Management of AIDS-related Kaposi sarcoma: advances in target discovery and treatment

Kaposi sarcoma (KS) is the most common tumor arising in HIV-infected patients and is considered an AIDS-defining illness by CDC guidelines. Recent advances in the elucidation of the pathogenesis of KS continue to uncover potential targets for therapies. Such targets include the KS herpesvirus/human herpesvirus 8 and the processes of angiogenesis and cellular differentiation. Five agents are currently approved by the FDA for the treatment o KS: alitretinoin gel for topical administration and liposomal daunorubicin, liposomal doxorubicin, paclitaxel, and interferon-alpha for systemic administration. Many more agents, particularly angiogenesis inhibitors and other pathogenesis-targeted therapies, are in clinical development. With increasing recognition that effective antiretroviral regimens are associated with both a decreased proportion of new AIDS-defining KS cases and a regression in the size and number of existing KS lesions, most, if not all, patients with KS should be advised to take antiretroviral drugs that will maximally decrease HIV-1 RNA levels.