Treatment

After a diagnosis of KS is made, several factors are weighed in deciding whether to treat it, including:

  • The number of lesions.
  • Whether lesions are internal, or associated with serious swelling (oedema)
  • CD4 cell count.
  • Age.
  • The presence of associated symptoms such as fever, night sweats or weight loss.
  • Prior opportunistic infections.

If lesions are external, limited and occur in someone with a CD4 count above 200 cells/mm3, chemotherapy is not recommended. Instead antiretroviral treatment should begin. Although a randomised trial has not tested the effect of starting antiretroviral therapy on KS, there are many case reports of the shrinkage and disappearance of skin lesions after starting antiretroviral therapy.

KS on the skin is not, in itself, a life-threatening condition and there is no evidence that the treatment of one or two small skin lesions makes any difference to life expectancy. Deciding to leave KS untreated also avoids the toxic effects of chemotherapy, which may also be immunosuppressive.

Rapidly progressive or disfiguring skin lesions may be treated with chemotherapy.

If lesions are internal and occur in someone with a very low CD4 count, are accompanied by swelling, internal obstruction and symptoms, chemotherapy will usually be recommended.

There are a range of treatments available for KS. These include local or general chemotherapy and pathogenesis-based treatments. The current standard of care for KS is liposomal doxorubicin (Caelyx / Myocet) for 21 days or DaunoXome for 14 days. Where KS does not respond to initial treatment, or relapses after initial chemotherapy, paclitaxel (Taxol) (a cancer drug also used in the treatment of ovarian and breast cancer) is recommended as a 14-day course of treatment.

Chemotherapy for KS may be difficult in countries where access to drugs outside the World Health Organization Essential Drugs List is limited, because the only chemotherapy agents included in this list are vincristine and methotrexate, both of which have shown limited efficacy in treating KS lesions.