Acquired immunodeficiency syndrome-related Kaposi's sarcoma: clinical features, staging, and treatment

The clinical course of acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) is highly variable, ranging from minimal stable disease to explosive growth. Although KS is primarily a cutaneous disease, extracutaneous spread is common; the oral cavity, gastrointestinal (GI) tract, lungs, and lymph nodes are often involved. The psychosocial burden associated with KS may be profound. The initial evaluation of a patient with KS consists mainly of a thorough physical examination with special attention paid to those areas typically affected by the disease, the testing of stool for occult blood, and a chest x-ray. Treatment options depend greatly on the tumor (extent of tumor and rate of growth), human immunodeficiency virus type I (HIV-I) viral load, and host factors (CD4+ T-lymphocyte count and overall medical condition). Limited cutaneous disease may be treated with topical alitretinoin gel, intralesional vinblastine, radiation therapy, laser therapy, or cryotherapy. The high benefit-to-risk ratio of liposomal anthracyclines (daunorubicin and doxorubicin) and paclitaxel have tremendously simplified the management of patients in whom systemic therapy is warranted. Additionally, epidemiologic evidence of a marked decline in new KS since the widespread use of highly active antiretroviral therapy (HAART) advocates its use. KS herpes virus/human herpes virus 8 (KSHV/HHV-8), sex hormones, and the processes of angiogenesis and cellular differentiation all serve as targets for pathogenesis-based clinical trials. Virtually all patients with KS can benefit from the many approved and investigational agents developed through years of collaborative translational and clinical research.