People infected with the human immunodeficiency virus (HIV) can remain at risk of acquired immunodeficiency syndrome (AIDS)-related Kaposi sarcoma despite appropriate treatment with modern antiretroviral therapy (ART), according to a study published in the Journal of Oncology Pharmacy Practice. The findings of this retrospective, single-institution study were consistent with other reports.
The causative agent of Kaposi sarcoma is the human herpesvirus 8. Kaposi sarcoma develops in cells lining lymph or blood vessels, and typically manifests as purple, red, or brown lesions or tumors on the skin. However, it can also appear on mucosal surfaces such as inside the mouth, as well as in other places throughout the digestive tract, and within organs such as the lung or liver.
Although 4 subtypes of Kaposi sarcoma have been identified, AIDS-related Kaposi sarcoma is the most common malignancy associated with HIV infection. In the era before development of ART, AIDS-related Kaposi sarcoma was typically associated with low CD4 T cell counts. The incidence of Kaposi sarcoma has dropped dramatically since the introduction of modern ART; however, some recent evidence in the medical literature has suggested that there have been some changes in the way this disease manifests in people infected with HIV.
In this retrospective study performed at Eisenhower Medical Center in Rancho Mirage, California, 27 patients with Kaposi sarcoma were identified between 2007 and 2017. More than 90% of patients in this cohort were men; of the 84% of patients in the cohort infected with HIV, all were receiving ART. In the overall cohort, approximately three-quarters of patients presented with skin-only disease; the remaining patients had a mucosal form of the disease. For the subgroup of patients infected with HIV, median time from diagnosis of HIV infection to diagnosis of Kaposi sarcoma was 11 years. The mean ages of patients in the skin-only and mucosal groups were 39.4 years and 50.4 years, respectively. Interestingly, the mean CD4 T-cell count in the 2 groups was 381cells/mm3 (95% CI, 282-480) [skin only] vs 83 cells/mm3 (95% CI, 27-139) [mucosal] (P =.005). Mean survival was 609 days for those with skin-only disease and 306 days for those with mucosal disease.
“Although Kaposi sarcoma incidence has drastically declined in recent years, we believe that its occurrence in HIV [-infected] patients who are on appropriate therapy carries substantial significance,” reported the investigators. “Adherence to effective ART remains the cornerstone intervention for primary and secondary Kaposi sarcoma prevention; however, well-controlled HIV disease and normal CD4 T-cell counts do not eliminate the risk of developing Kaposi sarcoma or experiencing disease recurrence.”
Hwang A, Iskandar AS, Kerr WT, et al. Clinico-epidemiologic characteristics and patterns of care in Kaposi’s sarcoma: data from a single-institution series [published online April 2, 2019]. J Oncol Pharm Pract. doi: 10.1177/1078155219838614.