Clinical aspects and management of AIDS-related Kaposi's sarcoma

AIDS-related Kaposi's sarcoma (KS) is a tumour of vascular endothelium. whi ch is seen predominately in men who have sex with men. The majority of affe cted individuals have advanced immunosuppression at the time of the initial KS diagnosis. The disease may present with cutaneous lesions, or with invo lvement of visceral organs. of which the gastrointestinal tract is most com mon. KS may also present with lymphoadenopathy or with isolated lymphoedema , even in the absence of cutaneous lesions. Affected individuals are unifor mly co-infected with HIV and with Human Herpesvirus type 8 (HHV8). HHVB is present within KS tissues, and is aetiological in the pathogenesis of disea se, along with aberrant cytokine expression, production of multiple angioge nic peptides. and immune dysregulation. While not presently curable. multip le treatment options exist and must be evaluated in terms of the specific n eeds of the individual patient. Various local therapies are aimed at eradic ating small lesions, while acknowledging that the KS in general, or its lik elihood of recurring will be unaffected. Systemic chemotherapy is used to t reat extensive visceral involvement, Knowledge of the pathogenesis of disea se has led to the development of novel treatment strategies, aimed at HHV8 as the target of therapy. or at the inflammatory cytokine or angiogenic mil ieu necessary for KS growth. Use of highly active anti-retroviral therapy, aimed at controlling the underlying HIV infection, has been associated with a dramatic decrease in the incidence of KS. and may also be useful in the treatment of existing KS disease. (C) 2001 Elsevier Science Ltd. All rights reserved.