Implications for practice

Patients with early stage disease, CD4 counts >200 cells x 106/litre, no "B" symptoms and no previous opportunistic infections are most likely to respond to interferon alfa. Response rates are greater with higher doses of interferon, whether given alone or in combination with zidovudine. A disadvantage of interferon in the treatment of KS is the need for frequent subcutaneous injections. The development of pegylated interferon which requires less frequent administration may be an advantage.

We found no systematic reviews of chemotherapy in KS. The majority of the randomised evidence is in the treatment of advanced AIDS-related KS. We found three small randomised trials of chemotherapy in African KS. Several drugs have been found active as single agents in uncontrolled phase II studies, the most active of which include paclitaxel, liposomal anthracyclines, vinca alkaloids and bleomycin. Two commonly used combination cytotoxic regimens in the treatment of AIDS-related KS are bleomycin plus vincristine (BV), and doxorubicin, bleomycin and vincristine (ABV), which have been compared in randomised studies with single-agent chemotherapy, including newer drugs such as liposomal anthracyclines. We found no randomised placebo-controlled trials and all the trials compared two or more actives, apart from a small randomised crossover comparison of liposomal daunorubicin versus observation for early KS.

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