Clinical presentations and standard therapy of AIDS-associated Kaposi's sarcoma

Kaposi's sarcoma (KS) is the most common HIV-associated malignancy. The incidence of KS has varied, rising steadily during the 1980s, followed by a significant decline over the subsequent decade. The drop in KS incidence has been more dramatic since the widespread use of highly active antiretroviral therapy (HAART). Although the incidence of KS as an AIDS-defining illness has decreased, KS as a secondary AIDS diagnosis has continued to increase. The clinical course of KS remains unpredictable. For some patients, KS is an indolent disease, whereas for others, it may rapidly progress and contribute to morbidity and mortality. In spite of the apparent beneficial effect of HAART on KS incidence and natural history, there continue to be patients with well-controlled HIV infection (as measured by CD4 counts and HIV viral load) who develop progressive KS. Optimal therapy or long-term management strategies for progressive KS have not been defined. The degree of immune competence, the extent of KS and its rate of progression, HIV comorbidity, and patient goals, and preferences dictate the choice of treatment.