Kaposi's sarcoma in patients with human immunodeficiency virus infection in Taiwan.

BACKGROUND AND PURPOSE Kaposi's sarcoma (KS) continues to occur in patients with human immunodeficiency virus (HIV) infection in the era of highly active antiretroviral therapy (HAART), and remains the most common HIV-associated malignancy. This retrospective study was conducted to describe the change in incidence and characteristics of HIV-associated KS in Taiwan. METHODS The medical records of patients with HIV infection who received a diagnosis of KS at the National Taiwan University Hospital between June 1994 and March 2008 were reviewed. RESULTS During the 14-year study period, 62 HIV-infected patients were diagnosed with KS, which included 40 definite diagnoses (64.5%) by pathology and 22 probable diagnoses (35.5%) ascertained by characteristic lesions, compatible clinical manifestations, and response to treatment. Most of the patients were men who have sex with men (MSM; n = 53; 85.5%). At the time of diagnosis of KS, the median CD4 count was 20 cells/microL (range, 1-371 cells/microL). A considerable decline in the incidence of KS in HIV-infected patients since the introduction of HAART was demonstrated; in the pre-HAART era, 18 of 175 patients (10.3%; 95% confidence interval [CI], 6.53- 15.75) developed KS, compared with 44 of 1615 patients in the HAART era (2.7%; 95% CI, 2.03-3.65) [p < 0.0001]. The prognosis of HIV-infected patients with KS has improved since the introduction of HAART, as the mortality rate has declined from 77.8% in the pre-HAART era to 34.1% in the HAART era (p = 0.002). CONCLUSIONS The incidence of KS in HIV-infected patients and the mortality rate of these patients significantly declined in the HAART era, although KS continued to occur in patients with advanced HIV infection.