KAPOSIS-SARCOMA IN HIV-INFECTION - IMPACT ON OPPORTUNISTIC INFECTIONSAND SURVIVAL

Objective: To determine the effect of Kaposi's sarcoma on survival of HlV-infected patients. Methods: Retrospective cohort study to compare the survival of 241 HIV-infected homosexual patients with Kaposi's sar coma (cases) with that of 241 HIV-infected homosexual patients without Kaposi's sarcoma (control subjects) but with a similar level of immun osuppression (measured by the absolute CD4+ lymphocyte count). Results : Cases and control subjects were similar in age, occurrence of previo us opportunistic infections, and the use of antiretroviral therapy. Th e mean CD4+ lymphocyte counts were similar for cases and control subje cts (185 x 10(6) versus 184 x 10(6)/l, respectively). Cases had a high er incidence of opportunistic infections (5.95 versus 3.88 infections, respectively, per 100 person-months of observation) and a greater num ber of infections typical of late-stage HIV infection. Cases had a sho rter overall survival than did control subjects (P = 0.0025). Kaposi's sarcoma was associated with an increased risk of death (odds ratio, 1 .28), even when adjusting for age, previous opportunistic infection, b aseline CD4+ lymphocyte count, and antiretroviral therapy. Conclusion: Kaposi's sarcoma appears to accelerate the clinical course of HIV inf ection. Opportunistic infections develop earlier and more often in pat ients with the disease than in control subjects. Survival was signific antly shorter in patients with Kaposi's sarcoma. (C) Lippincott-Raven Publishers.