AIDS-Related Kaposi Sarcoma, Version 2.2019

Abstract

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.

An Uncommon Presentation of Extrahepatic Cholestasis due to Single Biliary Stricture From Kaposi Sarcoma

“…As treatment of HIV has improved, a reduction in the incidence of HIV-associated KS has been evidenced; however, in patients without treatment or interrupted therapy, especially those with AIDS, high level of suspicion should be maintained to timely diagnose HHV-8 infection, treat accordingly, and avoid future complications [17,20]. Even though our patient's symptoms and chemistry improved initially, his marked immunosuppression triggering multiple opportunistic infections caused his death.…”

“…The current first-line treatment for advanced KS according to JNCCN (Journal of the National Comprehensive Cancer Network) guidelines is liposomal doxorubicin. An alternative option for first-line systemic therapy is paclitaxel [17]. Patients treated with pegylated liposomal doxorubicin or paclitaxel have shown clinical benefit and tumor response, but their side effects are not negligible [16,18].…”

“…Newer targeted treatments are being explored; however, the declining incidence of AIDS-related KS makes it difficult to create large-scale trials [19]. HHV-8 infection cannot be eradicated, and complete remission in the setting of advanced disease at presentation is rare; however, reduction or reversion of symptoms and mitigation of end-organ damage can be achieved [17].…”

Rare Ocular Involvement in a Newly Diagnosed AIDS Patient With Diffuse Kaposi’s Sarcoma

“…Several opportunistic infections may result in cutaneous lesions that mimic KS lesions, including bacillary angiomatosis, cryptococcus, and blastomycosis. For this reason, biopsy and consultation with an infectious disease specialist is recommended by current practice guidelines [6]. Due to the diffuse presentation of KS in the current case, we felt that diagnostic workup and biopsy were important prior to discharge.…”

“…Our patient was started on ART, with a resulting increase in his CD4 cell count; however, he developed a rapid, aggressive, and diffuse form of KS associated with IRIS that included multiple systems throughout his body. In some patients, initial development of a tumor or tumor exacerbation occurs after the initiation of ART; this may be due to IRIS [6]. Glucocorticoids, a common treatment for other forms of IRIS and/or AIDS-related pulmonary infections, can also exacerbate the tumor and should be avoided when possible [6].…”