Effect of highly active antiretroviral therapy on survival among HIV‐infected men with Kaposi sarcoma or non‐Hodgkin lymphoma

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Abstract
The effect of highly active antiretroviral therapy (HAART) on survival in HIV‐infected patients with Kaposi sarcoma (KS) or non‐Hodgkin lymphoma (NHL) is unknown. Our study examines survival after HAART for these 2 malignancies. Analyses were performed using data from 387 HIV‐infected men in the Multicenter AIDS Cohort Study (MACS) after a diagnosis of either KS or NHL in 1990–99. Potential prognostic factors, including HAART, were evaluated in univariate analyses using Kaplan‐Meier survival curves and log‐rank tests. Multivariate survival analyses were conducted using Cox's time‐dependent proportional hazards models, adjusting for CD4+cell levels at the time of cancer diagnosis and other covariates. Forty‐three of 287 KS patients (15%) and 13 of 100 NHL patients (13%) had been treated with HAART. HAART treatment was associated with improved survival for KS and NHL patients (log‐rankp= 0.0001 for each group). In multivariate analyses, HAART was associated with an 81% reduced risk of death among KS patients [relative hazard (RH) 0.19, 95% confidence limits (CL) (0.08, 0.45)], compared to those not exposed to HAART and an 84% reduced risk [RH 0.16, 95% CL (0.04, 0.64)] among NHL patients. Relative hazards estimates were similar for those with HAART initiation before and after NHL diagnosis. The use of HAART prolongs overall survival among HIV‐positive men diagnosed with KS and NHL. HAART appears to be effective in improving survival even when initiated after the diagnosis of NHL and KS.