Kaposi Sarcoma ( Part 5 ) : AIDS associated kaposi sarcoma : Pathology USMLE Step 1

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Kaposi Sarcoma ( Part 5 ) : AIDS associated kaposi sarcoma : USMLE Step 1 Pathology

AIDS-related or epidemic KS – AIDS-related or epidemic KS is the most common tumor arising in HIV-infected persons. KS is considered an AIDS-defining illness in the United States Centers for Disease Control and Prevention (CDC) guidelines. In the United States, KS was over 20,000 times more common in persons with AIDS than in the general population prior to the widespread use of potent antiretroviral therapy (ART), although its incidence has declined substantially since that time.

Epidemiology of AIDS-related KS — Although KS has been reported among all risk groups for HIV infection, it is most common in homosexual or bisexual men. AIDS-related KS is much less common in heterosexual injection drug users, transfusion recipients, women or children, and hemophiliacs .

In patients with AIDS-related KS, the CD4 count appears to be an important factor associated with the development of KS. In a series of 70 patients who presented with a new diagnosis of KS while on treatment with combined ART, the rate ratios for developing KS for patients with CD4 counts greater then 200, 200 to 349, and 350 to 499 cells/mm3 were 18.9, 3.6, and 4.1, compared with those with greater than or equal to 500 cells/mm3

However, trends in earlier initiation of ART and improved health care continuity have altered the epidemiology of AIDS-related malignancies. In a study including 466 patients with AIDS-related KS, less than half of KS cases diagnosed between 2007 and 2011 were in patients with CD4 counts greater then 200, with 29 percent having a viral load greater then 500 copies/mL . This reflects the growing proportion of the HIV population that, due to ART, has higher CD4 counts and suppressed viral loads, rather than an increased risk of cancer among such patients. In resource-rich areas, AIDS-related KS is predominantly a disease of men. In contrast, in resource-poor areas such as sub-Saharan Africa, AIDS-related KS is also more frequent in males, although the difference is less pronounced.

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