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Hiv-Related Malignancies: Kaposi & Sarcoma

Basic Information

Kaposi's sarcoma (KS) is a lesion-producing cancer of the lining of blood vessels that can be disfiguring and has a clinical course than can range from incidental or minimal disease to a rapid, widespread tumor growth, depending on the individual. There is an indication that a sexually transmitted co-factor is involved, perhaps a human herpesvirus (KSHV or HHV-8), that is linked to development of KS. Since KS rarely has appeared in women or IV drug users, a number of epidemiologists concluded that homosexual men are as a group at particular risk for KS. Research from England in the early '90s presented evidence that oral-anal contact was linked to KS -- indicating evidence of a sexually-transmitted co-factor.

  • KS appears most frequently in those who acquire HIV sexually.
  • Women who have AIDS are four times more likely to develop KS through sexual transmission from a bisexual partner than through IV drug use.
  • Gay and bisexual men make up more than 90% of cases of KS.
  • KS, an AIDS-defining illness, is diagnosed in 15% of patients at some stage of disease.
  • KS, according to several studies, declined from 1983 to 1988 in gay and bisexual men, a fact suggestive of a change in sexual practices and a less frequent exposure to STDs.
  • The KS co-factor, a suspected human herpesvirus, may coincidentally have appeared around the same time as HIV virus.
  • The cases of KS have lessened since HIV-infected persons began taking antiretroviral drugs for HIV disease although the future significance of this is unclear -- for now in those with immune status improvements, KS lesions have sometimes been reported to lessen or even disappear.
  • KS is the most commonly occurring AIDS-related malignancy in HIV-infected males in the western world.
  • KS progresses at a slower rate than opportunistic infections and except for gastrointestinal or pulmonary KS is rarely life threatening.
  • KS is marked by an abnormally rapid growth of spindle-shaped cells.
  • Caucasians develop KS more frequently than African-Americans.
  • Children do not get KS.

Symptoms

Symptoms of KS include:

  • Purple, pink or red nodules or patches ranging from a quarter of an inch to an inch that can appear anywhere on the skin or on internal organs and grow both in size and number.
  • Some nodules are painful, others are asymptomatic.
  • The KS lesions have a predilection for, but are not limited to, appearing on the face, neck, back or chest.

Other sites can include:

  • Lungs
  • Liver
  • Spleen
  • Brain
  • Lymph nodes
  • Adrenal glands
  • Gastrointestinal tract
  • Testes
  • Pancreas
  • KS in the lungs is the most life-threatening.

In cases where lesions are widespread, symptoms may include:

  • Weight loss
  • Loss of appetite
  • Fever
  • Severe fatigue

Diagnosis/Treatment

Definitive diagnosis can be made by:

  • Punch biopsy of a skin lesion
  • Fine-needle aspiration biopsy
  • Viewing by endoscopy

Treatment depends on the individual's immune system status and stage of malignancy -- treatment goals include alleviating patient pain and discomfort, decreasing lesion size, removal of cutaneous lesions, or treatment can aggressively combat severe cases through cancer drugs. Small lesions can be excised surgically (local therapy) and can be treated with appropriate topical medication.

Radiation therapy or laser surgery can reduce pain, local swelling and remove lesions. Lesions can be removed individually by a freezing process known as cryotherapy.

When to treat further is between the patient and medical team and is often based on strengths of patient's CD4 cell count.

Alpha-interferon has shown to have antiviral efficacy. And chemotherapeutic drugs have been widely used in patients with progressive KS or widespread severe KS disease.

We at Always Your Choice have had experience diagnosing and treating many cases of KS. If you have KS or need information about it we would be happy to see you.