Background: Kaposi disease (KD) is among the most frequent HIV associated cancers, classically occurring in HIV-replicating individuals. Since 2014, the ONCOVIH national multidisciplinary committee (MDC) registers cancers in HIV infected patients. We report our experience of KD occurring in patients despite sustained virological suppression.
Methods: This observational and national study enrolled all cases of individuals with a first episode or a relapse of KD, on ART for at least 12 months, with a plasma viral load (pVL) < 50cp/ml at the time of KD diagnosis.
Results: The French ONCOVIH MDC registered a total of 72 KD cases between 05/2014 and 11/2017. We included for analysis the 22/ 72 (31%) who fulfilled inclusion criteria, whereas 38/72 (53%) had pVL >50 cp/ml at the time of KD diagnostic, and 12 had missing data. They were 18 male and 4 female, born in France for 10 of them and in Africa for 12, with a median age of 51 years (IQR 34-61). HIV infection was diagnosed 12 years earlier (IQR 5-14). CD4 nadir was 200/mm3 (IQR 73-290), and median duration of virological suppression 4 years (IQR 2-5). KD was a relapse in 59% of cases, and a first episode in 41%. KD localisations involved skin (100% of cases), lymph nodes (27%), bronchi (18%), oesophagus/stomach (14%), bone (14%), and/or palate (5%). Median CD4 count was 478/mm3 (IQR 269-630) with a CD4/CD8 ratio of 0.58 (IQR 0.34-0.75). At time of MDC, KD therapy had included anthracyclines in 36% of cases and/or taxanes in 27% of cases. In November 2017, from the follow up of 16/22 patients, all were alive, with a KD in partial remission in 31% of cases, stability in 38% and progression in 31%.
Conclusions: Kaposi disease is observed in aging patients with suppressed viremia either as relapse or new case. HHV-8 as main cause for KD need to be further investigated. Follow up should bring information towards treatment response. Anti PD1 may deserve a pilot investigation in patients failing standard anti-KD chemotherapies.