Kaposi's Sarcoma Is Back in HIV Patients

SAN FRANCISCO — Kaposi's sarcoma in HIV patients is turning up again—sometimes in a surprisingly deadly form and other times in an indolent, nonthreatening form—according to two experts.

Kaposi's sarcoma (KS) used to be one of AIDS' signature complications before antiretroviral therapy, Dr. Deborah Greenspan said at a meeting on the medical management of HIV and AIDS sponsored by the University of California, San Francisco “We're starting to see Kaposi's sarcoma again,” presenting as oral lesions in patients who have started antiretroviral therapy for HIV but who still have low CD4 cell counts.

KS in the setting of HIV has a predilection for the palate, for reasons that have never been understood, said Dr. Greenspan, professor and chair of orofacial sciences and distinguished professor of dentistry at UCSF. Oral KS typically appears as a flat, plaque-like lesion on the hard or soft palate. Looking in the mouth can be a key step to diagnosing KS, she said.

“Years ago, KS seemed to disappear right off the radar screen, but it is back. We are seeing a lot of Kaposi's sarcoma,” Dr. Toby A. Maurer, an associate professor of clinical dermatology at UCSF said in a separate presentation.

She and her colleagues were surprised recently by the lethality of KS after they followed 65 of their patients being treated with antiretroviral therapy for HIV and with chemotherapy for KS. “We were shocked to find out that 25% of that cohort died of their Kaposi's sarcoma, even when they had chemotherapy,” she said.

A separate case series in Seattle found that 23% of patients who were on antiretroviral therapy for HIV and who received adequate chemotherapy for KS died of the cancer. “This is quite alarming,” Dr. Maurer said.

Physicians should always biopsy lesions they think might be KS, she advised. On darker-pigmented skin, it can be difficult to differentiate KS from other lesions without a biopsy.

Most patients who have not started treatment for HIV or KS should see their KS resolve within 9 months of starting antiretrovirals. Dr. Maurer and her associates are collecting immunology and laboratory test results at baseline and after 9 months of therapy in a study to compare response in patients. “Please send us your KS patients” who have not started antiretroviral therapy. “We would be very happy to biopsy them,” she said.

A less threatening form of KS is also starting to turn up in relatively young patients with HIV. “They develop what looks to us like 'old man's Kaposi's sarcoma'—that is, Mediterranean, classical-type KS,” Dr. Maurer said.

These are patients who develop small areas of KS, usually on the lower legs and feet, after having HIV for 17–20 years. Their HIV has been suppressed for at least 2 years on antiretroviral therapy, and they have relatively healthy CD4 counts of 300–600 cells/mm

“We think that they are showing signs of immune aging” and preliminary studies suggest this is the case, she said. In several years of follow-up, none have had exacerbations or internal involvement of KS, and none have needed chemotherapy, Dr. Maurer said.

Dr. Maurer and Dr. Greenspan reported having no relevant conflicts of interest.

Lesions believed to be Kaposi's—like the one shown above in an AIDS patient—should be biopsied.

Source Courtesy National Cancer Institute

SAN FRANCISCO — Kaposi's sarcoma in HIV patients is turning up again—sometimes in a surprisingly deadly form and other times in an indolent, nonthreatening form—according to two experts.

Kaposi's sarcoma (KS) used to be one of AIDS' signature complications before antiretroviral therapy, Dr. Deborah Greenspan said at a meeting on the medical management of HIV and AIDS sponsored by the University of California, San Francisco “We're starting to see Kaposi's sarcoma again,” presenting as oral lesions in patients who have started antiretroviral therapy for HIV but who still have low CD4 cell counts.

KS in the setting of HIV has a predilection for the palate, for reasons that have never been understood, said Dr. Greenspan, professor and chair of orofacial sciences and distinguished professor of dentistry at UCSF. Oral KS typically appears as a flat, plaque-like lesion on the hard or soft palate. Looking in the mouth can be a key step to diagnosing KS, she said.

“Years ago, KS seemed to disappear right off the radar screen, but it is back. We are seeing a lot of Kaposi's sarcoma,” Dr. Toby A. Maurer, an associate professor of clinical dermatology at UCSF said in a separate presentation.

She and her colleagues were surprised recently by the lethality of KS after they followed 65 of their patients being treated with antiretroviral therapy for HIV and with chemotherapy for KS. “We were shocked to find out that 25% of that cohort died of their Kaposi's sarcoma, even when they had chemotherapy,” she said.

A separate case series in Seattle found that 23% of patients who were on antiretroviral therapy for HIV and who received adequate chemotherapy for KS died of the cancer. “This is quite alarming,” Dr. Maurer said.

Physicians should always biopsy lesions they think might be KS, she advised. On darker-pigmented skin, it can be difficult to differentiate KS from other lesions without a biopsy.

Most patients who have not started treatment for HIV or KS should see their KS resolve within 9 months of starting antiretrovirals. Dr. Maurer and her associates are collecting immunology and laboratory test results at baseline and after 9 months of therapy in a study to compare response in patients. “Please send us your KS patients” who have not started antiretroviral therapy. “We would be very happy to biopsy them,” she said.

A less threatening form of KS is also starting to turn up in relatively young patients with HIV. “They develop what looks to us like 'old man's Kaposi's sarcoma'—that is, Mediterranean, classical-type KS,” Dr. Maurer said.

These are patients who develop small areas of KS, usually on the lower legs and feet, after having HIV for 17–20 years. Their HIV has been suppressed for at least 2 years on antiretroviral therapy, and they have relatively healthy CD4 counts of 300–600 cells/mm

“We think that they are showing signs of immune aging” and preliminary studies suggest this is the case, she said. In several years of follow-up, none have had exacerbations or internal involvement of KS, and none have needed chemotherapy, Dr. Maurer said.

Dr. Maurer and Dr. Greenspan reported having no relevant conflicts of interest.

Lesions believed to be Kaposi's—like the one shown above in an AIDS patient—should be biopsied.

Source Courtesy National Cancer Institute

SAN FRANCISCO — Kaposi's sarcoma in HIV patients is turning up again—sometimes in a surprisingly deadly form and other times in an indolent, nonthreatening form—according to two experts.

Kaposi's sarcoma (KS) used to be one of AIDS' signature complications before antiretroviral therapy, Dr. Deborah Greenspan said at a meeting on the medical management of HIV and AIDS sponsored by the University of California, San Francisco “We're starting to see Kaposi's sarcoma again,” presenting as oral lesions in patients who have started antiretroviral therapy for HIV but who still have low CD4 cell counts.

KS in the setting of HIV has a predilection for the palate, for reasons that have never been understood, said Dr. Greenspan, professor and chair of orofacial sciences and distinguished professor of dentistry at UCSF. Oral KS typically appears as a flat, plaque-like lesion on the hard or soft palate. Looking in the mouth can be a key step to diagnosing KS, she said.

“Years ago, KS seemed to disappear right off the radar screen, but it is back. We are seeing a lot of Kaposi's sarcoma,” Dr. Toby A. Maurer, an associate professor of clinical dermatology at UCSF said in a separate presentation.

She and her colleagues were surprised recently by the lethality of KS after they followed 65 of their patients being treated with antiretroviral therapy for HIV and with chemotherapy for KS. “We were shocked to find out that 25% of that cohort died of their Kaposi's sarcoma, even when they had chemotherapy,” she said.

A separate case series in Seattle found that 23% of patients who were on antiretroviral therapy for HIV and who received adequate chemotherapy for KS died of the cancer. “This is quite alarming,” Dr. Maurer said.

Physicians should always biopsy lesions they think might be KS, she advised. On darker-pigmented skin, it can be difficult to differentiate KS from other lesions without a biopsy.

Most patients who have not started treatment for HIV or KS should see their KS resolve within 9 months of starting antiretrovirals. Dr. Maurer and her associates are collecting immunology and laboratory test results at baseline and after 9 months of therapy in a study to compare response in patients. “Please send us your KS patients” who have not started antiretroviral therapy. “We would be very happy to biopsy them,” she said.

A less threatening form of KS is also starting to turn up in relatively young patients with HIV. “They develop what looks to us like 'old man's Kaposi's sarcoma'—that is, Mediterranean, classical-type KS,” Dr. Maurer said.

These are patients who develop small areas of KS, usually on the lower legs and feet, after having HIV for 17–20 years. Their HIV has been suppressed for at least 2 years on antiretroviral therapy, and they have relatively healthy CD4 counts of 300–600 cells/mm

“We think that they are showing signs of immune aging” and preliminary studies suggest this is the case, she said. In several years of follow-up, none have had exacerbations or internal involvement of KS, and none have needed chemotherapy, Dr. Maurer said.

Dr. Maurer and Dr. Greenspan reported having no relevant conflicts of interest.

Lesions believed to be Kaposi's—like the one shown above in an AIDS patient—should be biopsied.

Source Courtesy National Cancer Institute