CLINICAL AND BIOLOGICAL IMPACT OF ANTIRETROVIRAL THERAPY WITH PROTEASE INHIBITORS ON HIV-RELATED KAPOSIS-SARCOMA

Objective: To evaluate the clinical and biological impact of protease inhibitors on HIV-associated Kaposi's sarcoma. Design and setting: A c ohort of 10 patients included prospectively from April 1996 to June 19 97 were studied in one institutional centre after initiation of protea se inhibitors. Patients and methods: All patients but one (stable dise ase) had progressive Kaposi's sarcoma. Three out of 10 patients had st opped specific chemotherapy for Kaposi's sarcoma for more than 4 weeks , three were still under chemotherapy, and four had never received spe cific treatment of Kaposi's sarcoma. Plasma HIV viral load, human herp esvirus (HHV)-8 viraemia in peripheral blood mononuclear cells (PBMC), and CD4 cell count were sequentially assessed from the beginning of t herapy. For six patients, a semiquantitative evaluation of HHV-8 viral load in the Kaposi's sarcoma lesions was performed during treatment u sing polymerase chain reaction. Results: After initiation of HIV tripl e therapy with protease inhibitors, we observed six complete responses , two partial responses, and two patients with progressive disease. Al l patients had undetectable plasma HIV viral load within 2 months of t reatment. Undetectable HHV-8 viraemia in PBMC occurred in seven out of eight patients with partial or complete response and in none of the p rogressive patients. A decrease or negation of HHV-8 viral load in Kap osi's sarcoma lesions was observed in two complete responders. Conclus ion: Our results suggest that antiviral therapy with protease inhibito rs are clinically efficient in HIV-associated Kaposi's sarcoma and tha t there exists a correlation between clinical response and negation of HHV-8 viraemia. (C) 1998 Lippincott-Raven Publishers.