Regression of AIDS-related Kaposi's sarcoma following antiretroviral therapy with protease inhibitors: Biological correlates of clinical outcome

The clinical response of AIDS-related Kaposi's sarcoma (KS) to highly activ e antiretroviral therapy (HAART), a combination of human immunodeficiency v irus type 1 (HIV-1) protease and reverse transcriptase inhibitors, was stud ied in 11 patients, all but one with progressive KS. CD4 + cell counts, pla sma HIV-1 RNA levels, and antibody titres to lytic ORF65 and latency-associ ated human herpes virus type 8 (HHV-8) proteins were determined in sequenti al samples. Six complete and three partial clinical responses were achieved in a median time of 6 and 3 months, respectively, and confirmed after a me dian time of 16 months on HAART. 2 patients showed disease progression. A c onsistent decrease in HIV-1 RNA levels, paralleled by an increase in CD4 cell counts, was observed in all patients who showed complete or partial cl inical response; HIV-1 RNA levels remained persistently high in the two pat ients who progressed, despite a change in HAART. HHV-8 antibody titres were generally higher in patients with mucosal/visceral involvement compared wi th patients with limited disease; a decrease in ORF65 antibody titre was si gnificantly associated with a clinical response. These results indicate tha t HAART is effective for AIDS-related KS; the clinical response correlates with a decrease in plasma HIV-1 RNA levels, an increase in CD4 + lymphocyte s, and a decrease in antibodies to ORF65 HHV-8 protein. (C) 1999 Elsevier S cience Ltd. All rights reserved.