HIV-Associated Kaposi's Sarcoma

Abstract

Kaposi's sarcoma (KS) is still one of the most common malignancies in patients with human immunodeficiency virus (HIV) infection. Large randomized clinical trials have shown a protective effect of combination antiretroviral therapy (cART) against the development of KS, even in patients with a relatively preserved immune system. In patients with sufficient cART, KS has become a rarity. In most patients with HIV-associated KS who initiate cART, the KS lesions stabilize with decreasing HIV plasma viremia and immune reconstitution, or even resolve completely without any specific treatment. In patients with advanced or rapidly progressive disease, especially in the setting of an immune reconstitution syndrome, cART should be combined with cytotoxic chemotherapies. With regard to the KS pathogenesis, several new therapies have been suggested, such as antiviral agents, cytokines, and inhibitors of angiogenesis.

Pulmonary Kaposi's Sarcoma - Initial Presentation of HIV Infection 

“…Swellings occur frequently, especially on the face and extremities, possibly due to secondary obstruction of the lymph vessels. 13 The gastrointestinal tract and the lungs are the organs that become most often afflicted. Gastrointestinal involvement is usually asymptomatic but is an indicator of a progressing disease.…”

Extensive AIDS-associated Kaposi’s sarcoma

“…KS is in the spectrum of angioproliferative malignancies. It is mainly caused by HHV-8 and is known as the most common malignancy in HIV/AIDS patients (Curtiss et al, 2016;Hoffmann et al, 2017). In 2010, the most common cancers among HIVinfected people in the USA were non-Hodgkin lymphoma (incidence 21%) and KS (incidence 12%).…”

“…The differential diagnosis in this case scenario should include consideration of hemangioma, bacillary angiomatosis, mycobacterial infections, leiomyosarcoma, angiosarcoma, and other high-grade vascular tumors. Histopathological analysis is the mainstay of workup to confirm the diagnosis (Hoffmann et al, 2017).…”

“…This results in an increase in CD4+ T-cell count, which can suppress the HHV-8 virus. Visceral involvement is related to an unfavorable prognosis, despite the combination of systemic chemotherapy and HAART (Hoffmann et al, 2017;Goncalves et al, 2017).…”

HIV-Associated Malignancies

“…The high prevalence of smoking in the HIV-infected population increases the risk of lung cancer, which is often diagnosed in more advanced stages and in younger patients compared to immunocompetent individuals. Hoffmann et al [7] highlight the specifics in the treatment of Kaposi's sarcoma, the crucial role of consequent cART, and new therapeutic options. Oette et al [8] discuss recent approaches to anal cancer, which has an incidence up to 40 times higher compared with the general population.…”