I was infected about one year ago and have maintained CD4s of 1100 to 1250 (50-56)with a viral load of 18,000 to 45,000. I have antibodies for HHSV 8. I am on no antivirals. I have a raised purple lesion on the hand for about two weeks associated with pain on touching. My doctor is monitoring for a few more weeks and will biopsy it if unchanged.

He has never seen KS in patients with my counts; usually seeing it at CD4s of 500 or less. What is your experience? If this is KS, does this bode badly for other lesions in this setting?

Your new answer: Although it is true that Kaposi's sarcoma does indeed occur more commonly in patients with lower CD4 counts, KS can indeed occur in folks with CD4 counts as high as yours (1100 to 1250). Usually, but not always, folks with KS in the setting of high CD4 counts have more mild disease.

There's a bigger question here-- should you be on HIV drugs (HAART) if you indeed do have KS? No one knows the answer to this question. PLease note that the guidelines which say that one should be on HAART therapy when you CD4 count is in the 200-350 range do NOT apply to you. Those guidelines apply only to patients who are not symptomatic (e.g. no KS).

So what would I recommend for you?? First you should have your lesion biopsied. If you do indeed have a KS lesion and you are HIV positive, this would give you an AIDS diagnosis. You could then see what happens over the course of time in terms of developing new KS lesions. If you do not develop new lesions and there is no sign of internal KS, then you may not need to start HAART therapy. However, if you pop up with new lesions, then HAART therapy is very reasonable.