Pulmonary Kaposi Sarcoma - Incidence

2/23/01 (Fernandez)

RE:  A 31 year old African-American HIV+ male presenting with dyspnea, cough, fevers, and hemoptysis.

Question:  What is the incidence of isolated Pulmonary Kaposi sarcoma?

Link Directly to Fulltext article in Ovid

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 20231605

Authors: Aboulafia DM.

Institution: Section of Hematology/Oncology, Virginia Mason Medical Center, Seattle, WA 98111, USA.

Abstract: AIDS-related Kaposi's sarcoma (KS) occurs principally in homosexual or bisexual men infected with the newly identified human herpes virus-8, also called KS-associated herpes virus. Unlike classical forms of the disease, AIDS-associated KS is a multicentric entity that frequently involves lymph nodes and the GI tract. KS may also occur in the lung, commonly in the setting of extensive mucocutaneous disease and very rarely as an isolated event. The exact incidence of intrathoracic KS in patients with AIDS is unknown. Before the advent of highly active antiretroviral therapy (HAART), pulmonary KS had been reported in approximately 10% of patients with AIDS, 25% of patients with cutaneous KS, and in roughly 50% of postmortem examinations of patients with AIDS, KS, and respiratory infections. In the HAART era, the incidence of KS has declined precipitously in North America and Europe but not in third world countries where HAART is largely unavailable. Pulmonary KS may cause radiographic infiltrates and respiratory symptoms that mimic a variety of other infectious and neoplastic processes. An aggressive diagnostic evaluation of patients who have this condition is essential because chemotherapy and radiation therapy may provide significant palliation, particularly if used in conjunction with HAART. This review briefly explores the changing epidemiology of KS. The pathology and pathogenesis of KS is also reviewed, along with the clinical and radiographic presentation, diagnosis, and management of pulmonary KS. [References: 160]

Link Directly to Fulltext article in Ovid

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 98255737

Authors: Afessa B. Green W. Chiao J. Frederick W.

Institution: Division of Critical Care, University of Florida Health Science Center, Jacksonville, USA.

Abstract: STUDY OBJECTIVES: To describe the pulmonary complications in patients with HIV infection, and the changes in the incidence of these complications over a 12-year period. DESIGN: Retrospective review of autopsy records. SETTING: Two university-affiliated medical centers. PATIENTS: We studied autopsy findings from 233 patients with HIV infection who died between 1985 and 1996. Demographic data, risk factors for HIV infection, and the lengths of hospital stay were obtained. The histologic and microbiological findings of the respiratory system, and the extrapulmonary organ involvement by Kaposi's sarcoma (KS), Pneumocystis carinii, Mycobacterium tuberculosis, and Mycobacterium avium complex were reviewed. RESULTS: Ninety-two percent of the patients were black and 75% were male. The two most common identified risk factors for HIV infection were homosexuality (34%) and injection drug use (27%). Bacterial pneumonia was the most frequent pulmonary complication (42%). The two most common causes of bacterial pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. P carinii pneumonia (PCP) was found in 24%, with extrapulmonary involvement in 13%. Pulmonary mycobacterial infections were seen in 33%, with multiple extrapulmonary involvement. The most common site affected by KS was the lung. Of all pulmonary complications, only the incidence of PCP decreased over the 12-year period. CONCLUSIONS: Recognizing the high incidence rate of bacterial pneumonia, the high frequency of pulmonary KS and the not uncommon occurrence of extrapulmonary P carinii infection in patients with HIV helps in improving their care.