Site Under Construction

AIDS-associated Kaposi sarcoma: A case series in the Philippine setting

Ricky H Hipolito, MD, FPDS, Ma Teresita G Gabriel, MD, FPDS, Johannes F Dayrit, MD, FPDS, FDSP, Ma Carmela P Bucoy, MD

Abstract

Introduction

Acquired immunodeficiency syndrome-Kaposi sarcoma (AIDS-KS) has unique clinical characteristics, often disseminated on presentation, a rapidly progressive course, and often fatal outcome. Describing the epidemiology and clinical characteristics of AIDS-KS in the Philippines may lead to early recognition, diagnosis, and management of this condition, which are the keys to preventing significant complications.

 

Case Series

AIDS-KS in 11 Filipino MSM patients with a mean age of 36.55 years (SD 11.54) was described. Violaceous plaques and nodules were present for an average of 5.1 months prior to diagnosis confirmed by biopsy. Histopathologic findings from all patients were consistent with KS.

The median CD4+ count of patients was 44 cells/microliter (range, 4 to 181). Six patients presented with opportunistic infections (OI)/AIDS-related conditions (ARC). The most common OIs observed were pulmonary tuberculosis, oropharyngeal candidiasis, and Pneumocystis jiroveci pneumonia. Nine patients improved with highly active antiretroviral therapy (HAART). One patient required modification on his HAART regimen, which was shifted to 2 NRTI and ritonavir-boosted protease inhibitor, and one patient died due to AIDS-related complications.

Conclusion

This series of 11 cases of AIDS-KS showed similar demographic, clinical and histopathologic characteristics to previously published studies. Findings suggest the need for earlier recognition and diagnosis. While HAART afforded clinical improvement in a majority of patients, other treatment options such as chemotherapy should be considered for appropriate patients.

References

  1. Gonçalves PH, Uldrick TS, & Yarchoan R. HIV-associated Kaposi sarcoma and related diseases. AIDS. 2017;31(14):1903-16. doi: 10.1097/ QAD.0000000000001567.
  2. Gangcuangco LMA. HIV crisis in the Philippines: urgent actions needed. Lancet Public Health. 2019 Feb;4(2):e84. doi: 10.1016/S2468-2667(18)30265-
    2. PMID: 30738505.
  3. Pires CAA, Noronha MAN, Monteiro JCMS, Costa ALCD, Abreu Júnior JMC. Kaposi’s sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital. An Bras Dermatol. 2018 Jul-Aug;93(4):524-8. doi: 10.1590/abd1806-4841.20186978. PMID: 30066758.
  4. De Boer C, Niyonzima N, Orem J, Bartlett J, & Zafar SY. (2014). Prognosis and delay of diagnosis among Kaposi’s sarcoma patients in Uganda: a cross-sectional study. Infect Agents Cancer. 2014;9;17. doi: 10.1186/1750-9378-9-17.
  5. Mehta S, Garg A, Gupta LK, Mittal A, Khare AK, & Kuldeep CM. Kaposi’s sarcoma as a presenting manifestation of HIV. Indian J Sex Transm Dis AIDS. 2011;32(2):108-10. doi: 10.4103/0253-7184.85415.
  6. Pantanowitz L, & Dezube BJ. (Kaposi sarcoma in unusual locations. BMC Cancer. 2008;8:190. doi: 10.1186/1471-2407-8-190.
  7. Crum-Cianflone NF, Hullsiek KH, Ganesan A, Weintrob A, Okulicz JF, Agan BK, & Infectious Disease Clinical Research Program HIV Working Group. Is Kaposi’s sarcoma occurring at higher CD4 cell counts over the course of the HIV epidemic? AIDS. 2010;24(18):2881-3.
  8. Damtie D, Yismaw G, Woldeyohannes D. Anagaw B. Common opportunistic infections and their CD4 cell correlates among HIV-infected patients attending at antiretroviral therapy clinic of Gondar University Hospital, Northwest Ethiopia. BMC Res Notes. 2013;6:534. doi: 10.1186/1756-0500-6-534.
  9. Johnson EL, Pierpont YN, Donate G, Hiro MH, Mannari RJ, Strickland TJ, et al. Clinical challenge: cutaneous Kaposi’s sarcoma of the lower extremity. Int Wound J. 2011;8:163-8. doi: 10.1111/j.1742-481X.2010.00763.x.
  10. Radu O & Pantanowitz L. Kaposi Sarcoma. Arch Pathol Lab Med. 2013;137(2): 289-94. doi: 10.5858/arpa.2012-01010-RS.
  11. Douglas JL, Gustin JK, Moses AV, Dezube BJ, & Pantanowitz L. Kaposi sarcoma pathogenesis: a triad of viral infection, oncogenesis and chronic inflammation. Transl Biomed. 2010;1(2):172.
  12. Nguyen HQ, Okuku F, Ssewankambo F, Magaret AS, Johnston C, Wald A, et al. AIDS-associated Kaposi sarcoma in Uganda: response to treatment with highly active antiretroviral therapy and chemotherapy. Infect Agents Cancer. 2009;4(Suppl 2):O5. doi: 10.1186/1750-9378-4-S2-O5.
  13. Stebbing J, Portsmouth S, Gazzard B. How does HAART lead to the resolution of Kaposi’s sarcoma? J Antimicrob Chemother. 2003 May;51(5):1095-
    8. doi: 10.1093/jac/dkg199. PMID: 12668573.
  14. Catedral L, Caro-Chang L, Tan HN, Velasco R Jr, King R, Ting, FI, et al. AIDS-related Kaposi sarcoma in a tertiary university hospital in Manila, Philippines: a report of six cases. Asian J Oncol. 2020;06. doi: 10.1055/s-0040-1713317.
  15. Gwaram BA. Clinical presentation and treatment outcome of HIV associated Kaposi sarcoma in a tertiary health centre in Nigeria. J Med Res.
    2016;2:110-3.

REquesting Permission

AIDS-associated Kaposi sarcoma: A case series in the Philippine setting