| Author | Nyirenda, Mulinda | |
| Author | Ngongondo, McNeil | |
| Author | Kang, Minhee | |
| Author | Umbleja, Triin | |
| Author | Krown, Susan E. | |
| Author | Godfrey, Catherine | |
| Author | Samaneka, Wadzanai | |
| Author | Mngqibisa, Rosie | |
| Author | Hoagland, Brenda | |
| Author | Mwelase, Noluthando | |
| Author | Caruso, Stephanie | |
| Author | Martinez-Maza, Oto | |
| Author | Dittmer, Dirk P. | |
| Author | Borok, Margaret | |
| Author | Hosseinipour, Mina C. | |
| Author | Campbell, Thomas B. | |
| Access date | 2020-09-22T20:45:32Z | |
| Available date | 2020-09-22T20:45:32Z | |
| Document date | 2020 | |
| Citation | NYIRENDA, Mulinda et al. Early Progression and Immune Reconstitution Inflammatory Syndrome During Treatment of Mild-To-Moderate Kaposi Sarcoma in Sub-Saharan Africa and South America: Incidence, Long-Term Outcomes, and Effects of Early Chemotherapy. Journal of acquired immune deficiency syndromes, v. 84, n. 4, p. 422-429, Aug. 2020. | pt_BR |
| ISSN | 0894-9255 | pt_BR |
| URI | https://www.arca.fiocruz.br/handle/icict/43559 | |
| Description | A5264/AMC-067 team | |
| Language | eng | pt_BR |
| Publisher | Lippincott, Williams & Wilkins | pt_BR |
| Rights | open access | pt_BR |
| Title | Early Progression and Immune Reconstitution Inflammatory Syndrome During Treatment of Mild-To-Moderate Kaposi Sarcoma in Sub-Saharan Africa and South America: Incidence, Long-Term Outcomes, and Effects of Early Chemotherapy | pt_BR |
| Type | Article | pt_BR |
| DOI | 10.1097/QAI.0000000000002361 | |
| Abstract | Background: Early progression of AIDS-associated Kaposi sarcoma (KS-PD) and immune reconstitution inflammatory syndrome (KS-IRIS) sometimes occur after the initiation of antiretroviral therapy (ART). Methods: Early KS-PD and KS-IRIS were assessed in the A5264/AMC-067 trial in which participants with mild-to-moderate AIDS-KS were randomized to initiate ART with either immediate or as-needed oral etoposide. Early KS-PD was defined as tumor progression within 12 weeks of ART initiation. When investigators had concern that early KS-PD was KS-IRIS, additional evaluations were performed. Suspected KS-IRIS was defined as early KS-PD accompanied by a CD4 count increase of ≥50 cells per cubic millimeter or plasma HIV-1 RNA decrease of ≥0.5 log10 copies/mL. Clinical outcome was a composite end point categorized as failure, stable, and response at 48 and 96 weeks compared with baseline. Results: Fifty of 190 participants had early KS-PD (27%): 28 had KS-IRIS and 22 were not evaluated for KS-IRIS. Early KS-PD and KS-IRIS incidences with immediate etoposide versus ART alone were 16% versus 39%, and 7% versus 21%, respectively. Week 48 clinical outcome was 45% failure, 18% stable, and 37% response for no early KS-PD; 82% failure, 2% stable, and 16% response for early KS-PD; and 88% failure, 0% stable, and 12% response for KS-IRIS. Cumulative incidence of KS tumor response by week 96 was 64% for no early KS-PD, 22% with early KS-PD, and 18% with KS-IRIS. Conclusions: Early KS-PD, including suspected KS-IRIS, was common after starting ART for AIDS-KS and was associated with worse long-term clinical outcomes. Starting ART concurrently with etoposide reduced the incidence of both early KS-PD and KS-IRIS compared with ART alone. | pt_BR |
| Affilliation | University of Malawi. College of Medicine. Johns Hopkins Project. Blantyre, Malawi. | pt_BR |
| Affilliation | UNC Project Malawi. Lilongwe, Malawi. | pt_BR |
| Affilliation | Harvard T.H. Chan School of Public Health. Center for Biostatistics in AIDS Research. Boston, MA, USA. | pt_BR |
| Affilliation | Harvard T.H. Chan School of Public Health. Center for Biostatistics in AIDS Research. Boston, MA, USA. | pt_BR |
| Affilliation | AIDS Malignancy Consortium. New York, NY, USA. | pt_BR |
| Affilliation | National Institutes of Health. National Institute of Allergy and Infectious Diseases. Division of AIDS. Bethesda, MD, USA. | pt_BR |
| Affilliation | University of Zimbabwe College of Health Sciences. Department of Medicine. Harare, Zimbabwe. | pt_BR |
| Affilliation | Enhancing Care Foundation. Durban International Clinical Research Site. Durban, South Africa. | pt_BR |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
| Affilliation | University of Witwatersrand. Johannesburg, South Africa. | pt_BR |
| Affilliation | Frontier Science Foundation. New York, NY, USA. | pt_BR |
| Affilliation | University of California. David Geffen School of Medicine, Department of Obstetrics and Gynecology. Los Angeles, CA, USA. | pt_BR |
| Affilliation | University of North Carolina School of Medicine. Department of Microbiology & Immunology. Chapel Hill, NC, USA / Lineberger Comprehensive Cancer Center. Chapel Hill, NC, USA. | pt_BR |
| Affilliation | University of Zimbabwe College of Health Sciences. Department of Medicine. Harare, Zimbabwe. | pt_BR |
| Affilliation | UNC Project Malawi. Lilongwe, Malawi / University of North Carolina School of Medicine. Department of Microbiology & Immunology. Chapel Hill, NC, USA / Lineberger Comprehensive Cancer Center. Chapel Hill, NC, USA. | pt_BR |
| Affilliation | University of Colorado School of Medicine. Department of Medicine. Division of Infectious Diseases. Aurora, CO, USA. | pt_BR |
| Subject | HIV | pt_BR |
| Subject | Kaposi sarcoma | pt_BR |
| Subject | Immune reconstitution inflammatory syndrome | pt_BR |
| Subject | Antiretroviral therapy | pt_BR |
| Subject | Low-resource settings | pt_BR |
