HIV-Associated (Epidemic) Kaposi Sarcoma

Epidemic KS is an AIDS-defining diagnosis.
Because it is found almost exclusively in men who have had homosexual contact, KS is thought to be sexually transmitted.
KS is exceedingly rare in women, and women with KS are presumed to have had sexual contact with bisexual men.
KS is associated with infection of human herpesvirus 8 (HHV-8), which has been detected in saliva and in semen of affected patients.
Lesions may resolve spontaneously as immunity improves. A similar phenomenon has been observed in immunocompromised renal transplant recipients.

Clinical Manifestations ⬆ ⬇

Violaceous macules, papules, or nodules occur (Figs. 33.9 and 33.10).
Limb edema with subtle violaceous discoloration of the skin may be present.
Lesions are most commonly asymptomatic.
Edema occurs with lymphatic involvement, usually in the extremities, but sometimes it affects the face.
Oral lesions can cause pain, difficulty with eating, and loss of teeth.

Other Information ⬆

Distribution of Lesions

Differential Diagnosis

Pyogenic Granuloma

Bacillary angiomatosis (see below)

Management

All forms of KS regress spontaneously with successful treatment of immunodeficiency with HAART.

Disseminated Cutaneous Kaposi Sarcoma

Disseminated involvement that does not regress with HAART requires systemic chemotherapy.

Lymphangitic Kaposi Sarcoma

Lymphatic involvement that does not respond to HAART requires systemic chemotherapy.
Intermittent sequential compression boots can be used to decrease edema and to increase the comfort level of the patient.

Localized Cutaneous or Mucosal Kaposi Sarcoma

Radiation therapy is used, particularly for facial lesions.
Intralesional vinblastine is given at doses of 0.1 to 0.6 mg/mL.
Liquid nitrogen cryosurgery is used for macular lesions.
A retinoid gel, alitretinoin (Panretin), applied three to four times daily as tolerated, is useful for macular lesions.

Points to Remember

KS in an HIV-infected patient is an AIDS-defining diagnosis.
Treatment of individual lesions does not prevent the occurrence of new lesions.
Lesions may resolve spontaneously in patients receiving effective antiretroviral therapy, so it is beneficial to delay surgical treatment until the patient has been receiving HAART for several months.