Kaposi sarcoma: A continuing conundrum

Cancer Treatment Reviews, 2006

Journal of Clinical Oncology, 2005

Since the advent of highly active antiretroviral therapy (HAART), the incidence of Kaposi's sarcoma (KS) among AIDS patients has declined both nationwide and in King County, Washington. We sought to compare clinical parameters of patients diagnosed with KS in the pre- HAART (1990 to 1996) and HAART (1997 to 2002) eras. We used patient data abstracted from the Adult/Adolescent Spectrum of HIV-Related Diseases study of Public Health-Seattle and King County. Patients diagnosed with KS in the HAART era (n ϭ 40) were significantly more likely (P Ͻ .05) than pre-HAART-era KS patients (n ϭ 366) to be diagnosed with alcohol problems (43% v 18%), noninjection drug use (45% v 18%), injection drug use (25% v 10%), psychosis (25% v 13%), and hypertension (13% v 2%). Although median CD4 ϩ count and HIV-1 viral load at the time of KS diagnosis were not significantly different between the two groups, significantly fewer (P Ͻ .01) HAART-era KS patients developed opportunistic illnesses (OIs) during their follow-up. The risk of dying among KS patients diagnosed in the HAART era is significantly lower (P Ͻ .01) than for KS patients diagnosed in the pre-HAART era (hazard ratio, 0.24). Although HAART-era KS patients in King County were as likely to have a depleted CD4 ϩ cell count and high HIV-1 viral loads at the time of KS diagnosis as pre-HAART KS patients, they survived longer and fewer of them were diagnosed with other OIs. They also had an increased prevalence of substance abuse and mental illness, contributing to a dynamic and changing KS clinical profile.

International Journal of Dermatology, 1991

In the present study, 11 patients with epidemic Kaposi sarcoma wete evaluated; 55% wete In stage IV and 45% in stage 11; in addition, 75% had systemic symptoms, 89% had low total and T-lymphocyte counts, and all of them had not only low T-helper lymphocyte counts but also Thelpet/T-supptessor ratios. The majotity of patients (89%) had tow proliferative responses with phytohemaggiutinin (PHA). Nine patients were treated with: alpha-2 interferon (five patients), zidovudine (two patients), doxorubicin and zidovudine (one patient), and radiotherapy (one patient). There were only five patients with stable disease, three treated with alpha-2 interferon, one with doxorubicin, and one with doxorubicin plus azidothymidine. Two patients (one with doxorubicin and one with doxorubicin plus zidovudine) needed lithium to increase leukocyte and platelet counts. In May 1989, 73% of patients were dead (median survival 8 ±2 months). It is concluded that: (1) it is important to select the patients who have the best chance to improve with treatment; (2) the response with atpha-2 interferon or monochemotherapy is low and there is no change in overall survival; (3) a low helper cell count, low Thelper/ T-suppressor ratio, and low proliferative response with mitogens are features of poor prognosis; (4) toxicity with treatment was acceptable; and (5) lithium increased neutrophil and platelet counts. Kaposi sarcoma (KS) was first described as "idiopathic multiple pigmented sarcomas of the skin" by Moritz Kaposi in 1872. It is a rare tumor except in some African countries (Uganda, Zaire) where KS represents 9% of all registered tumors. Classical KS-affected individuals are older than 60 years, with Eastern European or Italian extraction. The lesions are localized in the legs and are treated principally with local radiotherapy or monocbemotherapy. Epidemic Kaposi sarcoma (EKS) began to be described in young homosexual men witb severe depression of cellular immunity in the spring of 1981. The cutaneous lesions are disseminated, affecting the head, neck.

AIDS, 1998

Objective: To determine the effect of Kaposi's sarcoma on survival of HIV-infected patients. Methods: Retrospective cohort study to compare the survival of 241 HIV-infected homosexual patients with Kaposi's sarcoma (cases) with that of 241 HIV-infected homosexual patients without Kaposi's sarcoma (control subjects) but with a similar level of immunosuppression (measured by the absolute CD4+ lymphocyte count). Results: Cases and control subjects were similar in age, occurrence of previous opportunistic infections, and the use of antiretroviral therapy. The mean CD4+ lymphocyte counts were similar for cases and control subjects (185 × 10 6 versus 184 × 10 6 /l, respectively). Cases had a higher incidence of opportunistic infections (5.95 versus 3.88 infections, respectively, per 100 person-months of observation) and a greater number of infections typical of late-stage HIV infection. Cases had a shorter overall survival than did control subjects (P = 0.0025). Kaposi's sarcoma was associated with an increased risk of death (odds ratio, 1.28), even when adjusting for age, previous opportunistic infection, baseline CD4+ lymphocyte count, and antiretroviral therapy. Conclusion: Kaposi's sarcoma appears to accelerate the clinical course of HIV infection. Opportunistic infections develop earlier and more often in patients with the disease than in control subjects. Survival was significantly shorter in patients with Kaposi's sarcoma.

Abstract: Background: Kaposi’s sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi’s sarcoma epidemic has increased as co-infection with HIV. Objectives: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. Methods: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi’s sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. Results: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. Study limitations: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. Conclusion: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized. Keywords: Acquired immunodeficiency syndrome; HIV; Human herpesvirus 8; Kaposi’s sarcoma

Epidemiologia e Serviços de Saúde, 2017

Objective: to estimate the prevalence of Kaposi's sarcoma (KS) in patients with AIDS and identify the associated factors to the occurrence of this neoplasm. Methods: this is a cross-sectional study with notification data from two AIDS reference centers in São Paulo-SP, Brazil, from January, 2003 to March, 2010; probabilistic linkage and multiple logistic regression methods were applied. Results: among 3,557 AIDS cases, 213 (6%) presented KS; 95.3% of them occurred in males; male sex (OR=3.1; 95%CI=1.4;6.6), age at the AIDS diagnosis >28 years old (OR=1.6; 95%CI=1.0;2.6), MSM (OR=3.2; 95%CI=2.0;4.9), prior use of HAART (OR=0.4; 95%CI=0.3;0.5), AIDS diagnosis between 2007-2010 (OR=0.3; 95%CI=0.2;0.4), and CD4+ T-cell counting under 200cells/mm 3 (OR=16.0; 95%CI=6.0;42.7) and 200-500cells/mm³ (OR=2,5; 95%CI=1.1;6.4) were associated to the occurrence of KS. Conclusion: KS has a high prevalence in São Paulo-SP; strategies for early HIV diagnosis may reduce this prevalence.

Journal of Clinical Medicine

Kaposi’s sarcoma (KS) was peculiarly described in the first notified cases of the acquired immunodeficiency syndrome as an opportunistic condition. However, the medical progress and the development of active antiretroviral therapy allowed the control of the HIV/AIDS epidemic, although the features of KS have changed throughout the past decades. The purpose of our study is to assess the epidemiological and clinical features of AIDS related KS in Romanian patients. A retrospective follow-up study was achieved in a single infectious diseases’ clinic from Galati—Romania, between 2001 and 2021. Referring to 290 new HIV diagnosed cases from our clinic retained in care, the prevalence of KS was 3.4%. The main characteristics of patients with KS are a median age of 33, a predominance of males, prevalent severe systemic forms of diseases, frequent association of past or concomitant tuberculosis, and context of immune reconstruction syndrome. The mortality rate was 70%. KS has occurred in pat...

Journal of Clinical Pathology, 1986

Of 22 patients with Kaposi's sarcoma, 16 had the acquired immune deficiency syndrome (AIDS). The histological pattern in AIDS differs from the more familiar classical Kaposi's sarcoma. The features most useful in making the diagnosis are: dissection of collagen; lymphatic vessel like spaces; angiomatoid lesions; premonitory sign; and spindle cell proliferation. It is important to examine multiple levels of small biopsy specimens and to be cautious in making the diagnosis of patch Kaposi's sarcoma in the presence of recent or healed ulceration and at sites of previous trauma. Only four of 16 patients with AIDS had evidence of systemic Kaposi's sarcoma, supporting the view that Kaposi's sarcoma in AIDS does not necessarily have an aggressive clinical course.

Journal of the National Comprehensive Cancer Network, 2019

As treatment of HIV has improved, people living with HIV (PLWH) have experienced a decreased risk of AIDS and AIDS-defining cancers (non-Hodgkin’s lymphoma, Kaposi sarcoma, and cervical cancer), but the risk of Kaposi sarcoma in PLWH is still elevated about 500-fold compared with the general population in the United States. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AIDS-Related Kaposi Sarcoma provide diagnosis, treatment, and surveillance recommendations for PLWH who develop limited cutaneous Kaposi sarcoma and for those with advanced cutaneous, oral, visceral, or nodal disease.

The American journal of case reports, 2018

BACKGROUND Kaposi's sarcoma (KS) is a common condition in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). In these patients, the occurrence of KS is reduced by treatment with highly active antiretroviral therapy (HAART). Fatal and disseminated KS is presented in two patients with HIV/AIDS. CASE REPORT A 25-year-old man and a 30-year-old man with HIV/AIDS presented with KS affecting the skin, oral cavity, gastrointestinal tract, liver, lungs, kidneys, adrenal glands, and bone. Both patients had a rapidly deteriorating clinical course associated with a low CD4 count and developed respiratory failure and death. CONCLUSIONS Fatal disseminated KS is associated with severe immunosuppression due to with a low CD4 count. The presentation of these two cases highlights the potentially aggressive clinical course of KS in patients with HIV/AIDS and reinforces the need for early diagnosis and rapid treatment with HAART.

The Internet journal of oncology, 2008

Skin manifestations are frequently associated with the Human Immunodeficiency Virus (HIV) infection. Kaposi's Sarcoma (KS) is one of the most common cancers seen in people with HIV, and is an AIDS defining illness. The incidence of HIV associated Kaposi's Sarcoma has decreased since the advent of antiretroviral drugs in developed countries. This is not the case with Cameroon people present with generalized and aggressive KS. This study reviews the characteristics and prevalence of KS and the impact of antiretroviral drugs in a treatment center in Yaoundé, Cameroon. The prevalence of KS among HIV infected patients was found to be 10.0%. Both sexes were equally affected unlike in endemic KS which is more common in males. Most patients had generalized disease, and death occurred within six months of diagnosis. These cases were associated with low CD4 cell count, anemia and low platelet counts. Patients with less extensive lesions, had tumor regression ranging from partial to total when Highly Active Antiretroviral Therapy was administered. Early diagnosis and antiretroviral therapy will decrease morbidity, mortality and severe Immune Reconstitution Inflammatory syndrome (IRIS) common in patients with aggressive HIV associated KS.

Journal of the American Academy of Dermatology, 1993

Backgrounds Kaposi's sarcoma (KS) is commonly associated with the acquired immunodeficiency syndrome (AIDS) in adults. Little is known regarding its occurrence in children. Objective: Our purpose was to report the clinical and epidemiologic characteristics of KS in three Romanian children with AIDS and to compare them with previouslyreported AIDSassociated KS in children. Methods: This was a clinicopathologic study and computer-based literature review. Results: All three Romanian children had skin involvement; two had involvement of lymph nodes and internal organs. All had acquired human immunodeficiencyvirus (HIV) infection postnatally. Including these children, 33 cases of AIDS-associated KS in children have been reported. Thirteen of 30 evaluable patients had acquired HIV infection postnatally; nine of these children (69%) had cutaneous involvement by KS. A perinatal route of transmission was present in the remaining 17 cases; only two of these children (12%) with KS had cutaneous involvement. No case was noted in which intravenous drug use was the sole parental HIV risk factor. Conclusion: The data support the contention that KS is caused by a second infectious agent prevalent only in certain HIV-infected populations. Children of parents in high-risk groups for KS and children who acquire HIV via contaminated blood or blood products are at highest risk for KS. The route of acquisition of HIV infection may also be associated with different clinical manifestations of KS in children. (J AM ACAD DERMATOL 1993;28:449-53.) Kaposi's sarcoma (KS) is a well-recognized finding in adults with acquired immunodeficiency syndrome (AIDS). Epidemiologic evidence suggests that KS is an "opportunistic" neoplasm that may be caused by a second infectious agent most efficiently spread via sexual intercourse. I, 2 Homosexual and bisexual men with AIDS account for the majority of cases of KS in the United States and in Western Europe, although in Africa and in the Caribbean,

Journal of Molecular Medicine, 1997

Patients suffering from the acquired immune deficiency syndrome (AIDS) have a 20 000-fold increased risk of developing a severe form of Kaposi's sarcoma (KS), a previously rare malignancy involving sharply defined nodular lesions of the skin and/or oral mucosa. Epidemiological evidence has long suggested that an infectious agent is the probable cause of KS. Recently sequences from a putative new herpesvirus have been found to be associated with KS in virtually 100% of the cases analyzed. The suspected etiological agent, a new human herpesvirus termed Kaposi's sarcoma associated herpes virus (human herpes virus 8) has now been propagated in cell culture. This significant advance should form the basis for a detailed analysis of the pathogenetic mechanisms involved in the development of KS. & k w d : Key words Kaposi's sarcoma • Human herpes virus 8 • Chemokines • Spindle cells Abbreviations AIDS Acquired immune deficiency syndrome • BCBL Body cavity based lymphoma • CMV Cytomegalovirus • EBV Epstein-Barr virus • ELISA Enzyme-linked immunosorbent assay • HCG Human chorionic gonadotropin • HHV Human herpesvirus • HIV Human immunodeficient virus • IFN Interferon • IL Interleukin • KS Kaposi's sarcoma • KSHV Kaposi's sarcoma associated herpes virus • PCR Polymerase chain reaction& b d y : Kaposi's sarcoma: an old yet novel disease More than 100 years ago the Hungarian physician Mór Kaposi described a rare, slowly progressing tumor seen predominantly in elderly men of Mediterranean or Eastern European descent [1]. The characteristic external manifestations of this disease are sharply defined, differently colored (purple, brown, violet, or black) nodular lesions of the skin (mostly on the extremities) and oral mucosa (Fig. 1). Histologically these lesions consist of long spindle-shaped cells, apparently of endothelial origin, as well as a number of other cell types including fibroblasts, neovascular structures, infiltrating leukocytes, and extravasated red blood cells. As a rule, classic Kaposi's sarcoma (KS) is associated with slow progression, relatively benign localized lesions, and a low mortality. Another form of KS is endemic in sub-Saharan Africa, where it affects mostly children and young male adults. African "endemic" KS presents both as a relatively benign disease with localized lesions and as a rapidly progressing life-threatening disease with disseminated lesions involving lymph nodes and inner organs. The distribution of KS overlaps in large parts with the regions which are endemic for malaria and Epstein-Barr virus (EBV). A third form of KS develops as a consequence of immunosuppressive therapy after organ transplantations. Although the lesions in posttransplantation KS are usually limited to the skin and oral mucosa, they occasionally

Surgical & Cosmetic Dermatology, 2017

Sarcoma de Kaposi variante queloidiana associada à síndrome da imunodeficiência adquirida (SIDA)

Acta Medica Marisiensis, 2016

The aim of the study was to describe clinical and laboratory characteristics in HIV-infected patients with Kaposi sarcoma (KS). Methods: We retrospectively studied data on HIV-infected patients hospitalized in one tertiary care hospital in Bucharest, Romania, in whom Kaposi Sarcoma was diagnosed, between January 2008 and November 2013. Results: We identified 27 HIV-infected patients diagnosed with KS within 6 years. They had a median age of 42 years old and a median CD4 cell count of 101 cells per mm 3 at the time of KS diagnosis. All patients received antiretroviral therapy (ART), with 18 patients (66%) already on ART at the time of KS diagnosis. Most patients (59%) were classified as ACTG poor-risk and 56% as Mitsuyasu stage I. The overall prognosis was poor, with 41% mortality, in a median time span of 6 months, significantly correlated with gastrointestinal involvement (p=0.019), poor-risk KS in ACTG classification (p<0.001) and stage IV Mitsuyasu (p=0.006). Conclusion: KS remains an important cause of morbidity and mortality in patients with HIV infection, especially in late presenters.