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Boosted PIs lower Kaposi sarcoma incidence
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Recent data suggest longer duration of treatment with protease inhibitors boosted with Norvir was associated with a reduced incidence of Kaposi sarcoma among veterans with HIV after at least 1 year of treatment.
Marc A. Kowalkowski, PhD, of the Levine Cancer Institute in Charlotte, North Carolina, and colleagues studied the effect of specific combination antiretroviral therapy (cART) regimens on Kaposi sarcoma incidence among 25,529 male veterans with HIV enrolled in the Department of Veterans Affairs HIV Clinical Case Registry. The veterans, aged 18 years and older, had known CD4 cell counts and HIV measurements and a confirmed HIV diagnosis date based on ICD-9 codes or prescription delivery of cART. Four classes of cART regimens were defined:
- protease inhibitors (PIs) boosted with Norvir (ritonavir, AbbVie);
- nonboosted PIs (other than Viracept [nelfinavir, Agouron]);
- Viracept;
- and nonnucleoside reverse transcriptase inhibitors (NNRTIs).
There were 341 cases of Kaposi sarcoma documented in the study population, with an incidence rate of 2.02/1,000 person-years. When the population was stratified by years after starting cART, each additional 10% time on boosted PIs was correlated with decreased Kaposi sarcoma incidence in the third year of cART drug use (incidence rate ratio [IRR] = 0.79; 95% CI, 0.69-0.9).
An association was identified between the number of months on boosted PIs and lower incidence of Kaposi sarcoma (P = .02). The researchers observed a lower incidence of Kaposi sarcoma at 12 to 23 months (IRR = 0.47; 95% CI, 0.23-0.95) and 36 months or more (IRR = 0.14; 95% CI, 0.02–1) on boosted PIs vs. less than 6 months. No association was seen between lower Kaposi sarcoma incidence and longer treatment duration with the other regimens.
“After accounting for potential immune reconstitution inflammatory syndrome effects, we found that longer duration on boosted PIs reduces [Kaposi sarcoma] incidence after at least 1 year on treatment,” the researchers wrote. “Our results provide preliminary clinical evidence that supports previous experimental findings of anti-[Kaposi sarcoma] activity of some PIs.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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