Profile of patients with Kaposi's sarcoma in the era of highly active antiretroviral therapy

Purpose Since the advent of highly active antiretroviral therapy (HAART), the incidence of Kaposi's sarcoma (KS) among AIDS patients has declined both nationwide and in King County, Washington. We sought to compare clinical parameters of patients diagnosed with KS in the pre-HAART (1990 to 1996) and HAART (1997 to 2002) eras. Methods We used patient data abstracted from the Adult/Adolescent Spectrum of HIV-Related Diseases study of Public Health-Seattle and King County. Results Patients diagnosed with KS in the HAART era (n = 40) were significantly more likely (P<.05) than pre-HAART-era KS patients (n = 366) to be diagnosed with alcohol problems (43% v 18%), noninjection drug use (45% v 18%), injection drug use (25% v 10%), psychosis (25% v 13%), and hypertension (13% v 2%). Although median CD4(+) count and HIV-1 viral load at the time of KS diagnosis were not significantly different between the two groups, significantly fewer (P <.01) HAART-era KS patients developed opportunistic illnesses (Ols) during their follow-up. The risk of dying among KS patients diagnosed in the HAART era is significantly lower (P <.01) than for KS patients diagnosed in the pre-HAART era (hazard ratio, 0.24). Conclusion Although HAART-era KS patients in King County were as likely to have a depleted CD4(+) cell count and high HIV-1 viral loads at the time of KS diagnosis as pre-HAART KS patients, they survived longer and fewer of them were diagnosed with other Ols. They also had an increased prevalence of substance abuse and mental illness, contributing to a dynamic and changing KS clinical profile.