ORIGINAL RESEARCH Pulmonary Kaposi sarcoma in the era of highly active antiretroviral therapy C Palmieri, 1 T Dhillon, 1 C Thirlwell, 1 T Newsom-Davis, 1 A-M Young, 1 M Nelson, 2 BG Gazzard 2 and M Bower 1 1 Departments of Medical Oncology and 2 HIV, The Chelsea and Westminster Hospital, London, UK Objective Since the introduction of highly active antiretroviral therapy (HAART) there has been a dramatic reduction in the incidence of Kaposi sarcoma (KS) and an improvement in survival. We wished to examine whether the outcome in pulmonary KS (pKS) has also altered. Methods In a single-institution cohort of 1140 HIV-positive patients with KS, 305 patients were diagnosed in the HAART era (1996–2004). We examined the clinicopathological features and outcomes of these patients, of whom 25 had pKS and 280 did not. Results Patients with pKS had lower CD4 cell counts at the time of KS diagnosis (Mann–Whitney U-test P 5 0.005). The incidence of pKS was higher in African patients than in non-African patients in this sample (Fisher’s test, P 5 0.001). There were no significant differences in age, gender, plasma HIV-1 viral load or prior HAART treatment at the time of KS diagnosis. Five-year overall survival in the pKS group was 49% [95% confidence interval (CI) 26–73%] as compared with 82% (95% CI 76–87%) for the non-pKS group (log rank, Po0.0001). Conclusion PKS remains an ominous diagnosis in the era of HAART, with a median survival of just 1.6 years. Keywords: AIDS, HAART, HIV, pulmonary Kaposi sarcoma Received: 13 May 2005, accepted 18 October 2005 Introduction Kaposi sarcoma (KS) remains the most common tumour in HIV-1-infected individuals and is a significant cause of morbidity and mortality, particularly in sub-Saharan Africa [1]. In established market economies, highly active anti- retroviral therapy (HAART) has reduced the incidence of KS [2,3], prolongs the time to treatment failure [4] and may lead to KS resolution in those affected [5,6]. Moreover, we have previously demonstrated that HAART regimens based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) are as effective at protecting against KS as protease inhibitor (PI)-based regimens [7]. Pulmonary involvement in KS (pKS) has been demon- strated in as many as 6–32% of AIDS patients with cutaneous disease by fibreoptic bronchoscopy and in 47– 75% of these patients at post mortem [8]. Median survival following diagnosis of pKS in the pre-HAART era was 3–10 months [9–13]. We have previously reported the features of pKS in 106 patients from our cohort who presented between 1988 and 1994, and their median survival was 4 months (range 0–37 months) [14]. We wished to examine whether there remained clinico- pathological differences between patients with and without pKS diagnosed in the era of HAART and whether the overall survival for patients with pKS had improved. Methods The Chelsea and Westminster HIV cohort is one of the largest in Europe, and we prospectively collect data on these individuals. This study focused on HIV-infected patients who had been diagnosed with KS since the commencement of the HAART era, which we have defined Correspondence: Dr Mark Bower, Department of Medical Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Tel: 1 44 208237 5054; fax: 1 44 208746 8863; e-mail: m.bower@imperial.ac.uk r 2006 British HIV Association HIV Medicine (2006), 7, 291–293 291