ks (KAPOSI'S SARCOMA)

Question

Hi Dr Bob,

Just logged back in over the last couple of weeks... my bf started his meds in jan and his cd 4 has come up to 500 and he is undetectable at mo . He seeems so much healthier and has much more energy but has just been diagnosed with KS - he had a biopsy and his doc, who is an amazing guy said that they will wait to see what the HIV drugs will do - however they may have to look at other treatments if they don't clear. You couldnt give me some advice, what does this mean ? is it life threatening ? his doc said to wait until july and they will see then. What are your thoughts, I seem more worried than him!

Im prob just been a big poof yeah?

Love to you keep up the fab work ,

Worried UK x

Answer

Hello Worried UK,

That your boyfriend is responding both virologically (undetectable viral load) and immunologically (CD4 count skyrocketing to 500) is excellent and extremely encouraging news! Congratulations! Kaposi sarcoma (KS) is a type of cancer triggered by a herpes virus called Human Herpes Virus 8 (HHV-8). KS affects about 20% of HIVers who aren't taking anti-HIV drugs. The rate of KS has dropped dramatically (over 80 %!) since the introduction and increased use of HAART (highly active antiretroviral therapy) in the mid-1990s. KS occurs eight times more frequently in men than women and involves the development of many new, tiny blood vessels. This process is called angiogenesis.

KS on the skin is not life threatening; however, if the lesions are extensive, they can be disfiguring and make walking difficult if the feet and legs are involved. KS can spread to other body parts, such as the lungs and other internal organs, and become much more serious, even fatal.

The best treatment for KS is potent, effective HAART. This has been shown not only to stop further growth and spread of KS, but also to make existing lesions melt away. There are also a variety of other treatments that can be used for skin lesions if HAART is not working. These include:

  1. Local injections of cancer chemotherapy drugs

  2. Interferon alpha

  3. Radiation

  4. Panretin gel (retinoic acid)

  5. Liquid nitrogen

  6. Surgical excision

If KS has spread to internal organs, then systemic (whole-body) treatment is recommended. Doxil (doxorubicin), DaunoXome (daunorubicin) and Taxol (paclitaxel) have all been shown to be helpful.

There are also a variety of more experimental approaches being studied. These include anti-cytokine therapies to slow down the growth of KS, monoclonal antibodies and anti-angiogenesis drugs.

Your partner's HIV/AIDS specialist's advice seems right on track to me. Good luck to you and your partner. Give him a big hug from me, OK?

Dr. Bob