• Effect of HAART on Survival with Kaposi's Sarcoma and Non-Hodgkin's Lymphoma (Poster 589)
  Authored by H. Tam, Z. Zhang, L. P. Jacobson, J. B. Margolick, L. Kingsley, J. Chmiel, and R. Detels for the Multicenter AIDS Cohort Study
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Many clinicians have observed the decreasing rate of opportunistic infections and cancers that have occurred in HIV-infected patients treated with highly active antiretroviral therapy (HAART). This study confirms the many anecdotal reports and studies that have been presented over the past four years, including several studies presented at this conference documenting the significant decline in mortality and morbidity of HIV-infected patients treated with HAART.

This study evaluated the effect of HAART on the survival of 387 HIV-positive men in the Multicenter AIDS Cohort Study (MACS) who had been diagnosed as having either Kaposi's Sarcoma (KS) (287 cases) or Non-Hodgkin's Lymphoma (NHL) (100 cases). It found that HAART led to an 81% reduction in the risk of death from KS and an 83% reduction in the risk of death from NHL. This reduction in risk occurred whether HAART was started before or after the KS or NHL diagnosis was made.

This is encouraging data and shows that HAART therapy can even help to control opportunistic cancers such as KS and NHL. It is still unclear, however, why this is so. There are several theories including:

1. overall immune restoration with improved surveillance and control;

2. a specific immune response to HHV-8, the virus implicated as a cause of KS and some lymphomas;

3. a decrease in HIV leading to a decrease in overall inflammation and the hyperproliferative state associated with NHL; and

4. a direct effect of antiretrovirals on either HHV-8 or EBV, another virus implicated in the development of NHL in HIV-infected patients.

The implication of this study, and other studies like it, is that HAART can control many cancers associated with HIV. Therefore, neither patients nor physicians should lose hope so long as HAART-induced immune recovery or some other mechanism associated with HAART is a possibility for controlling these tumors.