The value of a clinical definition for epidemic KS in predicting HIV seropositivity in Africa

Article Abstract:

Kaposi's sarcoma (KS; a form of cancer characterized by lesions on the skin) has been seen in certain African countries for about 30 years. Older males are most commonly affected by this classic, or endemic, KS, and many survive with the condition for 10 years or more. With the AIDS epidemic has come an increase in the number of cases of KS seen in Africa and in other parts of the world, and the strain of KS most often seen in HIV-seropositive individuals (those infected with the human immunodeficiency virus) is much more aggressive (known as epidemic KS). It responds less well to treatment and is more prone to relapse than classic KS, and it afflicts a much younger population. In most instances, blood testing for HIV antibodies has been used to distinguish epidemic (HIV-related) KS from classic KS. The present study sought to determine if the clinical characteristics of epidemic KS and classic KS are sufficiently different to use them as a basis for differential diagnosis. If they are, there would be less need for expensive HIV testing. A clinical definition was written for epidemic KS, and histories and physical evaluations were obtained for 235 patients who had KS. Those who were symptomatic had chest X-rays and gastrointestinal endoscopies (a flexible instrument was inserted to view the inside of the stomach), and 80 percent (174 patients) had blood tests for HIV antibodies as well. Using the clinical definition to predict whether a patient was HIV seropositive, the definition had a sensitivity of 91 percent and a specificity of 95 percent. It was concluded that the clinical definition was a useful way to distinguish between those with HIV-related (epidemic) KS and those with classic KS; knowledge of the type of KS allows for use of the appropriate treatment techniques. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, HIV infection, HIV infections, HIV patients, Africa, HIV seropositivity, HIV positive

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The relationship between Kaposi's sarcoma and intestinal parasites among homosexual males in the United States

Article Abstract:

Patients with AIDS have a significantly higher incidence of intestinal parasites, including those that cause disease, than other individuals. The immune system, and specifically cell-mediated immunity, must be functional in order for the body to resist intestinal parasites. Since the immune system is compromised in AIDS patients, it is not surprising that parasitic infections occur. One type of parasite, the ameba, causes chronic stimulation of the immune system, which leads to the inability to mount an effective immune response against a particular infectious agent. One study showed that the existence of amebiasis in individuals infected with the human immunodeficiency virus (HIV) was the most significant factor differentiating between those whose infection developed into AIDS and those whose infection did not. Another study showed that AIDS patients with Kaposi's sarcoma (KS) who had an increased incidence of oral-anal insertion sexual practices were more likely to have parasitic infections than AIDS patients who developed opportunistic infections. These data also suggested a link between intestinal parasites and the development of KS, due to both chronic stimulation of the immune system and infection with HIV. It is concluded that efforts to eliminate parasites from the intestinal tracts of homosexual men, and the decline in oral-anal sexual practices known to transmit amebiasis, may be contributing to the decrease in the incidence of KS that has been seen in the United States in recent years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, AIDS (Disease), Protozoan diseases, Parasitic diseases, Amebiasis

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Kaposi's sarcoma: introduction and overview

Article Abstract:

In the early 1980s, Kaposi's sarcoma (KS) was most often seen in homosexual men and was frequently found to be the first sign of AIDS. Over 40 percent of AIDS patients had KS. Since 1986, the proportion of AIDS patients with KS has decreased to below 20 percent. KS is a cancer of endothelial cells, cells that line the blood and lymph vessels, the heart, and other cavities of the body. The tumor can cause various clinical symptoms and signs, including skin lesions. The cause of KS is not known. It is possible that an infectious agent or other cofactors, such as chemicals, genetic predisposition, hormones, or the dysfunction of the immune system, may cause KS. There is evidence that the lesions in KS are stimulated by growth factors that are induced by HIV, the human immunodeficiency virus. The lesions stimulate the growth of blood and lymph vessels and cause the development of spindle-type cells. Eventually, the lesions produce their own growth factors. The role of the immune system in the development of KS is not certain. Stimulation of the immune system causes the production of growth factors that result in proliferation of endothelial cells, including those in blood vessels. The author concludes that the development of KS is related to geographic, environmental, genetic and acquired conditions. (Consumer Summary produced by Reliance Medical Information, Inc.)

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