Highly active anti-retroviral therapy (HAART) prolongs time to treatment failure in Kaposi's sarcoma

Objective: To evaluate the impact of highly active antiretroviral therapy ( HAART) on Kaposi's sarcoma. Design: Retrospective study of patients who had received systemic or local treatment for AIDS-related Kaposi's sarcoma who subsequently commenced HAAR T. Methods: Case note review to determine time to treatment failure for Kaposi 's sarcoma before and after starting HAART. Time to treatment failure was c alculated from the end of last therapy to the start of the next new treatme nt for Kaposi's sarcoma. Results: The cohort contained 78 patients. Only 38% had good risk Kaposi's sarcoma (stage T010) at presentation. The median time to treatment failure before starting HAART was 0.5 years. Initial HAART therapy was three or mor e drugs including a protease inhibitor for 38 (49%), three or more drugs wi thout a protease inhibitor for 27 (35%) and a two-drug protease combination for 13 (16%). The median follow-up after starting HAART was 12 months (ran ge, 0.5-52 months) and anti-Kaposi's sarcoma treatment has been required fo r 24 (31%) patients. The median time to treatment failure for Kaposi's sarc oma from the start of HAART is 1.7 years. This is statistically longer than the time to treatment failure for the same cohort of patients before they started HAART (log rank chi(2) = 16.5, P < 0.0001). The serum HIV RNA viral load (VL) at the time of Kaposi's sarcoma progression revealed virological failure of HAART (defined as VL > 5000 copies/ml) in 14 of 24 (58%) and go od control (VL < 200 copies/ml) in five of 24 (21%). Conclusion: HAART is associated with prolonged time to treatment failure in Kaposi's sarcoma. Progression of Kaposi's sarcoma while on HAART is not ne cessarily associated with virological failure as determined by rising viral RNA titre.