1. Kaposi disease in HIV-infected patients
Oral Presentation – Wednesday 25th July 2018
Session: Keep your eyes on Ois and STIs
Abstract number: WEAB0105
Kaposi disease in HIV-infected patients
with suppressed HIV viremia: the experience of the French national multidisciplinary committee ONCOVIH
R. Palich*, M. Veyri, M.-A. Valantin, A.-G. Marcelin, F.Boué, A. Guihot, C. Solas,
H. Ait-Mohand, V. Martinez, I. Poizot-Martin, D. Costagliola, J.-P. Spano, C. Katlama,
for the CancerVIH study group
* Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
Logos INSERM et SORBONNE UNIVERSITE

2. Changing epidemiology on highly active antiretroviral therapy
Introduction
Kaposi disease (KD)
Incidence of KD in HIV-positive patients over time1
Changing epidemiology
on highly active antiretroviral therapy
Decrease in the incidence of KD since (PI/r, triple therapies)1
Numéroter les références
Référence RR = 35
« comparativement aux personnes HIV-negative »
Despite immunological and virological control on ART, high risk of developing KD for HIV-positive patients2
Incident and recurrent KD in HIV-controlled patients
1. Shils, Curr Opin HIV AIDS, Yanik, JCO, 2016

3. The French committee ONCOVIH
Introduction
The French committee ONCOVIH
+ DOM-TOM
+ Switzerland
Experts’ discussion about cases of cancers occurring in HIV-infected patients
Every 15 days, by teleconference
Specific form completed by clinicians of the different French centers
Goal: to provide advices for diagnosis, therapeutic approaches and prevention of drug-drug interactions
« fiches remplies par les cliniciens des centres français » et « téléconférence »
From May 2014 to December 2017
530 records (427 patients)
90 centers

4. The French committee ONCOVIH
Introduction
The French committee ONCOVIH
Lung
Kaposi
NHL
Anus
ENT
Breast
Bladder
Rectum
Pancreas
Liver
Hodgkin
Indeterminate
Esophagus
Skin
Colon
Distribution of cancers referred to the ONCOVIH committee from May 2014 to December 2017
« fiches remplies par les cliniciens des centres français » et « téléconférence »
From May 2014 to December 2017
530 records (427 patients)
90 centers

5. Objective, definition of cases
Objective: to describe the clinical, biological and therapeutic characteristics of virally-suppressed HIV-infected patients with Kaposi disease
Current episode of KD
Patients with
suppressed viremia
First episode: patients who had never had Kaposi lesions in their history
Recurrent episode: new lesions of Kaposi in patients with previous KD in their history
HIV plasma viral load
<50 cp/ml at time of KD diagnosis (current episode)
and
On ART for at least 12 months

6. Methodology ONCOVIH forms: Back to the centers:
Observational study from ONCOVIH committee data, from May 2014 to November 2017
ONCOVIH forms:
Data on patients (demographic and clinical information, virological and therapeutic history)
Data on KD (first episode or recurrent disease, localisations, previous treatments)
Back to the centers:
To complete missing information
To update patients’ evolution

7. N = 72 patients with Kaposi disease
Results
Repartition of KD cases
N = 72 patients with Kaposi disease
Patients with
suppressed viremia
Patients with
unsuppressed viremia
N = 12
missing data
N = 21
N = 39
pVL <50 cp/ml
and on ART >12 months
pVL >50 cp/ml
or on ART <12 months
13 centers
26 centers

8. Number of patients with available data
Results
Patients’ characteristics
Number of patients with available data
Male
81%
N=17/21
Origin: metropolitan France
45%
N=9/20
DOM-TOM 5%
N=1/20
Africa
50%
N=10/20
Age (years)
54 (35-61)
N=21
Time from HIV diagnosis (years)
14 (6-22)
Time of virological suppression (years)
3 (2-5)
N=17
CD4 nadir (/mm3)
196 (84-329)
N=19
ART regimen: 2 NRTI + NNRTI
32%
N=6/19
2 NRTI + PI/r
21%
N=4/19
2 NRTI + INSTI
47%
N=9/19
CD4 at time of KD diagnosis (/mm3)
449 ( )
CD4/CD8 ratio at time of KD diagnosis
0,58 (0,33-0,65)
N=12

9. Patients’ characteristics
Results
Patients’ characteristics
Number of patients with available data
Male
81%
N=17/21
Origin: metropolitan France
43%
N=9/21
DOM-TOM 5%
N=1/21
Africa
48%
N=10/21
Age (years)
54 (35-61)
N=21
Time from HIV diagnosis (years)
14 (6-22)
Time of virological suppression (months)
36 (24-60)
N=17
CD4 nadir (/mm3)
196 (84-329)
N=19
ART regimen: 2 NRTI + NNRTI
32%
N=6/19
2 NRTI + PI/r
21%
N=4/19
2 NRTI + INSTI
47%
N=9/19
CD4 at time of KD diagnosis (/mm3)
449 ( )
CD4/CD8 ration at time of KD diagnosis
0,58 (0,33-0,65)
N=12
Distribution of CD4 count at time of KD diagnosis
Patients’ characteristics
Median CD4 count according to the KD status
First episode: 375 ( )
Recurrent episode: 478 ( )

10. Status of Kaposi disease
Results
Kaposi diseases’ characteristics
Status of Kaposi disease
Localisations
27%
lymph nodes (N=6/21)
100%
skin
(N=21/21)
40%
first episodes
(N=8/20)
18%
bones
(N=4/21)
18%
bronchi
(N=4/21)
60%
recurrent episodes
(N=12/20) 5%
mucous
(N=1/21)
14%
esophagus, stomach
(N=3/21)

11. 53% 47% Kaposi diseases’ characteristics not yet treated
Results
Kaposi diseases’ characteristics
Previous treatments for the current episode of KD (at time of case presentation to ONCOVIH committee)
53%
not yet treated
(N=10/19)
47%
Previously treated
(N=9/19)
Anthracyclines (78%)
Taxanes (33%)
2 patients had received other treatments (bleomycin, IFN-α)

12. ONCOVIH committee proposals (N=21)
Results
Therapeutic management
ONCOVIH committee proposals (N=21)
Kaposi disease
ART
14 treatment initiations
Antracycline (7)
Taxane (4)
Other (3): bleomycine, etoposide, lenalidomide
Radiotherapy (1)
3 treatment continuations
2 therapeutic abstentions
2 awaiting further examinations
17 treatment continuations
With monitoring of renal function in one case
4 treatment modifications
Drug-drug interaction (3)
Resistance for ongoing treatment (1)

13. Evolution of Kaposi disease
Results
Follow-up
Evolution of Kaposi disease
at time of analysis* (N=16)
87%
N=13/15
Regression
Progress
Stabilization
N=6
N=4
ONCOVIH committee proposals (N=21)
Kaposi disease
ART
* Median time from cases presentation to ONCOVIH committee from analysis: 25 months (14-34)
14 initiations of treatment
Antracycline (7)
Taxane (4)
Other (3): bleomycine, etoposide, lenalidomide
Radiotherapy (1)
3 continuations of treatment
2 therapeutic abstentions
2 awaiting further examinations
17 continuations of treatment
With monitoring of renal function in one case
4 modifications of treatment
87%
N=13/15
88%
N=14/16
16 back to the medical records from associated centers
Drug-drug interaction (3)
Resistance for ongoing treatment (1)

14. Conclusion Highlighting Kaposi disease in HIV-infected individuals
with sustained virological suppression
Controlled immunological and virological situation
More than 10 years of HIV infection evolution
3 years of virological suppression
CD4 at 450/mm3
Therapeutic concerns
Majority of patients referred due to recurrent KD
Many patients previously treated for KD
Patients progressing despite ongoing treatments
Toxicity of conventional chemotherapies: therapeutic dead-end

15. Discussion Limitations Perspectives Retrospective cohort
Missing data
ONCOVIH specific form not suitable for clinical research
Small number of cases
Selection bias (most problematic cases)
Perspectives
CancerVIH working group to federate a large number of centers in France
Constitution of a prospective cohort
Low CD4/CD8 ratio as a risk factor of developing KD in virally-suppressed patients1
Alteration of HHV-8-specific immunity in HIV-positive patients developing KD2
This immunity should be explored in HIV-controlled patients
Evaluation of alternative therapeutic strategies as immunotherapies (anti-PD-1)
1. Caby, Abs. TUPEC 265, AIDS 2018, Amsterdam Guihot, JID, 2006

16. Aknowledgment CancerVIH Study Group Associated Centers
Isabelle Poizot-Martin
Jean-Philippe Spano
François Boué
Christine Katlama
Anne-Geneviève Marcelin
Dominique Costagliola
Caroline Solas
Marc-Antoine Valantin
Sylvain Choquet
Rodolphe Garrafo
Amélie Guihot
Brigitte Autran
Armelle Lavolé
Jacques Cadranel
Project leader: Marianne Veyri
T. Lecompte
D. Makhloufi
V. Martinez
C. Merle de Boever
A. Montoya-Ferrer
J. Pacanowski
S. Patrat-Delon
S. Pavel
M.-C. Thiebaut-Drobacheff
M.-O. Vareil
D. Vittecoq
Associated Centers
T. Allègre
K. Belhouari
N. Bernard
S. Bouchez
R. Calin
A. Canestri
P. Chiarello
L. Cotte
C. Flateau
H. Hitoto
B. Hoen
N. Landgraf

17. Number of patients with available data
Results
HIV-replicative patients
Number of patients with available data
Age (years)
44 (35-49)
N=39
Time from HIV infection diagnosis (years)
4 (3-6)
CD4 nadir (/mm3)
93 (34-173)
N=35
CD4 at time of KD diagnosis (/mm3)
170 (51-367)
KD concomittant of HIV infection diagnosis
64%
N=23/36
KD occuring during an ART discontinuation
36%
N=13/36
Patients’ characteristics