Doctors See Return of Kaposi's Sarcoma in Handful of AIDS Patients

By Randy Dotinga
HealthDay Reporter

WEDNESDAY, Sept. 26 (HealthDay News) -- San Francisco doctors say they've seen a small number of longtime HIV patients with mild cases of Kaposi's sarcoma, a potentially dangerous condition that once plagued people with AIDS.

It's not clear why Kaposi's sarcoma is making a comeback, or whether it may pose a significant health threat to AIDS patients. Still, it's unusual that the condition is appearing in people who have largely controlled the AIDS virus in their bodies, said report lead author Dr. Toby Maurer, associate professor of dermatology at the University of California, San Francisco.

Kaposi's sarcoma, a type of skin cancer that causes disfiguring lesions, was largely limited to Mediterranean men before the AIDS epidemic. When the epidemic began in the United States, many gay men with AIDS developed the condition, apparently because their bodies already harbored the virus that causes it, Maurer said.

Kaposi's sarcoma stigmatized AIDS patients by causing lesions on their faces, and some people died. But a new generation of AIDS drugs released in the late 1990s helped patients strengthen their immune systems and kept Kaposi's sarcoma at bay, at least in the Western world.

The condition remains common in Africa, where it affects both men and women, Maurer said.

The condition hasn't disappeared entirely in the United States, however, and is still seen in AIDS patients who don't take antiretroviral drugs.

In a new report, published in a letter to the editor in the Sept. 27 issue of the New England Journal of Medicine, Maurer and his colleagues said they've seen an "unusual" cluster of nine cases of Kaposi's sarcoma in patients who have their HIV infection under control.

The patients, who were diagnosed with Kaposi's sarcoma between 2004 and 2006, had been HIV-positive for an average of 18 years and had taken antiretroviral AIDS drugs for an average of seven years. The average age of the patients was 51.

"They've been doing well for a long period of time, and they have Kaposi's sarcoma," Maurer said. "We're curious as to what this means. Is something going on with their immune systems after years of HIV and drug therapy? It's a reminder of how HIV presented 25 years ago, and it brings up a lot of questions and worries."

Fortunately, the new cases of Kaposi's sarcoma are not severe, although they do begin with lesions, Maurer said. Doctors can use a variety of treatments, including injections and a topical gel, to treat the condition.

Dr. David Aboulafia, attending hematologist and oncologist at Virginia Mason Clinic in Seattle, said AIDS patients should know that Kaposi's sarcoma remains very rare, especially when compared to the early days of the AIDS epidemic, when it struck about one-third of patients. And the treatments available today are effective and fairly easy for people to tolerate, he said.

SOURCES: Toby Maurer, M.D., associate professor of dermatology, University of California, San Francisco, and chief of dermatology, San Francisco General Hospital; David Aboulafia, M.D., clinical professor of medicine, University of Washington, and attending hematologist/oncologist, Virginia Mason Clinic, Seattle; Sept. 27, 2007, New England Journal of Medicine

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