Outcomes of Kaposi sarcoma in people living with HIV who maintain long-term viral suppression: A prospective case-series

Abstract

Background

Data on chemotherapeutic efficacy and tolerability for Kaposi Sarcomas (KS) in people living with HIV (PWH) and HIV-virological control are limited. We aimed to describe clinical responses and tolerability of KS therapies in PWH with HIV-aviraemic KS in a prospective cohort.

Methods

We analysed all PWH with active KS with an HIV plasma viral load <200 copies/mL for more than 12 months under combination antiretroviral therapy (cART), whose clinical conditions were presented between the 1st of June 2021 and the 2nd of January 2023 to a national French Cancer HIV network panel. Clinicians completed a standardized questionnaire to assess KS history and standardized treatment response.

Results

We included 18 PLHIV (94% male, median age 49 years). The median CD4 count was 614/mm3 and the median CD4/CD8 ratio was 0.8. Fifteen had already experienced relapses of KS. Median follow-up time was 30.1 months (IQR [24 to 34.2]). We observed seven well-controlled PWH with no KS relapse after a median follow-up of 16 months (IQR 9.5 to 22.5), eight well-controlled PWH who experienced KS relapse after a median of 6 months (IQR, 3–12) following chemotherapy, primarily limited to the skin, and two PWH with visceral KS relapse in a context of non-adherence. PWH who relapsed/progressed were older and had a longer duration of HIV virological control.

Conclusions

KS in PWH with virological control respond to chemotherapy, but are prone to relapses, primarily to the skin, and strategies can be limited by past and cumulative toxicities. Older age and longer duration of virological control may negatively impact the probability of KS response.