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Regression of Kaposi's sarcoma during therapy with HIV-1 protease inhibitors: a prospective pilot study
J Krischer1, O Rutschmann, B Hirschel
1Department of Dermatology, University Hospital Geneva, Switzerland.
Background:
Early studies using HIV protease inhibitors (PI) showed regression of Kaposi's sarcoma (KS) lesions in some patients.
Objective:
Our purpose was to determine prospectively the influence of PI on HIV-related KS.
Methods:
KS lesions of nine patients with progressive cutaneous disease were prospectively evaluated clinically and by means of epiluminescence microscopy before and during PI therapy. HIV viremia and CD4 cell count were measured in parallel.
Results:
All patients experienced reduction or initial stabilization of KS lesions during the first 4 to 8 weeks of HIV-1 PI therapy. After a median follow-up of 7 months and according to AIDS Clinical Trials Groups criteria, six patients had a partial response, two showed stable disease, and in one noncompliant patient KS progressed, requiring chemotherapy. With epiluminescence microscopy, a reduction in skin surface alterations, lesional size, and color intensity was demonstrated in six of nine patients. PI induced a median decrease in viremia of 1.66 log and a median increase in the CD4 count of 49 cells/mm3.
Conclusion:
In this series, HIV PI therapy reduced or stabilized KS. The efficacy of HIV-1 PI in KS may result from the improvement in cellular immunity. These results suggest the use of PI in AIDS-related KS regardless of the level of CD4 lymphocyte count and HIV viremia.
Insights
HIV protease inhibitors (PI) therapy effectively reduced or stabilized Kaposi's sarcoma (KS) lesions in patients. This suggests PI is a viable treatment for HIV-related KS, improving immune function.
Area of Science:
- Immunology
- Oncology
- Virology
Background:
- Early research indicated HIV protease inhibitors (PI) could regress Kaposi's sarcoma (KS) lesions.
- HIV-associated KS remains a significant concern in patients with compromised immune systems.
Purpose of the Study:
- To prospectively assess the impact of PI therapy on HIV-related KS.
- To evaluate clinical and microscopic changes in KS lesions during PI treatment.
Main Methods:
- Prospective evaluation of KS lesions in nine patients with progressive cutaneous disease.
- Clinical assessment and epiluminescence microscopy before and during PI therapy.
- Parallel monitoring of HIV viremia and CD4 cell counts.
Main Results:
- All patients showed KS lesion reduction or stabilization within 4-8 weeks of PI therapy.
- Six patients achieved partial response, two had stable disease; one progressed.
- Epiluminescence microscopy revealed reduced lesion size and color intensity in six patients.
- PI therapy led to a median 1.66 log decrease in viremia and a 49 cells/mm³ increase in CD4 count.
Conclusions:
- HIV PI therapy demonstrated efficacy in reducing or stabilizing KS.
- Improved cellular immunity likely contributes to PI's effectiveness against KS.
- PI therapy is recommended for AIDS-related KS irrespective of CD4 count or viremia levels.