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Review
. 2022 Feb 16;14(4):986.
doi: 10.3390/cancers14040986.

Immune Reconstitution Inflammatory Syndrome Associated Kaposi Sarcoma

Isabelle Poizot-Martin  1 , Sylvie Brégigeon  2 , Romain Palich  3 , Anne-Geneviève Marcelin  4 , Marc-Antoine Valantin  3 , Caroline Solas  5 , Marianne Veyri  6 , Jean-Philippe Spano  6 , Alain Makinson  7
Affiliations
Review

Immune Reconstitution Inflammatory Syndrome Associated Kaposi Sarcoma

Isabelle Poizot-Martin et al. Cancers (Basel). .

Abstract

People living with HIV (PLWH) with advanced immunosuppression who initiate antiretroviral therapy (ART) are susceptible to the occurrence of an immune reconstitution inflammatory syndrome (IRIS). Although ART is responsible for AIDS- associated Kaposi sarcoma (KS) improvement and resolution, new onset (unmasking KS-IRIS) or sudden progression of preexisting KS (paradoxical KS-IRIS) can occur after a time delay of between a few days and 6 months after the initiation or resumption of ART, even in patients with a low degree of immunocompromise. KS-IRIS incidence varies from 2.4% to 39%, depending on study design, populations, and geographic regions. Risk factors for developing KS-IRIS include advanced KS tumor stage (T1), pre-treatment HIV viral load >5 log10 copies/mL, detectable pre-treatment plasma-KSHV, and initiation of ART alone without concurrent chemotherapy. Both paradoxical and unmasking KS-IRIS have been associated with significant morbidity and mortality, and thrombocytopenia (<100,000 platelets/mm3 at 12 weeks) has been associated with death. KS-IRIS is not to be considered as ART failure, and an ART regimen must be pursued. Systemic chemotherapy for KS in conjunction with ART is recommended and, in contrast with management of IRIS for other opportunistic infections, glucocorticoids are contra-indicated. Despite our preliminary results, the place of targeted therapies in the prevention or treatment of KS-IRIS needs further assessment.

Keywords: AIDS; HIV; IRIS; Kaposi sarcoma; immune reconstitution inflammatory syndrome; target therapies.

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Conflict of interest statement

Isabelle Poizot-Martin: consultancies (Gilead Sciences, MSD), travel/accommodation/meeting expenses (Gilead sciences, ViiVhealthcare), outside the submitted work. Sylvie Brégigeon: congress grants (ViiV, Healthcare), consultancies (ViiV Healthcare, Gilead, Janssen, MSD), outside the submitted work. Romain Palich has declared no conflict of interest with the submitted work. Anne-Geneviève Marcelin: consultancies (Gilead Sciences, VIIV Healthcare, MSD, Theratechnologies), research grants (Gilead sciences, ViiV Healthcare, MSD), outside the submitted work. Marc-Antoine Valantin has declared no conflict of interest with the submitted work. Caroline Solas has declared no conflict of interest with the submitted work. Marianne Veyri has declared no conflict of interest with the submitted work. Jean-Philippe Spano has no direct conflict of interest but received an honorarium as a consultant for Roche, MSD and Biogaran and has received a speaker honorarium from MSD, Roche, AstraZeneca, Leopharma, Mylan, Pfizer, BMS, Novartis, PFO, Myriads, Gilead and Lilly. Alain Makinson: travel grants (MSD, Mylan; Donations (MSD), outside the submitted work. The other authors declare no conflict of interest.

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