Scand J Infect Dis. 1997;29(1):3-12. Unique Identifier : AIDSLINE
KS is the most frequent malignancy in homo/bisexual male AIDS patients,
affecting more than 30% of these patients. KS may present itself as a
few innocent cutaneous lesions or may show progression resulting in
severe morbidity and mortality. Approximately half of the patients may
develop severe progressive disease. The prognosis of patients with
progressive disease is poor, with a median survival of less than 6
months. There is no cure for AIDS-related KS, but several therapies are
available for palliation. The treatment options may be applied locally
or systemically. Radiotherapy is efficacious and safe, but only a few
lesions may be treated at one time. For severe progressive KS, systemic
therapy with various forms of chemotherapy is used. Three regimes in
particular have been focused on, namely bleomycin/vincristine (BV),
doxorubicin + BV (DBV), or liposomal daunorubicin (LD) administered
every 2 weeks. The agents result in a clinically relevant response (in
50-80% of patients) 2-4 weeks after initiation, but few patients have
complete remission of the KS (< 10%), and the tumour may relapse after
4-6 months despite continued therapy. BV is less effective but also less
toxic compared with the other regimens. Time to response for DBV may be
slightly better than for LD, but the overall efficacy of these 2 regimes
is similar. LD treatment is associated with significantly fewer episodes
of peripheral neuropathy and alopecia than treatment with DBV. Thus, the
recommended order of use of chemotherapeutic agents is BV, LD and DBV.
Alpha-interferon may have a role in the small percentage of patients
with CD4 cell count > 200 mill/L. In conclusion, several therapeutic
options are available for palliation of KS. All systemically applied
therapies are associated with severe side-effects and the optimal choice
of treatment is a careful balance between response and toxicity. The
recent discovery of human herpes virus 8 as a putative causative agent
for KS and new potent groups of anti-retroviral agents, may lead to the
development of more effective treatments of KS.
*AIDS-Related Opportunistic Infections/DIAGNOSIS *AIDS-Related
Opportunistic Infections/THERAPY *Sarcoma, Kaposi's/DIAGNOSIS
*Sarcoma, Kaposi's/THERAPY
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