A prospective study of clinical outcomes of HIV-associated and HIV-negative Kaposi sarcoma in Uganda.
A prospective study of clinical outcomes of HIV-associated and HIV-negative Kaposi sarcoma in Uganda.
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DOI：
10.1097/qad.0000000000003376
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发表时间：
2023-01-01
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进一步了解HIV感染对卡波西肉瘤（KS）表现和结局的影响将指导更有效的KS分期和治疗方法的发展。我们在乌干达招募了流行性（HIV阳性; HIV+KS）和地方性（HIV阴性; HIV−KS）KS患者的前瞻性队列，以确定与生存和反应相关的因素。对2012年10月至2019年12月期间在乌干达坎帕拉的乌干达癌症研究所（UCI）接受治疗的新诊断KS成人进行了评估。参与者按照标准指南接受化疗，并随访1年以上，以评估总生存期（OS）和治疗反应。200名参与者入组; 166名（83%）患有HIV+KS，176名（88%）为低风险肿瘤（T1）分期。1年OS为64%（95%置信区间[CI] 57-71%），HIV+KS的死亡风险几乎高出3倍（风险比[HR] = 2.93; P = 0.023）。 在HIV+KS患者中，胸部X线检查异常（HR = 2.81; P = 0.007）、CD 4 + T细胞计数降低（HR = 0.68/100 cells/μl; P = 0.027）、HIV病毒载量升高（HR = 2.22/log 10 copies/ml; P = 0.026）和血浆卡波西肉瘤相关疱疹病毒（KSHV）拷贝数升高（HR = 1.79/log 10 copies/ml; P = 0.028）与死亡率增加相关。 在HIV-KS中，与死亡相关的因素包括Karnofsky评分<70（HR = 9.17; P = 0.045），胸部X线异常（HR = 8.41; P = 0.025）和较高的血浆KSHV拷贝数（HR = 6.21/log 10拷贝/ml; P <0.001）。 尽管HIV-KS的存活率高于HIV+KS，但两组的高死亡率强调了迫切需要确定新的分期和治疗方法。与死亡率相关的因素，包括高血浆KSHV，可能是治疗的重要靶点。
Improved understanding of the effect of HIV infection on Kaposi sarcoma (KS) presentation and outcomes will guide development of more effective KS staging and therapeutic approaches. We enrolled a prospective cohort of epidemic (HIV-positive; HIV+KS) and endemic (HIV-negative; HIV−KS) KS patients in Uganda to identify factors associated with survival and response. Adults with newly diagnosed KS presenting for care at the Uganda Cancer Institute (UCI) in Kampala, Uganda, between October 2012 and December 2019 were evaluated. Participants received chemotherapy per standard guidelines and were followed over 1 year to assess overall survival (OS) and treatment response. Two hundred participants were enrolled; 166 (83%) had HIV+KS, and 176 (88%) were poor-risk tumor (T1) stage. One-year OS was 64% (95% confidence interval [CI] 57–71%), with the hazard of death nearly threefold higher for HIV+KS (hazard ratio [HR] = 2.93; P = 0.023). Among HIV+KS, abnormal chest X-ray (HR = 2.81; P = 0.007), lower CD4+ T-cell count (HR = 0.68 per 100 cells/μl; P = 0.027), higher HIV viral load (HR = 2.22 per log10 copies/ml; P = 0.026), and higher plasma Kaposi sarcoma-associated herpesvirus (KSHV) copy number (HR = 1.79 per log10 copies/ml; P = 0.028) were associated with increased mortality. Among HIV−KS, factors associated with mortality included Karnofsky score <70 (HR = 9.17; P = 0.045), abnormal chest X-ray (HR = 8.41; P = 0.025), and higher plasma KSHV copy number (HR = 6.21 per log10 copies/ml; P < 0.001). Although survival rates were better for HIV−KS than HIV+KS, the high mortality rate seen in both groups underscores the urgent need to identify new staging and therapeutic approaches. Factors associated with mortality, including high plasma KSHV, may serve as important targets of therapy.