadiego Fossas, Pamela" sort="Garciadiego Fossas, Pamela" uniqKey="Garciadiego Fossas P" first="Pamela" last="Garciadiego-Fossas">Pamela Garciadiego-Fossas</name><name sortKey="Rojas Marin, Enrique" sort="Rojas Marin, Enrique" uniqKey="Rojas Marin E" first="Enrique" last="Rojas-Marin">Enrique Rojas-Marin</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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