***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Twenty-eight HIV patients either naive or failing highly active antiretroviral therapy (HAART)with moderate-advanced Kaposi 's sarcoma (KS)were r and omly chosen to initiate a new HAART regimen plus pegylated liposomal doxorubicin(PLD ) or the new HAART regimen alone . After 48 weeks , better response rates were observed in the HAART plus PLD group ( 76 % versus 20 % ) . In HIV-infected patients with moderate-advanced KS , HAART alone may not be enough for KS response Background : The optimal approach to HIV-associated Kaposi sarcoma ( HIV-KS ) in sub-Saharan Africa is unknown . With large-scale rollout of highly active antiretroviral therapy ( HAART ) in South Africa , we hypothesized that survival in HIV-KS would improve and administration of chemotherapy in addition to HAART would be feasible and improve KS-specific outcomes . Methods : We conducted a r and omized , controlled , open-label trial with intention-to-treat analysis . Treatment-naive patients from King Edward VIII Hospital , Durban , South Africa , a public-sector tertiary referral center , with HIV-KS , but no symptomatic visceral disease or fungating lesions requiring urgent chemotherapy , were r and omized to HAART alone or HAART and chemotherapy ( CXT ) . HAART arm received stavudine , lamivudine , and nevirapine ( Triomune ; CXT arm received Triomune plus bleomycin , doxorubicin , and vincristine every 3 weeks . When bleomycin , doxorubicin , and vincristine were not available , oral etoposide ( 50–100 mg for 1–21 days of a 28-day cycle ) was substituted . Primary outcome was overall KS response using AIDS Clinical Trial Group criteria 12 months after HAART initiation . Secondary comparisons included time to response , progression-free survival , overall survival , adverse events , HIV control , CD4 reconstitution , adherence , and quality of life . Results : Fifty-nine subjects were r and omized to HAART and 53 to CXT ; 12-month overall KS response was 39 % in the HAART arm and 66 % in the CXT arm ( difference , 27 % ; 95 % confidence interval , 9%–43 % ; P = 0.005 ) . At 12 months , 77 % were alive ( no survival difference between arms ; P = 0.49 ) , 82 % had HIV viral load < 50 copies per milliliter without difference between the arms ( P = 0.47 ) ; CD4 counts and quality -of-life measures improved in all patients . Conclusions : HAART with chemotherapy produced higher overall KS response over 12 months , whereas HAART alone provided similar improvement in survival and select measures of morbidity . In Africa , with high prevalence of HIV and human herpes virus-8 and limited re sources , HAART alone provides important benefit in patients with HIV-KS The long-term impact of highly active antiretroviral therapy ( HAART ) in AIDS patients with Kaposi 's sarcoma ( KS ) was evaluated in 22 consecutive , HAART-naïve KS patients attending a single Italian referral centre for HIV/AIDS . Clinical , virologic and immunologic responses to HAART were assessed at baseline and every three months during the follow-up . Peripheral blood mononuclear cell ( P BMC ) -associated human herpesvirus 8 ( HHV-8 ) load was also evaluated by real-time PCR in 13 patients with durable clinical KS complete response ( CR ) . In a median follow-up of 40 months ( range 17 - 78 ) , the KS overall clinical response rate was 91 % : 18 complete and 2 partial responses were achieved , and two patients experienced disease progression . CR persisted in all 18 patients , including the 5 poor-risk KS patients in whom CR lasted for > 60 months , and was significantly linked to an increase in CD4 + cell counts and a drop in HIV-1-RNA copies . Compared to baseline levels , a decrease in P BMC HHV-8 load was observed at CR , and a significant further reduction was found at the end of follow-up . In this monocentric study , AIDS-KS patients treated with HAART showed high clinical response rate . Patients with CR showed a prolonged remission , lasting more than 5 years in a group of poor-risk patients , and a persistent reduction in circulating HHV-8-infected cells . These findings highlight that HAART deeply modifies the natural history of this tumour in AIDS patients , and that this long-lasting approach may be considered a first-line treatment for the majority of HIV-1-infected patients developing KS STUDY OBJECTIVE To evaluate the toxicity , effects on immune function , antitumor effects , antiretroviral effects , and pharmacokinetics of zidovudine therapy in patients with early human immunodeficiency virus ( HIV ) infection and Kaposi sarcoma . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING National Institutes of Health , a referral-based research institution ( single site ) . PATIENTS Physician-referred volunteer patients with HIV infection , Kaposi sarcoma , CD4 + lymphocyte counts greater than 0.2 x 10(9)/L , and no systemic symptoms or history of opportunistic infection . Of 41 patients enrolled , 4 had not met all entry criteria and were therefore not evaluable . INTERVENTIONS Patients were r and omized to one of four treatment groups for an initial 12-week treatment period : oral placebo ( 9 patients ) ; zidovudine , 250 mg orally every 4 hours ( 9 patients ) ; zidovudine , 0.5 mg/kg body weight intravenously every 4 hours ( 9 patients ) ; and zidovudine , 2.5 mg/kg intravenously every 4 hours ( 10 patients ) . After at least 12 weeks of therapy at their assigned dose , patients were treated with oral zidovudine , generally 250 mg every 4 hours , with a mean 42-week follow-up . MEASUREMENTS AND MAIN RESULTS Anemia and granulocytopenia were the major toxicities . Significant increases in platelet counts and declines in serum HIV antigen and IgG and IgM levels occurred in treated patients . Treated patients were more likely than those on placebo to clear HIV from the cerebrospinal fluid . There were no differences in tumor progression or CD4 + or CD8 + lymphocyte counts among the groups . CONCLUSIONS Zidovudine was well tolerated and had antiretroviral activity in patients with early HIV infection and Kaposi sarcoma but it had no significant effect on the extent of Kaposi sarcoma or on immune function Objective This r and omized , double-blind and vehicle-controlled phase III study was conducted to evaluate the efficacy and safety of alitretinoin gel 0.1 % for the topical treatment of the cutaneous lesions of AIDS-related Kaposi ’s sarcoma ( KS ) . Methods Patients received treatment with alitretinoin gel ( n = 62 ) or vehicle gel ( n = 72 ) twice daily for 12 weeks . The primary efficacy endpoint was the cutaneous KS tumor response rate according to AIDS Clinical Trials Group ( ACTG ) objective criteria applied to topical therapy , with the patient as the unit of analysis . Results Treatment of patients with alitretinoin gel  result ed in a significant antitumor effect . The overall patient response rate ( complete plus partial response ) was 37 % ( 23 of 62 ) for the alitretinoin-treated patients and 7 % ( 5 of 72 ) for the vehicle-treated patients ( p = 0.00003 ) . The difference in response rates for the 2 treatment groups remained significant even after taking into consideration numerous variables , including age ( p = 0.00001 ) , Eastern Cooperative Oncology Group ( ECOG ) status ( p = 0.00002 ) , CD4 + cell count ( p = 0.00002 ) , history of opportunistic infection ( p = 0.00002 ) , aggregate area of indicator lesions ( p = 0.00005 ) , number of raised indicator lesions ( p = 0.00002 ) , prior therapy for KS ( p = 0.00003 ) , and number of drugs ( p = 0.00002 ) used in concomitant antiretroviral therapy . Generally , treatment with alitretinoin gel was well tolerated . The overall incidence of adverse events was similar for the 2 treatment groups . Adverse events related to treatment with alitretinoin gel tended to be mild to moderate in severity and limited to the site of application . The most frequent adverse event occurring at the application site following alitretinoin gel treatment was irritation coded as rash ( 32 % ) . Conclusions The results of this study provide convincing evidence of the superiority of alitretinoin gel over vehicle gel for the treatment of the cutaneous lesions of AIDS-related KS Intravenous paclitaxel , 100 mg/m2 , given over 3 hours every 2 weeks is associated with a response rate of 59 % in patients with recurrent or refractory acquired immunodeficiency syndrome (AIDS)‐related Kaposi sarcoma ( KS ) . However , this regimen is associated with significant myelosuppression , and the inconvenience of a 3‐hour infusion . Moreover , no effective therapies have been defined for use after treatment failure with this agent . A Phase II trial was conducted with weekly docetaxel in patients with advanced‐stage KS to assess safety and antitumor activity PURPOSE To compare the safety and efficacy of liposomal daunorubicin ( DaunoXome ; NeXstar Pharmaceuticals , Inc , Boulder , CO ) with a reference regimen of doxorubicin , bleomycin , and vincristine ( ABV ) in advanced AIDS-related Kaposi 's sarcoma ( KS ) . PATIENTS AND METHODS In a prospect i ve r and omized phase III trial , 232 patients were r and omized to receive DaunoXome 40 mg/m2 or a combination regimen of doxorubicin 10 mg/m2 , bleomycin 15 U , and vincristine 1 mg  , administered intravenously every 2 weeks . Treatment was continued until complete response ( CR ) , disease progression , or unacceptable toxicity . RESULTS Of 232 patients r and omized , 227 were treated : 116 with DaunoXome and 111 with ABV . The overall response rate ( CR or partial response [ PR ] ) was 25 % ( three CRs and 26 PRs ) for DaunoXome and 28 % ( one CR and 30 PRs ) for ABV . The difference in response rates was not statistically significant . The median survival time was 369 days for DaunoXome patients and 342 days for ABV patients ( P = .19 ) . The median time to treatment failure was 115 days for DaunoXome and 99 days for ABV ( P = .13 ) . ABV patients experienced significantly more alopecia and neuropathy ( P < .0001 ) . DaunoXome patients experienced more grade 4 neutropenia ( P = .021 ) . Cardiac function remained stable , with no instances of congestive heart failure on either treatment arm . CONCLUSION In this large phase III trial , the efficacy of DaunoXome was comparable to that of ABV .  Response rates , time to treatment failure , and overall survival were similar on both treatment arms . DaunoXome is a safe and effective primary therapy for advanced AIDS-related KS Objectives : To assess the incidence , predictors , and outcomes of Kaposi sarcoma-associated paradoxical immune reconstitution inflammatory syndrome ( KS-IRIS ) in  antiretroviral therapy (ART)-naive HIV-infected patients with Kaposi sarcoma initiating ART in both well re source d and limited-re source d setting s. Design : Pooled analysis of three prospect i ve cohorts of ART-naive HIV-infected patients with Kaposi sarcoma from sub-Saharan Africa ( SSA ) and one from the UK . Methods : KS-IRIS case definition was st and ardized across sites . Cox regression and Kaplan – Meier survival analysis were used to identify the incidence and predictors of KS-IRIS and Kaposi sarcoma-associated mortality . Results : Fifty-eight of 417 ( 13.9 % ) eligible individuals experienced KS-IRIS with an incidence 2.5 times higher in the African vs. European cohorts ( P = 0.001 ) . ART alone as initial Kaposi sarcoma treatment ( hazard ratio 2.97 , 95 % confidence interval ( CI ) 1.02–8.69 ) ; T1 Kaposi sarcoma stage ( hazard ratio 2.96 , 95 % CI 1.26–6.94 ) ; and plasma HIV-1 RNA more than 5 log10 copies/ml ( hazard ratio 2.14 , 95 % CI 1.25–3.67 ) independently predicted KS-IRIS at baseline . Detectable plasma Kaposi sarcoma-associated herpes virus ( KSHV ) DNA additionally predicted KS-IRIS among the 259 patients with KSHV DNA assessed ( hazard ratio 2.98 , 95 % CI 1.23–7.19 ) . 
    Output:
    
The findings from this review suggest that HAART plus chemotherapy may be beneficial in reducing disease progression compared to HAART alone in patients with severe or progressive Kaposi 's sarcoma .
For patients on HAART , when choosing from different chemotherapy regimens , there was no observed difference between liposomal doxorubicin , liposomal daunorubicin and paclitaxel