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Mudança do Curso Clínico do Sarcoma de Kaposi em Pacientes com HIV, 1994-2003

11/08/2004


 

A introdução de terapia antiretroviral altamente ativa (HAART) tem mudado radicalmente o curso clínico da infecção pelo vírus da imunodeficiência humana (HIV). Em um artigo publicado recentemente na Cancer,  os autores avaliaram a mudança da incidência de sarcoma de Kaposi (SK) entre pacientes europeus com HIV desde a introdução da HAART e identificaram os fatores associados ao desenvolvimento do SK entre pacientes que recebem a  HAART.

 

A incidência de SK e os fatores associados ao desenvolvimento desta malignidade em pacientes com a HAART foram avaliados através da regressão de Poisson. Os pacientes avaliados neste estudo estavam entre os 9803 indivíduos com HIV que foram selecionados para o estudo EuroSIDA, uma investigação multicêntrica  Européia. Houve uma redução anual estimada de 39% (95% de intervalo de confiança [IC], 35-43%; P < 0.0001) na incidência de SK entre 1994 e 2003. A proporção de diagnósticos da síndrome da imunodeficiência adquirida (AIDS) foi feita devido ao SK durante um seguimento prospectivo que variou de 4.1% a 7.5% e não houve mudança significativa neste número ao longo do tempo (P = 0.97).

 

Quatro mil e quatorze pacientes receberam a HAART durante o seguimento prospectivo; 41 destes 4014 foram subseqüentemente diagnosticados com SK (1.0%). Após o ajuste nas análises multivariadas, os pacientes com maiores contagens de CD4 apresentavam incidência diminuída de SK (razão da taxa de incidência [RTI], 0.60; 95% IC, 0.53-0.68; P < 0.0001), como também ocorreu com aqueles com maior tempo decorrido desde o início da HAART (TI, 0.77; 95% IC, 0.60-0.98; P = 0.037). Por outro lado, os homossexuais masculinos apresentaram um aumento significante na incidência de SK (RTI, 2.12; 95% IC, 1.00-4.54; P = 0.050).

 

Os autores concluíram que a incidência atual de SK entre os pacientes com HIV é menos de 10% da incidência relatada em 1994; a proporção de diagnósticos de AIDS feitos com base nos diagnósticos de SK permanece próxima de 6%. A maioria dos indivíduos que desenvolveram SK enquanto recebiam HAART  começaram o tratamento com baixas contagens de células CD4 e desenvolveram SK dentro de seis meses de início da HAART. Continua havendo um aumento da incidência de SK entre os homossexuais masculinos e tem reduzido grandemente a incidência de SK entre pacientes com contagens mais elevadas de CD4.

The changing pattern of Kaposi sarcoma in patients with HIV, 1994-2003 - Cancer - 2004; Volume 100, Issue 12:2644 - 2654

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Cancer

Volume 100, Issue 12 , Pages 2644 - 2654

Published Online: 10 May 2004

Copyright © 2004 American Cancer Society

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 Original Article
The changing pattern of Kaposi sarcoma in patients with HIV, 1994-2003§||

The EuroSIDA study
Amanda Mocroft, B.Sc., M.Sc., Ph.D. 1 2 *, Ole Kirk, M.D. 3, Nathan Clumeck, M.D. 4, Panaglotis Gargalianos-Kakolyris, M.D. 5, Hanna Trocha, M.D. 6, Nelly Chentsova, M.D., Ph.D. 7, Francisco Antunes, M.D. 8, Hans-Jürgen Stellbrink, M.D. 9, Andrew N. Phillips, M.D., Ph.D. 1 2, Jens D. Lundgren, M.D. 3
1Royal Free Centre for HIV Medicine, Royal Free and University College Medical School, London, United Kingdom
2Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom
3EuroSIDA Coordinating Centre, Copenhagen HIV Programme, Hvidovre Hospital, Copenhagen, Denmark
4Department of Infectious Diseaes, Saint-Pierre Hospital, Brussels, Belgium
5First Department of Medicine, General Hospital of Athens, Athens, Greece
6Department of Infectious Diseases, Medical University of Gdansk, Gdansk, Poland
7Kiev Centre for AIDS, Kiev, Ukraine
8Department of Infectious Diseases, Hospital Santa Maria, Lisbon, Portugal
9Eppendorf Medizinische Kernklinik, Hamburg, Germany
email: Amanda Mocroft (a.mocroft@pcps.ucl.ac.uk)

*Correspondence to Amanda Mocroft, Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College London Medical Schools, Royal Free Campus, Rowland Hill St., London, NW3 2PF, United Kingdom

Performed on behalf of the EuroSIDA Study Group.
The following were members of the EuroSIDA multicenter study group (asterisks denote national coordinators): Argentina: M. Losso* and A. Duran (Hospital Jose Maria Ramos Mejia, Buenos Aires); Austria: N. Vetter* (Pulmologisches Zentrum der Stadt Wien, Vienna); Belgium: N. Clumeck*, S. De Wit, K. Kabeya, and B. Poll (Saint-Pierre Hospital, Brussels); and R. Colebunders (Institute of Tropical Medicine, Antwerp); Czech Republic: L. Machala* and H. Rozsypal (Faculty Hospital Bulovka, Prague); Denmark: J. Nielsen*, J. Lundgren, O. Kirk, and C.H. Olsen (Hvidovre Hospital, Copenhagen); J. Gerstoft, T. Katzenstein, A.-B.E. Hansen, and P. Skinhøj (Rigshospitalet, Copenhagen); and C. Pedersen (Odense University Hospital, Odense); Estonia: K. Zilmer* and M. Rauka (Tallinn Merimetsa Hospital, Tallinn); France: C. Katlama* and M. De Sa (Hôpital de la Pitié-Salpétière, Paris); J.-P. Viard (Hôpital Necker-Enfants Malades, Paris); T. Saint-Marc (Hôpital Edouard Herriot, Lyon); P. Vanhems (University Claude Bernard, Lyon); and C. Pradier (Hôpital de l'Archet, Nice); Germany: M. Dietrich* and C. Manegold (Bernhard-Nocht Institute for Tropical Medicine, Hamburg); J. van Lunzen and H.-J. Stellbrink (Eppendorf Medizinische Kernklinik, Hamburg); V. Miller and S. Staszewski (J.W. Goethe University Hospital, Frankfurt); F.-D. Goebel (Medizinische Poliklinik, Munich); G. Fätkenheuer (Universität Köln, Cologne); J. Rockstroh (Universitäts-Klinik Bonn, Bonn); and R.E. Schmidt and M. Stoll (Medizinisch Hochschule, Hannover); Greece: J. Kosmidis*, P. Gargalianos, H. Sambatakou, and J. Perdios (Athens General Hospital, Athens); and G. Panos and A. Filandras (First IKA Hospital, Athens); Hungary: D. Banhegyi* (Szent László Hospital, Budapest); Ireland: F. Mulcahy* (St. James's Hospital, Dublin); Israel: I. Yust* and M. Burke (Ichilov Hospital, Tel Aviv); S. Pollack and J. Hassoun (Rambam Medical Center, Haifa); Z. Sthoeger (Kaplan Hospital, Rehovot); and S. Maayan (Hadassah University Hospital, Jerusalem); Italy: S. Vella* and A. Chiesi* (Istituto Superiore di Sanità, Rome); C. Arici (Ospedale Riuniti, Bergamo); R. Pristerá (Ospedale Generale Regionale, Bolzano); F. Mazzotta and A. Gabbuti (Ospedale Santa Maria Annunziata, Florence); R. Esposito and A. Bedini (Università di Modena, Modena); A. Chirianni and E. Montesarchio (Presidio Ospedaliero A.D. Cotugno, Naples); V. Vullo and P. Santopadre (Università di Roma La Sapienza, Rome); P. Narciso, A. Antinori, P. Franci, and M. Zaccarelli (Ospedale Spallanzani, Rome); A. Lazzarin and A. Castagna (Università Vita e Salute, IRCCS, Ospedale San Raffaele, Milan); and A. D'Arminio Monforte (Ospedale Luigi Sacco, Milan); Latvia: L. Viksna* and B. Rozentale (Infectology Centre of Latvia, Riga); 2Lithuania: S. Chaplinskas* (Lithuanian AIDS Centre, Vilnius); Luxembourg: R. Hemmer* and T. Staub (Centre Hospitalier, Luxembourg); The Netherlands: P. Reiss* (Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam); Norway: J. Bruun*, A. Maeland, and V. Ormaasen (Ullevål Hospital, Oslo); Poland: B. Knysz* and J. Gasiorowski (Medical University of Wroclaw, Wroclaw); A. Horban (Centrum Diagnostyki i Terapii AIDS, Warsaw); D. Prokopowicz and A. Wiercinska-Drapalo (Medical University of Bialystok, Bialystok); A. Boron-Kaczmarska and M. Pynka (Medical University of Szczecin, Szczecin); M. Beniowski (Osrodek Diagnostyki i Terapii AIDS, Chorzow); and H. Trocha and T. Smiatacz (Medical University of Gdansk, Gdansk); Portugal: F. Antunes* (Hospital Santa Maria, Lisbon); K. Mansinho (Hospital de Egas Moniz, Lisbon); and F. Maltez (Hospital Curry Cabral, Lisbon); Romania: D. Duiculescu* (Spitalul de Boli Infectioase si Tropicale Dr. Victor Babes, Bucharest); and A. Streinu-Cercel (Institute of Infectious Diseases, Bucharest); Slovakia: M. Mokrá* (Infectious Diseases Hospital, Bratislava); and D. Staneková (Institute of Preventive and Clinical Medicine, Bratislava); Spain: J. González-Lahoz*, B. Diaz, T. García-Benayas, L. Martin-Carbonero, and V. Soriano (Hospital Carlos III, Madrid); B. Clotet, A. Jou, J. Conejero, and C. Tural (Hospital Germans Trias i Pujol, Badalona); and J.M. Gatell, J.M. Miró, and L. Zamora (Hospital Clinic Universitari, Barcelona); Sweden: A. Blaxhult* (Karolinska Hospital, Stockholm); A. Karlsson (Södersjukhuset, Stockholm); and P. Pehrson (Huddinge Sjukhus, Stockholm); Switzerland: B. Ledergerber* and R. Weber (University Hospital, Zurich); P. Francioli (Centre Hospitalier Universitaire Vaudois, Lausanne); B. Hirschel and V. Schiffer (Hospital Cantonal Universitaire de Geneve, Geneva); and H. Furrer (Inselspital Bern, Bern); Ukraine: N. Chentsova* (Kiev Centre for AIDS, Kiev); United Kingdom: S. Barton* (St. Stephen's Clinic, Chelsea and Westminster Hospital, London); A.M. Johnson and D. Mercey (Royal Free and University College Medical School [University College Campus], London); M. Youle, A. Phillips, M.A. Johnson, and A. Mocroft (Royal Free and University College Medical School [Royal Free Campus], London); M. Murphy (Medical College of Saint Bartholomew's Hospital, London); J. Weber and G. Scullard (Imperial College School of Medicine at St. Mary's, London); M. Fisher (Royal Sussex County Hospital, Brighton); and R. Brettle (Western General Hospital, Edinburgh).
§Members of the EuroSIDA Virology Group included Clive Loveday (central coordinator) and Bonaventura Clotet (central coordinator), as well as ad hoc virologists from participating institutions.
The following were members of the EuroSIDA Steering Committee: Francisco Antunes, Anders Blaxhult, Nathan Clumeck, Jose Gatell, Andrzej Horban, Anne Johnson, Christine Katlama, Bruno Ledergerber (chair), Clive Loveday, Andrew Phillips, Peter Reiss, and Stefano Vella.
||The following were members of the coordinating center staff: J. Lundgren (project leader), I. Gjørup, O. Kirk, N. Friis-Moeller, A. Mocroft, A. Cozzi-Lepri, W. Bannister, D. Mollerup, M. Nielsen, A. Hansen, D. Kristensen, L. Hansen, and J. Kjær.
Fax: (011) 44 0 2077941224

Funded by:
 The European Commission BIOMED 1; Grant Number: CT94-1637
 BIOMED 2; Grant Number: CT97-2713
 European Union Fifth Framework Programme; Grant Number: QLK2-2000-00773
 Bristol-Myers Squibb
 GlaxoSmithKline
 Roche
 Boehringer-Ingelheim
 Swiss Federal Office for Education and Science

Abstract

BACKGROUND
The introduction of highly active antiretroviral therapy (HAART) has radically changed the clinical course of human immunodeficiency virus (HIV) infection. The goals of the current study were to assess the change in the incidence of Kaposi sarcoma (KS) among European patients with HIV since the introduction of HAART and to identify the factors associated with the development of KS among patients receiving HAART.

METHODS
The incidence of KS and the factors associated with the development of this malignancy in patients receiving HAART were evaluated using Poisson regression. Patients examined in the current study were among the 9803 individuals with HIV who were enrolled in the EuroSIDA study, a pan-European multicenter investigation.

RESULTS
There was an estimated annual reduction of 39% (95% confidence interval [CI], 35-43%; P < 0.0001) in the incidence of KS between 1994 and 2003. The proportion of acquired immunodeficiency syndrome (AIDS) diagnoses made due to KS during prospective follow-up ranged from 4.1% to 7.5%, and there was no significant change over time in this figure (P = 0.97). Four thousand fourteen patients began receiving HAART during prospective follow-up; 41 of these 4014 were subsequently diagnosed with KS (1.0%). After adjustment in multivariate analyses, patients with higher current CD4 counts were found to have a decreased incidence of KS (incidence rate ratio [IRR], 0.60; 95% CI, 0.53-0.68; P < 0.0001), as were those for whom more time had elapsed since the initiation of HAART (IRR, 0.77; 95% CI, 0.60-0.98; P = 0.037). In contrast, homosexual men were found to have a significantly increased incidence of KS (IRR, 2.12; 95% CI, 1.00-4.54; P = 0.050)

CONCLUSIONS
The current incidence of KS among patients with HIV is less than 10% of the incidence reported in 1994; the proportion of AIDS diagnoses made on the basis of KS diagnoses remains near 6%. Most individuals who developed KS while receiving HAART began treatment with low CD4 cell counts and developed KS within 6 months of the initiation of HAART. There continues to be an increased incidence of KS among homosexual men and a greatly reduced incidence of KS among patients with higher CD4 counts. Cancer 2004. © 2004 American Cancer Society.


Received: 4 March 2004; Revised: 26 March 2004; Accepted: 26 March 2004

Digital Object Identifier (DOI)

10.1002/cncr.20309  About DOI

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