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Advanced KS and HAART

Posted: Aug 30, 2006

QUESTION:

I have a patient that was diagnosed one year ago with HIV-PCP and CMV pneumoniitis as an AIDS defining illnesses. He also had Stage IV Kaposi's Sarcoma with extensive pulmonary involvement. His initial CD4 count was 23 and viral load was 750,000.

He has been on Kaletra and Epzicom for 48 weeks . His viral load has been undetectable for the past 6 months and his CD4 count has risen to 75.

He has received Doxil every 3 weeks for the past 5 months.

His CT scan after 5 months of Doxil still shows multiple 0.5 to 1.5 cm lesions consistent with KS that are too numerous to count but he has had slight improvement compared to baseline scan. He has undergone two bronchospies which confirmed the KS.

I am his family practice doctor. He has an experienced ID doctor and an oncologist who are pushing him to continue chemo indefinitedly.

The patient looks to me for advice and guidance.Since the chemo is making his miserable he is considering stopping the chemo.

Any words of wisdom? Is this the best response he can expect from both his HAART and for the KS? Will he need chemo the rest of his life?


  

RESPONSE FROM:   

    Thanks for your post.

    I'm not sure I have any sage words of widsom, but here goes.

    Your patient was very seriously ill at time of presentation; I'd agree with the choices in medications and the need for systemic chemotherapy, given his extensive visceral KS.

    The fact that his pulmonary lesions have improved radiographically is quite reassuring, though the timeline to resolution is quite individual. Clearly, improving his CD4 count will accelerate the rate of improvement; his levels are still in a range where I'm not sure he's yet benefiting (from a KS standpoint), but hopefully this trend will also continue. To your question, I'd doubt that he'd need chemo for life; indeed, with CD4s over 200, most patients don't require additional treatment (other than HAART) for their KS.

    With radiographic improvement, it might be possible to entertain a monitored break from the Doxil. It might be worth trying this, if for no other reason than to nurture your doctor-patient relationship and to give him a time to recharge his emotional and side effect batteries.

    So, I hope this is helpful. Keep us informed on your patient's progress.

    Best of luck. BY




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