The previous therapy regimens included ABV in 52, liposomal daunorubicin in 49, and liposomal doxorubicin in 40 patients. Moreover, only 77% were receiving concomitant HAART (all protease inhibitor based) and 33% started this treatment at the same time as the taxane chemotherapy. The paclitaxel protocol BGB324 clinical trial used was 100 mg/m2 fortnightly. The overall response rate was 56% with no significant difference in response rate when comparing patients on or not on HAART. Less surprising was the finding that patients on HAART had a significantly improved survival. The main side effect reported in these studies was neutropenia that generally

resolved prior to the next chemotherapy cycle [101]. A second study enrolled 17 patients with anthracycline refractory AIDS-KS, defined as KS that had progressed during or within 6 months of completing liposomal anthracycline chemotherapy. All patients were JNK inhibitor cost receiving a stable HAART regimen to avoid confounding of results. The treatment schedule was again 100 mg/m2 fortnightly. The objective response rate to paclitaxel was 71% (95% CI: 60–81), with 8 of 17 partial responses and 4 of 17 complete responses. There were no significant changes in CD4, CD8, CD16/56 (natural killer cells) and CD19

(B cells) lymphocyte subset cell counts during and for up to 1 year following chemotherapy. Similarly, plasma HIV-1 viral loads did not change significantly during or after treatment suggesting that the combined use of paclitaxel and HAART reduces the risk of chemotherapy-related immunological decline and opportunistic infections [102]. In contrast, previous trials without concomitant HAART were worrying in this respect; Gill [100] reported 51 AIDS-defining opportunistic infections in the 56 patients treated with paclitaxel (10.5/100 patient months on paclitaxel), only 36% of whom received HAART, and Welles [99] reported 27 opportunistic infections (8.4/100 person months on paclitaxel) among

her cohort of 28, none of whom received HAART. Thus the concomitant use of HAART CYTH4 and paclitaxel appears to be safe and not detrimental to immune function despite initial concerns over pharmacological interactions [104–106]. These findings suggest that standard opportunistic infection prophylaxis guidelines may be followed when treating patients with taxane chemotherapy for KS. The higher rates of toxicity and the need for a 3-hour infusion make paclitaxel a less attractive first-line option than PLD [103]. The clinical experience in KS with docetaxel, another taxane, is much more limited though two small studies suggest that this agent can produce meaningful responses when used weekly [107], and in anthracycline pretreated individuals [108]. However, severe toxicities, including one death, have been reported in patients prescribed docetaxel with ritonavir-boosted protease inhibitors [109,110].