Kaposi’S Sarcoma

Clinical description

Kaposi’s sarcoma (KS) is a vascular tumour associated with human herpesvirus 8 (HHV-8).

It is the most common tumor in HIV-infected individuals in Africa and is a WHO Stage IV AIDS illness.

The tumor may arise in multiple locations: most commonly skin, but any organ (excluding the brain) may be involved.

Four forms exist: classic, equatorial Africa endemic, secondary to iatrogenic immunosuppression, and HIV/AIDS related.

Investigations

• Erythematous violaceous cutaneous lesions, macular, patch, plaque, nodular, or exophytic; solitary,

localized, or disseminated

• Lymphoedema

Investigations HIV test with CD4+ cell count and FBC, Cr,liver function tests and coagulation assays; skin biopsy of lesion may be done to confirm diagnosis, although clinical diagnosis in setting of HIV infection is generally sufficient.

Treatment

• All patients with KS are eligible for ART regardless of CD4+ cell count:
• ART prevents new KS lesions.
• ART may induce immune reconstitution inflammatory syndrome (IRIS).
• Chemotherapy is indicated in patients with:
• KS lesions > 25 in number
• Extensive oedema
• Symptomatic visceral involvement
• IRIS

Need to weigh risks and benefits to decide whether to deliver and startchemotherapy vs. start chemotherapy while still pregnant. Regimens include:

• Paclitaxel alone
• Doxorubicin, bleomycin, and vinblastine or vincristine (ABV)
• Gemcitabine monotherapy may be used after previous treatment with ABV

KS and Pregnancy

• Case reports in the literature show that KS may improve or worsen during pregnancy, with a low-risk of

HHV-8 vertical transmission

• Given potential fetal toxicity of chemotherapy, non-threatening skin lesions without visceral involvement

should be monitored and managed conservatively References:

KAPOSI’S SARCOMA Union for International Cancer Control, 2014 Review of Cancer Medicines on the WHO List of Essential Medicines:http://www.who.int/selection_medicines/committees/expert/20/applications/KaposisSarcoma.pdf?ua=1.

Accessed 20 Oct 2017.

Brunet-Possenti, F., Pages, C., Rouzier, R., Dupin, N., Bagot, M., & Lebbé, C. (2013). Kaposi's sarcoma and pregnancy: Case report and literature review.Dermatology, 226(4), 311-4.