1. Home>
2. Specialties>
3. HIV/AIDS>
4. Summary and Comment

An Unusual Cluster of HIV-Associated Kaposi Sarcoma?

A recent report from San Francisco described nine patients with long-standing HIV infection who developed KS despite good immune function.

HIV-associated Kaposi sarcoma (KS) typically occurs in patients who have low CD4 counts (<150 cells/mm³) and high viral loads (>10,000 copies/mL). In most patients, KS lesions regress within the first year of antiretroviral therapy (ART), as immune function improves and viral load declines. However, investigators in San Francisco recently reported an unusual cluster of nine patients who developed HIV-associated KS despite good immune function.

At the time of KS diagnosis, patients were aged 41 to 74 (median, 51) and had been infected with HIV for 4 to 25 years (median, 18 years). None had a history of opportunistic infections. All were receiving maximal ART and had sustained CD4 counts >300 cells/mm³ and undetectable viral loads for at least 2 years. Seven of the patients were receiving regimens that contained PIs, which had previously been proposed to be beneficial in treating KS because of their antiangiogenic and antitumorigenic effects. All nine patients had relatively mild skin disease with no visceral involvement. The authors hypothesized that these unusual cases of HIV-associated KS may be more common in San Francisco than elsewhere because of the large population of aging people there who are coinfected with HIV and human herpesvirus 8 (HHV8; a known cause of KS).

Comment: The clinical picture in this report closely resembles classic KS (originally described by Moritz Kaposi in 1872), an indolent neoplasm that is seen predominantly in elderly men of Mediterranean or Jewish descent and often involves the lower extremities (Semin Oncol 1987; 14:7). Whether any of the nine patients described in the present report had a history of KS or recent HHV8 infection would be interesting to know. Regardless, this cluster reflects the likelihood that even when HIV is ostensibly under good control, the immune system is still impaired, possibly due to HIV infection itself or to additional effects of aging. Fortunately, mild skin lesions can be treated relatively easily with local measures rather than with systemic chemotherapy, but patients with KS might eventually require more-specific treatment for their underlying HHV8 infection. Clinicians should continue to perform careful skin exams on all patients and should be aware of the manifestations of mild KS, particularly as their patients become older.

— Joan Goldberg, MD

Dr. Goldberg is Medical Director of the HIV Program at Harvard Vanguard Medical Associates in Boston and a member of the Hematology/Oncology Department there.

Published in AIDS Clinical Care October 29, 2007

Citation(s):

Maurer T et al. HIV-associated Kaposi’s sarcoma with a high CD4 count and a low viral load. N Engl J Med 2007 Sep 27; 357:1352.

• Original article (Subscription may be required)
• Medline abstract (Free)