Objective: The aim of the study was to describe clinical and laboratory characteristics in HIV-infected patients with Kaposi sarcoma (KS).
Methods: We retrospectively studied data on HIV-infected patients hospitalized in one tertiary care hospital in Bucharest, Romania, in whom Kaposi Sarcoma was diagnosed, between January 2008 and November 2013.
Results: We identified 27 HIV-infected patients diagnosed with KS within 6 years. They had a median age of 42 years old and a median CD4 cell count of 101 cells per mm3 at the time of KS diagnosis. All patients received antiretroviral therapy (ART), with 18 patients (66%) already on ART at the time of KS diagnosis. Most patients (59%) were classified as ACTG poor-risk and 56% as Mitsuyasu stage I. The overall prognosis was poor, with 41% mortality, in a median time span of 6 months, significantly correlated with gastrointestinal involvement (p=0.019), poor-risk KS in ACTG classification (p<0.001) and stage IV Mitsuyasu (p=0.006).
Conclusion: KS remains an important cause of morbidity and mortality in patients with HIV infection, especially in late presenters.
1. Gao SJ, Kingsley L, Hoover DR, et al. Seroconversion to antibodies against Kaposi’s sarcoma-associated herpesvirus-related latent nuclear antigens before the development of Kaposi’s sarcoma. N Engl J Med. 1996; 335(4):233.
2. Engels E, Biggar RJ, Hall H, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008; 123:187-194.
4 Simard EP, Pfeiffer RM, Engels EA. Cumulative incidence of cancer among individuals with acquired immunodeficiency syndrome in the United States. Int J Cancer. 2011;117:1089-1096.
5. European Center for Diseases Control. HIV/AIDS surveillance in Europe 2008-2013. http://ecdc.europa.eu/en/ [accessed 28.01.2015]
6. Krown SE, Metroka C, Wernz JC. Kaposi’s sarcoma in the acquired immune deficiency syndrome: a proposal for uniform evaluation, response, and staging criteria. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol. 1989;7(9):1201-7.
7. Mitsuyasu RT. Clinical variants and staging of Kaposi’s sarcoma. Semin Oncol. Jun. 1987;14(2Suppl3):13-8
8. Stebbing J, Sanitt A, Nelson M, et al. A prognostic index for AIDS associated Kaposi’s sarcoma in the era of highly active antiretroviral therapy. Lancet. 2006;367:1495-502.
9. Jipa RE, Manea E., Benea S, et al. Characteristics of late presenters in Bucharest. J Int AIDS Soc. 2014;17(Suppl 3):19691.
10. Laney AS, Cannon MJ, Jaffe HW, et al. Human herpes virus 8 presence and viral load are associated with the progression of AIDS-associated Kaposi's sarcoma. AIDS. 2007;21:1541-1545.
11. Sofia Fernandes L. Human immunodeficiency virus and cancer. A population of HIV-infected patients at Hospital de Santa Maria and predictors of cancer. GERMS. 2012;2:60-74.
12. Lacombe JM, Boue F, Grabar S, et al. Risk of Kaposi sarcoma during the first months on combination antiretroviral therapy. AIDS. 2013;27:635-43.
13. Agaba PA, Sule HM, Ojoh Ro, et al. Presentation and survival of patients with AIDS-related Kaposi’s sarcoma in Jos, Nigeria. Int J STD AIDS. 2009;20:410–413
14. Phipps W, Sewankambo F, Nguyen, et al. Gender differences in clinical presentation and outcomes of epidemic Kaposi Sarcoma in Uganda. PLoS ONE. 2010.5:e13936. doi:10.1371/journal.pone.0013936.
15. K. Chu., G. Mahlangeni, S. Swannet, et al. AIDS-associated Kaposi’s sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa. J Int AIDS Soc. 2010;13:23.
16. Bower M, Dalla Pria A, Coyle C, et al. Prospective stage-stratified approach to AIDS-related Kaposi’s sarcoma. J Clin Oncol. 2014;32:409-14.
17. Martelotta F, Berretta M, Vacher E, et al. AIDS-Related Kaposi Sarcoma: State of the ART and therapeutic Strategies. Current HIV Research. 2009; 7:634-638.
18. Krown SE, Northfelt DW, Osoba D, et al. Use of liposomal anthracyclines in Kaposi’s sarcoma. Semin Oncol. 2004;31:36-52.
19. Di Lorenzo G, Konstantinopoulos PA, Pantanowitz L, et al. Management of AIDS-related Kaposi’s sarcoma. Lancet Oncol. 2007;8:167-176.
20. Kibria R, Siraj U, Barde C. Kaposi sarcoma of the stomach and duodenum in human immunodeficiency virus infection. Dig Endosc. 2010;22:241-2.
21. Borie R, Cadranel J, Guihot A, Marcelin AG, et al. Pulmonary manifestations of human herpesvirus-8 during HIV infection. Eur Respir J. 2013;42:1105-18.