Sunday, April 7, 2013

Kaposi's Sarcoma and HIV

Kaposi sarcoma (KS) also known as Kaposi’s cancer, is a tumor caused by Human herpesvirus 8 (HHV8), also known as Kaposi sarcoma-associated herpesvirus (KSHV).  Kaposi's sarcoma creates tumors below skin surfaces and in membranes of the mouth, nose, anus, or eyes. It can spread to the lungs, liver, stomach, intestines, or lymph nodes. This involves a process called angiogenesis, where tiny new blood vessels form.  

 There are four main types of Kaposi’s sarcoma.  

 1)  Classic Kaposi’s sarcoma, seen mainly in elderly Mediterranean and Eastern European men, more especially, in Italian and Jewish men, and rarely, in elderly women. 
2)  Endemic Kaposi’s sarcoma, seen mainly in young adult males in sub Saharan Africa. One form is also common in young African children. 
3)  Transplant Kaposi’s sarcoma, is contracted when a HHV-8 infected organ is transplanted into a patient who has not had a history of the disease Endemic Kaposi’s cancer.
Among these first 3 groups, the tumors developed slowly. 
4)  HIV related Kaposi’s sarcoma, is self explanatory but the cancers here develop very rapidly due to the persons weakened immune system.  Occasionally they will appear on a HIV+ person with a high CD4 count as well.  The KS that appears in this instance is most frequently the same type as Transplant KS.  Kaposi's Sarcoma is considered to be AIDS defining illnesses by both The United States Center for Disease Control (CDC) and The World Health Organization. (WHO) regardless of the CD4 count.  Kaposi's sarcoma can be deadly for a HIV+ person with a low CD4 count.
Symptoms

 The tumors are flat and painless, aren't itchy, and don't drain.  They appear as red or purple spots on white skin and bluish, brownish, or black on dark skin because they are rich in blood vessels.   They may grow into raised bumps or grow together.  Unlike bruises, they don't turn white when you press on them.  In some people, these growths change slowly.  In others, new spots may show up each week.  The lesions may first appear on the feet or ankles, thighs, arms, hands, face, or any other part of the body. The most visible signs of Kaposi's sarcoma are lesions on the skin, which are not life threatening.   They also can appear on sites inside the body causing other symptoms and can be life threatening. These other symptoms are:  

  1. Trouble eating or swallowing  
  2. Nausea, vomiting, and abdominal pain from internal bleeding and blockages  
  3. Severe swelling in your arms, legs, face, or scrotum  
  4. Serious coughing &/or shortness of breath.  
Exams and Tests

 Experienced HIV Medical Specialists may diagnose KS simply by looking at it. However, these “spots” can be signs of other skin conditions such as Melasma, Riehl's melanosis, Poikiloderma of Civatte, Erythromelanosis follicularis, Linea Fusca and Post inflammatory hyperpigmentation.  Thus, attempting to self diagnose “spots” is fraught with danger.  

 Always consult your HIV Medical Specialists regarding any “spots” that start to appear on your skin.  Your HIV Medical Specialists or Dermatologist may remove a sample of tissue from a spot and examine it under a microscope. Called a biopsy, this can confirm the diagnosis. If you have respiratory symptoms, your HIV Medical Specialists may recommend a bronchoscopy to view your breathing passages through a lighted tube. If you have gastrointestinal symptoms, an endoscopy may be used to view your gastrointestinal system through a lighted tube.  A computed tomography (CT) scan may also be used.  It is an imaging method that uses x-rays to create pictures of cross-sections of the body.  These pictures are then compared to pictures of normal tissue.   

 Treatment

 Kaposi sarcoma is not curable (in the usual sense of the word) but, like shingles, it can often be effectively palliated for many years, possibly even indefinitely.  This is the aim of treatment

 How this condition is treated depends on:

  1. How much the immune system is suppressed (immunosuppression)
  2. Number and location of the tumors
  3. Symptoms
Treatments include:

  1. Antiretroviral therapy against HIV (ARVs) is, in many cases, the best way to treat active Kaposi's sarcoma. It may even clear up the skin lesions. 
  2. Combination chemotherapy
  3. Single agent chemotherapy
  4. Freezing (cryotherapy)
  5. Radiation therapy
Lesions may return after treatment.  Treating Kaposi's sarcoma does not improve the chances of survival from AIDS itself.  The outlook depends on the person's immune status and how much of the HIV virus is in the patient's blood (viral load).  Thus, being compliant with your ARV regimen not only ensures you are healthier in other ways, is also the best way to ensure that lesions don’t reappear.

 Awareness

 It has been reported that only 6% of men who have sex with men are aware that KS is caused by a virus different from HIV.  Thus, there is little community effort to prevent KSHV infection. Likewise, no systematic screening of organ donations is in place.

 Prevention

 Blood tests to detect antibodies against KSHV have been developed and can be used to determine whether a patient is at risk for transmitting infection to their sexual partner, or whether an organ is infected prior to transplantation. However, these tests are not available except as research tools, and, thus, there is little screening for persons at risk for becoming infected with KSHV, such as sexually active men who have sex with men.  Safe sexual practices can prevent HIV infection. This prevents AIDS and its complications, including Kaposi's sarcoma.

I hope readers have found this post helpful.

Credits:  http://www.nlm.nih.gov/medlineplus/ency/article/000661.htm
                http://hivinsite.ucsf.edu/InSite?page=kb-06-02-04
                http://www.webmd.com/hiv-aids/guide/aids-hiv-opportunistic-infections-kaposis-sarcoma__
                http://www.aidsmap.com/Kaposis-sarcoma/page/1044692/
                http://emedicine.medscape.com/article/279734-treatment
                http://www.cancerin.com/2010/03/what-is-kaposi%E2%80%99s-sarcoma/
                http://www.nhs.uk/conditions/Kaposis-sarcoma/Pages/Introduction.aspx


Get tested, stay healthy and, if you’re HIV+, compliant with your ARV regimen,

Malcolm Brown.



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