Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
AIDS-ASSOCIATED KAPOSI'S SARCOMA
AIDS Clinical Review 1990. Volberding P and Jacobson MA, eds. New York, Marcel Dekker, p. 115-28, 1990.. Unique Identifier : AIDSLINE ICDB/91675541 Kahn JO; Dept. of Medicine, Univ. of California-San Francisco, San; Francisco, CA
Abstract:
Kaposi's sarcoma (KS) was one of the first manifestations of the AIDS epidemic. Early in the HIV epidemic, 40-45% of AIDS patients (pts) developed KS as their index AIDS diagnosis. Recently, the incidence of KS, as an index AIDS diagnosis, has been reduced to 10% among all risk groups and 18% in homosexual men. Characteristics and management of AIDS-associated KS are reviewed, including epidemiology, etiology, and pathogenesis, evaluation and staging, limited intervention (local therapy and systemic interferon [IFN] therapy), and aggressive intervention. A complete evaluation of the pt with KS that includes clinical understanding of tumor burden, assessment of immunologic competence, detection of signs and symptoms of systemic infection, and determination of zidovudine tolerance may improve the staging of KS and provide a mechanism for assessing and optimizing a pt's response to therapy. The separation of KS into the two categories of limited disease and extensive disease permits therapy to be divided into limited and aggressive interventions. Limited disease usually requires local therapy consisting of cosmetic control of lesions on visible areas of the skin, whereas extensive disease usually requires aggressive therapy consisting of single or multiple agent chemotherapy and zidovudine. The unifying principle of local therapy is the induction of an inflammatory response leading to the clinical resolution of the KS lesion. Radiation therapy can be useful in this context; intralesional chemotherapy and tumor necrosis factor therapy have also been effective. IFN-alpha, alone or combined with zidovudine, has demonstrated anti-HIV effects, and antiangiogenic therapy is an area of active research with exciting clinical implications. The exact role of antineoplastic agents in aggressive therapy for KS remains undefined. Single agents demonstrating activity against AIDS-associated KS include vinblastine, etoposide, doxorubicin, and vincristine. Combination chemotherapy may increase the response rate of the KS lesions, but usually results in increased toxicities and an increased rate of opportunistic infections. There are no data suggesting that a higher response rate translates into improved survival. New areas of active research include combining chemotherapy with zidovudine. (43 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/THERAPY Combined Modality Therapy Cross-Sectional Studies Human Incidence Interferons/THERAPEUTIC USE Sarcoma, Kaposi's/*ETIOLOGY/THERAPY MONOGRAPH REVIEW 911030
M91A1115
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
