Background:  HAART therapy is efficient in HIV-associated Kaposi’s sarcoma (KS). The goal of the study is to determine prognostic factors of KS in HIV infected patients treated with HAART.

Methods:  Data of 138 HIV-infected patients presenting with KS (and multicentric Castleman’s disease in 5 cases) and treated with HAART (before or at the diagnosis of KS) were retrospectively analyzed. We considered 2 groups of KS evolution: remission (complete or partial) and progression (stabilization, progression or death). We compared, every 6 months, the following data in both groups: age, TIS classification, chemotherapy for KS, antiretroviral treatment, evolution of HIV (CD4 cell counts, HIV viral load). Data were analyzed using SPSS Software and we used chi-square test or Fisher exact test for statistical analysis.

Results:  Most patients were men (97.8%) and mean age was 45 years. More than 50% of patients were classified T0I1S1; 53% of patients were naive of HAART at the diagnostic of KS. We observed 51, 62, 70, and 76% of remission at month 6, 12, 18, and 24, respectively. At month 6, 12, 18, and 24, respectively, 54, 15, 5.5, and 4% of patients were receiving chemotherapy for KS. We observed no statistical difference between remission or progression group for age, CD4 cell counts assessed every 6 months, and HIV viral load at the diagnosis of KS. Patients with S1 stage and those naive of HAART had higher risk of progression at month 6 only (p<0.03).

During follow-up, partial or complete remission, at month 6, 24, 48 and 60 of HAART, appeared more frequently in patients with suppressed HIV viral load for at least 6 months (p <0.001) independently of CD4 cell counts. Castleman’s disease was associated with progression of KS at the end of the study (p <0.0001). We observed no difference in the progression of KS in patients receiving PI-based regimen when compared with those receiving NNRTI-based therapy during the follow-up.

Conclusions:  Patients naive of antiretroviral therapy and those with S1 stage at onset of KS diagnosis had an additional risk of progression of KS at month 6. Our results shown a relationship between remission of KS and suppression of HIV viral load under HAART. CD4 cell count does not provide prognostic information. Exposure to NNRTI-based regimen was found to have a similar effect to PI-based regimen in the prognosis of KS.

Keywords: Kaposi’s sarcoma; prognostic factors; HAART