Occurrence, clinical behaviour and management of Kaposi's sarcoma in Zambia

The incidence of HIV related KS has increased 50-fold since it was first recognized in Zambia in 1983. The mean age at diagnosis is 35 years for men and 28 years for women, with a sex ratio of M:F = 5:1. The most common symptoms and signs are weight loss, symmetrical lymphadenopathy, oral plaques, skin plaques in a central distribution, oedema and cough with dyspnoea. Biopsy is needed to confirm the diagnosis if disease is confined to lymph nodes. Objective regression occurs in 80% of patients receiving adequate doses of actinomycin D and vincristine (median survival time greater than 3 years for stage I or II disease and 7.5 months for stage III); epirubicin with vincristine was more effective in a phase II trial. Both treatments give good relief of symptoms, allowing patients to return to work. Clinical, histological and biological features of HIV related KS do not support conclusively its classification as a "malignant tumour". Heterosexual and perinatal transmission of HIV in Africa ensures that KS affects families, not just individuals.