B21.0
DESCRIPTION
Kaposi Sarcoma (KS) is a malignancy of lymphatic endothelial origin associated with Human Herpes Virus-8, also known as KS Herpes Virus, infection.
KS may involve the skin, oral cavity, lymph nodes or viscera (especially lung and GIT).
Most patients have multiple lesions.
Lymphoedema is a common complication.
10–20% of cases of visceral KS will have no oral or skin involvement.
KS is an AIDS-defining illness (WHO clinical stage 4).
Although most cases are diagnosed on the typical macroscopic appearance of skin and oral lesions, biopsy confirmation is necessary for atypical lesions and if chemotherapy is considered. One important differential diagnosis is bacillary angiomatosis, which develops more rapidly.
MEDICINE TREATMENT
All patients with KS should be commenced on ART (see: Antiretroviral therapy) and cotrimoxazole prophylaxis (see : Opportunistic infection prophylaxis, with cotrimoxazole) regardless of CD4 count.
Many patients with limited mucocutaneous KS will have complete resolution or substantial regression on ART alone.
REFERRAL
Prior to referral, all patients must be started on ART.
- Radiotherapy/intralesional chemotherapy for symptomatic local lesions.
- Systemic chemotherapy is indicated in patients with poor prognostic factors:
- more than 25 skin lesions,
- rapidly progressive disease,
- visceral involvement,
- extensive oedema, or
- “B” symptoms, i.e. fever, night sweats, significant constitutional symptoms.
- Failure of KS to respond to ART.