Michael Carter for Aidsmap (16 September 2010)
Over a third of cases of Kaposi’s sarcoma now occur in patients with a CD4 cell count above 350 cells/mm3, investigators from the US military report in the online edition of AIDS.
The study found that although rates of the AIDS-defining cancer have fallen since effective antiretroviral therapy became available, the proportion of cases that occur at higher CD4 cell counts has increased.
“Clinicians should be aware of these trends and watchful for the occurrence of Kaposi’s sarcoma despite robust CD4 cell counts”, comment the investigators.
Most cases of HIV-related Kaposi’s sarcoma occur when patients have a CD4 cell count below 200 cells/mm3. Although there is a large amount of evidence showing that rates of the cancer have decreased since effective antiretroviral therapy was introduced in the mid-1990s, it is not known whether Kaposi’s sarcoma will be seen at higher CD4 cell counts.
Therefore researchers from the US Military HIV Natural History Study reviewed the medical records of 5067 patients between 1985 and 2008.
“Our study demonstrates that although Kaposi’s sarcoma rates have declined during the HAART era and lower CD4 cell counts remain an important risk factor, a greater proportion of Kaposi’s sarcoma cases are now occurring at higher CD4 cell counts”, write the researchers.
Given these findings the investigators believe that it is important to see if starting HIV treatment at higher CD4 cell counts will reduce the risk of the cancer. “We found a suggestion of increased risk of Kaposi’s sarcoma among those not on HAART compared to those on HAART with CD4 cell counts of at least 350 cells/mm3”, they note.
Is Kaposi’s sarcoma occurring at higher CD4 cell counts over the course of the HIV epidemic?
Crum-Cianflone, Nancy F; Hullsiek, Katherine Huppler; Ganesan, Anuradha; Weintrob, Amy; Okulicz, Jason F; Agan, Brian K; the Infectious Disease Clinical Research Program HIV Working Group
AIDS, advance online publication, September 4, 2010. DOI: 10. 1097/QAD.0b013e32833f9fb8 .
Link to AIDS abstract