Hiv Infection

Kaposi's sarcoma, a warning sign of HIV infection

Kaposi's sarcoma (KS) was first described in the nineteenth century as a tumor more common among elderly men of Mediterranean or Jewish middle age. Kaposi's sarcoma is a malignant tumor composed of spindle cells and vascular elements. More recently, it has been seen in Africa where it is endemic, particularly in East Africa. The lesions of these groups were generally slow growing and responded readily to therapy. However, in association with HIV infection, the lesions of Kaposi's sarcoma may be more aggressive and sometimes quite resistant to therapy.

The causes and course of the disease:

The pathogenesis of Kaposi's sarcoma is unknown. A viral etiology is suggested by epidemiological characteristics. human immunodeficiency virus (HIV) itself is a cofactor in AIDS patients, as suggested by the induction of Kaposi's sarcoma.

Kaposi's sarcoma is characterized by multifocal lesions to widespread outbreak of disease. In the first stage of the patch or the lesions are small, flat and macular and may be reddish, pink, purple or brown. These lesions may be discrete they are easily overlooked. These lesions may involve skin, oral mucosa, lymph nodes and viscera, and new lesions appear throughout the disease. In rare cases the patient has a single skin lesion, often on the head or neck.

Intra-oral lesions may occur alone or in combination with the skin, visceral lesions and lymph nodes. Often, the first lesions of Kaposi's sarcoma appear inside the mouth. They can be red, blue or purple and can be flat or raised, solitary or multiple. The site is the most frequently reported oral hard palate, although the lesions can be found on any part of the oral mucosa, including the gums, soft palate and oral mucosa. KS lesions on the gums to produce a diffuse swelling of the gingival papilla, like periodontal disease or may sometimes seem like a gum-boil. The gingival lesions may be associated with gingival hypertrophy causing significant periodontal pockets. Periodontal pockets can become secondarily infected because of poor oral hygiene, and mucosal surface can become secondarily infected by Candida. When the lesions on the tongue, usually in the midline, they may be lighter in color, and several cases have been reported in KS showing a swelling of the lining of normal color.

Another unfortunate feature of Kaposi's sarcoma is approximately one third of patients subsequently develop a second cancer, usually lymphoma, leukemia or myeloma.

Clinical signs:

Four forms of Kaposi's sarcoma are recognized: 1. The classical or European form, first described by Kaposi in 1862, was endemic to older men of Eastern Europe (particularly Ashkenazi Jews) or Mediterranean origin. The tumor is rare in the United States, representing only 0.02% of all malignancies. Clinically, this form consists of red patches or purple multiple skin nodules mainly in the lower limbs, gradually increasing in size and number and spread to other sites proximal. The tumors often remain localized to the skin and subcutaneous tissue, but are locally aggressive, with an erratic course of relapses and remissions, often killing the patient. Visceral involvement occurs in 10% of cases and is usually clinically asymptomatic. 2. AIDS in Africa is clinically similar to the European form, but occurs in young men in Equatorial Africa.95 It has a very high prevalence in these regions, representing up to 10% of all tumors. Among children aged 2 to 3 years in Africa, the disease is often associated with generalized lymph node involvement, resembling lymphoma. 3. Kaposi's sarcoma associated with a kidney transplant. This form occurs in transplant patients undergoing immunosuppressive therapy. It is indicated in patients with Jewish or Mediterranean.