Epidemiology and Treatment of Kaposi’s Sarcoma in HIV-1 Infected Individuals in a Poor Resource Setting

Abstract

Kaposi’s sarcoma was first described in 1872 by Moritz Kaposi, a Vienna-based Hungarian dermatologist, as a rare multifocal angioproliferative tumour involving blood and lymphatic vessels in elderly men of Jewish origin (Kaposi, 1872). Before the AIDS epidemic three clinico-epidemiological forms with similar histological features have been described. The classic Kaposi’s sarcoma (KS) originally described by Kaposi is primarily a skin disease with a chronic indolent course that can sometimes regress spontaneously (Kaposi, 1872). Most of the cases occurred in elderly men of Mediterranean and Jewish origin. The African-endemic KS is seen in the indigenous population of sub-Saharan Africa (Franceschi & Geddes, 1995). It is also seen more commonly among male patients, but differs from the classic form in that it may affect a younger population and is more likely to spread to visceral organs and lymphatics. In addition, it has a variable clinical presentation ranging from a benign disease with few skin lesions to a widely disseminated disease associated with high morbidity and mortality (Franceschi & Geddes, 1995; Taylor et al 1971). Kaposi’s sarcoma seen in patients as a result of immunosuppression complicating organ transplantation may have chronic or progressive course and spontaneous remission after discontinuation of immunosuppressive therapy is observed in the majority of patients (Penn, 1979). The first description of AIDS-associated Kaposi’s sarcoma (AAKS) was in 1981, when Friedman-Kien et al (1981) reported some previously healthy young homosexual men with Kaposi's sarcoma involving lymph nodes, viscera, and mucosa as well as skin. This was associated with life-threatening opportunistic infections and a profound defect in cellmediated immunity. This aggressive and frequently fatal form of Kaposi's sarcoma is the most common cancer in patients with HIV infection (Schwartz, 2004). Before the discovery and widespread use of highly active antiretroviral therapy (HAART) KS was over 20,000 times more common in AIDS patients than the general population (Engels et al 2006). However, several studies showed that HAART reduced the incidence of KS in high income countries (.Franceschi et al, 2008; Pipkin et al, 2011; Simard et al, 2011). The cumulative incidence of Kaposi sarcoma declined from 14.3% during 1980 to 1989, to 6.7% during 1990