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Kaposi's Sarcoma with a 426 CD4 count?
Apr 10, 2004

I have been positive for about 5-1/2 years and to date have not been on any meds. My most recent (late January) lab results were VL 30,000 and CD4s of 426. These numbers have been fairly constant over the past year or two. My CD4 level has never gone below 425.

The only prescription medications that I take are Propecia, Oxandrin (just finished a 3-month cycle to increase BMI), and the occasional Restoril. Following a visit to my doctor last week, I learned yesterday that the 4 or 5 small lesions on my arms and legs are not basal cell carcinoma but, in fact, KS. Somehow I had the impression that KS was an opportunistic infection that occurred once one was diagnosed with AIDS or certainly at a much lower CD4 level (like under 300). My general knowledge of KS indicates that HHV-8 is necessary (which presumably I have been exposed to) but not sufficient for KS to exist. While I await my new lab results over the next week, I have 2 related questions: "First,is there any plausible reason why/how I have gotten KS at this stage of HIV (CD4s of 426), short of my CD4's having really plummeted in just 10 weeks?" Other than a staph infection about a month ago (not MRSA), I've felt great and had no other medical problems since my labs in January. "Second, assuming my CD4s are still above 350 (the CDC guideline for meds), does the KS diagnosis virtually dictate that I must start meds or can the KS be treated separately without going on HIV meds?"

Thanks for your response in advance.

Response from Dr. Young

Thanks for your question and sorry to hear about your KS diagnosis.

KS typicaly occurs in persons with low CD4 counts, but can occur in persons with higher ones too (I have a couple of patients who were diagnosed with KS with CD4s greater than 500). I'd think that it's unlikely that your CD4s have plummeted, though this is a remote possibility that would still need to be explored and measured, because for anyone with an AIDS-defining event, like KS, I'd be thinking about starting therapy in the near-term future.

If you look closely at the HIV treatment guidelines, the 350 cell cutoff for starting therapy only applies to those persons who are asymptomatic or do not have an AIDS-defining event or diagnosis. Because of your Kaposi's sarcoma, all treatment guidelines (and I) recommend that you start on combination antiretroviral therapy.

Indeed, often the best treatment for KS (especially if it is limited only to the skin, and does not involve any internal organs) is to start HAART treatment for HIV.

Hope this clarifies things. Keep in touch. Good luck, BY



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