The Bay Area Reporter - July 2, 1996
Dean Knutson, ACT UP Writers Pool

Hank was diagnosed with KS in 1987 and his lesions have come most frequently during periods of high stress. Many of those lesions have then receded.

According to the CDC, KS is the cause of death in 10-12 percent of people with AIDS. While the percentage of cases in gay men are declining, the total number of cases are increasing. As people live longer with opportunistic infection prophylaxis and aggressive anti-viral treatments, those with KS are at risk for more serious problems related to this condition.

There are four subsets of Kaposi's Sarcoma (KS) that have been identified. Classic KS, African or Endemic, immunosuppressive KS, and AIDS KS.

Classic KS is a relatively slow-growing type of KS that appears on the legs of elderly men of Mediterranean, Eastern European, or Jewish heritage. This type of KS is chronic but less aggressive than the AIDS-associated KS.

African or Endemic KS can be slow-growing but is often very aggressive in children and young adults.

Patients receiving chronic immunosuppressive drug therapies, usually for organ transplants, can be affected by iatrogenic or immunosuppressive KS. Normally, there is a spontaneous remission when the immunosuppressive therapy is stopped.

(Note: It is interesting that this type of KS usually resolves completely when immunosuppressive drugs are removed. It may be productive to study this KS type to establish whether there are consistent factors, absent during suppression, that recur when immunosuppressive drugs are removed. It would also be interesting to study whether poppers and nitrites, which are immunosuppressive, have a direct effect on the development of KS and whether the severity of the KS is reduced when the immunosuppressive agents such as nitrites and poppers are removed or reduced.)

AIDS-associated, epidemic KS tends to be more variable and aggressive than the other forms. It occurs in males with AIDS ten times as often as it does in women, and typically affects homosexual and bisexual men, or women who have had bisexual partners.

Basic facts

KS is a systematic disease that usually appears on the face or lower extremities as a reddish, brown, or purplish spot on the skin called a lesion. The number and size of these lesions can change as the KS progresses. The lungs, inside of the mouth, lymph system, and other organs can be affected. KS is particularly dangerous when it occurs in the lungs, as it can cause fluids to build up making it difficult to breathe.

While it is still unclear what causes KS, some studies indicate that a herpes virus called HHV-8 or KS Herpes Virus (KSHV) may be responsible. Some researchers have discussed the possibility that KS is caused by a cascade of events or factors.

KS can be diagnosed by biopsy of the lesion. Chest x-ray or Gallium scans are also used for KS diagnosis.

There is not a cure or prophylaxis for Kaposi's Sarcoma at this time. However, there are treatments available now and treatments that are being tested in an effort to control KS.

In early stages of KS, local therapies can be applied to lesions. Radiation therapy, liquid nitrogen therapy, intralesional therapy (in which chemotherapeutic agents are injected directly into the lesion) and surgery are some commonly used strategies.

More aggressive approaches, usually for systemic KS, have included chemotheraputic agents or combinations of agents. ABV (a combination of Adriamycin (doxorubicin), bleomycin, and vincristine) has been one conventional therapy. DOXIL and DuanoXome have been recently approved for chemotherapy. Both DuanoXome, approved April of this year, and DOXIL (approved in 1995) are liposomal drugs. The medication is enclosed in fat, which enables more of the drug to be delivered to the tumor and less to spread throughout the body. This process limits side effects and toxicity in the rest of the body. These two drugs tend to have lower toxicity profiles than that of ABV.

Other studies with promising results

Foscamet was studied in five people with KS. The dose was l80 mg/kg/day for ten days. Four of the five had CD4 counts below 30. Three went into long term remission. One patient was free of relapse for 12 months and two were still in remission 13 and 20 months after the treatment.

HCG: Two women with AIDS-related KS were observed during pregnancy. Both women had a reduction in KS lesions. After pregnancy, the KS returned. HCG - Human Chodonic Gonadotropin - appears in women's urine and raises to higher than normal levels during pregnancy. Some have speculated that it is this level of HCG which partially accounts for the lower incidence of KS in women. An additional HCG trial at the AIDS Clinical Research Center in Washington DC also showed promising results. Regression was maintained for participants until financial constraints required a reduction in dose - at which point the KS returned.

Inhibitors to Angiogenisis (growth of blood vessels needed to support growth of tumors) are also being reviewed by some researchers. There are chemical and natural forms of these inhibitors. In AIDS Treatment News #196, John James writes briefly about genistein, which is found in high levels of the urine of those eating a soy-rich diet. Genistein had a strong anti-angiogenisis affect in laboratory tests. Perhaps this and other nutritional strategies would benefit the arsenal of tools to fight or control KS.

Retinoic acids have been shown to inhibit cell growth and, according to a ViRx spokesperson, to cause tumor cells to self-destruct. ViRx is currently running a study for Trentinoin, a type of retinoic acid. This is a naturally occurring form of Vitamin A, and the active ingredient in Retin-A. This form of Trentinoin is encased in fatty liposomal cells, much like DOXIL and DuanoXome, allowing more drug to be deposited directly to the lesions, resulting in reduced toxicity. ViRx also produces a topical gel ALRT-1057 containing retinoic acid.

Sixteen out of eighteen people have completed the 24- to 32-week study. According to Tom Webber, the study clinician, the results look promising. They are still enrolling for this study. For more information call Debbie Hildebrandt at ViRx (415) 353- 5623.

ACTion UPdate:

For those interested in speaking with other people about Kaposi's Sarcoma, whether your KS has improved with the addition of protease drugs or combination therapies, or strategies you would like to discuss, leave a message for Hank at the ACT UP/Golden Gate Office at (415) 252-9200.

ACT UP/Golden Gate normally meets Tuesdays at 7:30 at 592 Castro Street, Suite B, but the July 9 meeting has been canceled so activists can go to the AIDS conference in Vancouver.
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