VA Resident Report: What is the management strategy of Kaposi Sarcoma and pneumocystis pneumonia in a HIV positive patient?

The Bottom Line:

The management of pulmonary KS is challenging. There is a risk of precipitating IRIS upon initiating cART. Chemotherapy can also cause further immunosuppression and increase the risk of further infections. In many of these patients, initiation of cART with careful monitoring for IRIS and empiric treatment of suspected infections may be the best therapeutic option. In some patients, there was a hesitancy to start cART if there was a history of poor medication adherence. Many of these patients required prolonged hospitalization, where their adherence could have been carefully monitored and encouraged.

Kasturia, S., Gunthel, C., Zeng, C., & Nguyen, M. (n.d.). Severe Kaposi Sarcoma in an Urban Public Hospital. AIDS Research and Human Retroviruses, 33(6), 583-589.

The majority of patients were highly immunosuppressed when KS was diagnosed (median CD4 count: 11), and 68% had multiple organ involvement with KS. Comorbidities at diagnosis included hepatitis B (26%) and pneumocystis pneumonia (33%). Frequent reasons for admission included skin and soft tissue complaints (28.4%) and respiratory complaints (27.2%). The estimated median survival after KS diagnosis was 3.0 years. Lung involvement, liver involvement, poor performance status, and low CD4 T cell count (<50) were associated with lower survival.

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