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Spreading KS
Mar 2, 2001

Hello Doctor: I was just diagnosed with KS. I have two lesions, one on the sole of my foot and one on my thigh. There are two other spots that are discolored that I have been watching. I started using Panretin gel. This morning I found two spots one on the back of each thigh, that are most likely new lesions. I will probably use the gel on them. I am taking Combivir and Viramune and have had good results Tcells from 140(9) to 357(19) and VL 390,000 to 50 after 4 months. My question is with the drug regimen and the gel, will my immune system be able to control the KS? If the two spots that I have been watching turn out to be lesions that would be 4 new lesions in a month. Does that mean that it is likely to spread internally? Does it indicate chemotherapy? I am very concerned because I have been in relatively good health.

Response from Dr. Dezube

The best defense against KS is a good immune system (i.e. a good offense)! With your relatively high CD4 count and low viral load, I imagine your body is fighting off the KS. However, I have seen patients who clearly have sky high CD4 counts and undetectable viral loads, who nevertheless develop KS. KS often stays on the skin. I would suggest both for medical reasons and for your peace of mind that you be checked out by your health provider. I would suggest a chest x-ray to see if you have any involvement in your lungs and an examination of your stool to see if you have any blood which might suggest KS of your bowels. My suspicion is that your KS will NOT spread internally given your relatively intact immune system. Chemotherapy with liposomal drugs (DaunoXome or Doxil) would be indicated if you developed internal involvement or if the lesions on your skin really began to spread (for instance 6 new lesions every month). I would give yourself another month to see the pace of the disease. As you reconstitute your immune system, the pace of your KS may slow. Good Luck.


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