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  • 1.  recurrent Kaposi Sarcoma

    Posted 21 days ago

    Hello all! I have a 62 year old male, a long term survivor. He had Kaposi Sarcoma back in the early 90's which was treated with chemotherapy. He has been on HAART since then and has done very well over the years and maintains an undetectable viral load. He recently had a lump biopsied on his leg, and its KS! Have any of you ever had a patient living with HIV get KS back, despite having a good CD4 and undetectable viral load? Thanks!

    Kristi Walz, MD
    Sioux City, Iowa



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    Kristi Walz
    Siouxland Community Health Center
    Sioux City IA
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  • 2.  RE: recurrent Kaposi Sarcoma

    Posted 20 days ago

    Hi Kristi,

    Yep!   It happens.   I have two patients with viral suppression and adequate CD4 count reconstitution who have initial, or recurrent, KS.   Both cases were cutaneous limited.   I think the way to think about it would be that this guy would likely have much more severe disease if he was not suppressed. I read in CID that KS is 80 times or so more likely in some one with HIV and viral suppression compared with some one who is HIV negative.  So, this suggests that even though the CD4 count appears adequate, there is likely some type of  acquired defect in immune function in these patients that we can't quite identify. I don't think that this would change your strategy with him.   Thanks!



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    Adam Zweig
    AIDS Healthcare Foundation
    San Diego CA
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    Original Message


  • 3.  RE: recurrent Kaposi Sarcoma

    Posted 19 days ago
    Yes we have seen isolated local lesions in a few of our patients; could consider biopsy to confirm; if they are on stable ART the risk of dissemination or complications such as lymphedema appears to be low.
    Sent from my iPad


    Original Message


  • 4.  RE: recurrent Kaposi Sarcoma

    Posted 18 days ago

    Thank you everyone for your help!



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    Kristi Walz
    Siouxland Community Health Center
    Sioux City IA
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    Original Message


  • 5.  RE: recurrent Kaposi Sarcoma

    Posted 20 days ago
    Kristi,

    Interestingly, I have a patient of about the same age that was recently diagnosed with a KS lesion on the plantar surface of his foot. He is a long-term survivor; stable CD4 counts in the 400-500 range and virologist controlled (typically fully suppressed). In contrast to your patient however, he was never known to have KS in the past (nadir CD4 ~ 300 in the late 1980’s, early 1990’s).
    CT scan C/A/P wnl, oncology has referred to GI for an EGD.
    DHHS guidelines refer to increases in cases like these, but this is our center’s first experience. I’m interested to hear if there are more. Thanks for sharing!

    Roxanne Underwood FNP-BC, AAHIVS


    Original Message


  • 6.  RE: recurrent Kaposi Sarcoma

    Posted 20 days ago
    Edited by Michael Harbour 20 days ago

    Hi Kristi,

    I, too, have had several patients with KS despite virologic control and good immune reconstitution.  I  currently care for a 58 year old Nigerian cisgender male who had disseminated KS over a decade ago on his legs bilaterally.  He was successfully treated with chemotherapy and ART at that time.  Approximatley 3 months ago he developed profound recurrent left leg KS disease (multiple lesions on thigh, calf and foot) and leg edema.  All further work-up for other diseases was negative. He remains virologically controlled on Biktarvy and a Tcell count of 600-700 (20-25%).  Approximatey 3 years ago he had a robotic prostatectomy for prostate cancer in situ.  His PSA remains undetectable.  His only immune suppresive risk factor has been the use of steroid containing eye drops for chronic dry eyes.  I stopped these drops immediately upon his KS diagnosis.  I intensified his ART regimen by adding Prezcobix as there is a great amount of older data treating KS with protease inhibitors (it may be a better option).  He also is receiving IV nivolumab monthly and responding well.  Two weeks atter his first dose the lesions were improving.  Given the responses you have received, I imagine that recurrent (and de novo) KS may be more prevalent than what we are aware.   Please let us know how he does and how you treat him.

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    Michael Harbour, MD, MPH, FACP, AAHIVS
    Palo Alto, CA
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    Original Message


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