Effect of highly active antiretroviral therapy on survival in patients with AIDS-associated pulmonary Kaposi's sarcoma treated with chemotherapy

Purpose: Kaposi's sarcoma (KS) is the most common AIDS-related malignancy. Pulmonary involvement by KS (PKS) has carried a poor prognosis with median reported survival ranging from 3 to 10 months. We studied whether the intro duction of highly active antiretroviral therapy (HAART; triple antiretrovir al therapy including a protease inhibitor and two reverse transcriptase inh ibitors) has been associated with improved survival for AIDS patients with PKS. Patients and Methods: A retrospective study was performed of 37 consecutive patients with PKS and human immunodeficiency virus infection in the tumor registry at a large municipal hospital in New York City between 1994 to 199 7. There were 16 patients from 1994 to 1995 (pre-HAART period) and 21 patie nts from 1996 to 1997 (post-HAART period). The primary end point was surviv al, which was defined as time from start of chemotherapy until death from a ny cause. Results. Patients were analyzed by the date of diagnosis (pre- v post-HAART period) and whether or not they received HAART. Kaplan-Meier analysis show ed significantly better survival in patients diagnosed in the post-HAART pe riod (P = .0025). Additional Kaplan-Meier analysis indicated that patients on HAART had substantially better survival (P < .0001). Cox multivariate an alyses showed that HAART therapy was associated with a reduced risk of deat h (hazard ratio = 0.09; 95% confidence interval, 0.03 to 0.69). Conclusion: In patients with AIDS-associated PKS and undergoing chemotherap y, administration of HAART was associated with increased survival. J Clin O ncol 19:3848-3857. (C) 2001 by American Society of Clinical Oncology.