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SAN FRANCISCO — Some HIV-infected patients who are well managed on highly active antiretroviral therapy are developing Kaposi's sarcoma, Dr. Toby A. Maurer said at a meeting on HIV management sponsored by the University of California, San Francisco.
In this trend, which has been identified in San Francisco by Dr. Maurer and her associates, patients often have CD4 counts of 300 and even 600 cells/mcL and low viral loads. Yet they have the telltale purple blotches of Kaposi's, said Dr. Maurer, chief of dermatology at San Francisco General Hospital.
Dr. Maurer said that these are not flares of Kaposi's, which can sometimes happen at the start of highly active antiretroviral therapy (HAART). Rather, these are occurrences in patients who are fairly well maintained on the therapy.
The main question is whether these patients have developed abnormal T-cell function over time on HAART, despite high CD4 cell counts, thus causing the loss of immunologic control of their Kaposi's sarcoma; or, alternatively, whether their systemic disease was not detected and treated.
“We're really trying to understand these patients and, more importantly, clinically we are trying to decide what to do with these patients because antiretrovirals don't seem to do it,” Dr. Maurer said. “And, [the patients] are not sick enough nor do they have evidence of systemic KS to warrant chemotherapy.”
Although she said there is still no good, reliable method of detecting Kaposi's that has spread and is systemic, Dr. Maurer offered a suggestion to those checking Kaposi's lesions on the legs: Look for edema in the appendage because that is a sign of systemic disease. Systemic disease has a high mortality rate, about 25%; those patients need more than just antiretrovirals.
Physicians who've seen patients on HAART who have had a recurrence of Kaposi's sarcoma should contact Dr. Maurer by e-mail at maurert@derm.ucsf.edu
SAN FRANCISCO — Some HIV-infected patients who are well managed on highly active antiretroviral therapy are developing Kaposi's sarcoma, Dr. Toby A. Maurer said at a meeting on HIV management sponsored by the University of California, San Francisco.
In this trend, which has been identified in San Francisco by Dr. Maurer and her associates, patients often have CD4 counts of 300 and even 600 cells/mcL and low viral loads. Yet they have the telltale purple blotches of Kaposi's, said Dr. Maurer, chief of dermatology at San Francisco General Hospital.
Dr. Maurer said that these are not flares of Kaposi's, which can sometimes happen at the start of highly active antiretroviral therapy (HAART). Rather, these are occurrences in patients who are fairly well maintained on the therapy.
The main question is whether these patients have developed abnormal T-cell function over time on HAART, despite high CD4 cell counts, thus causing the loss of immunologic control of their Kaposi's sarcoma; or, alternatively, whether their systemic disease was not detected and treated.
“We're really trying to understand these patients and, more importantly, clinically we are trying to decide what to do with these patients because antiretrovirals don't seem to do it,” Dr. Maurer said. “And, [the patients] are not sick enough nor do they have evidence of systemic KS to warrant chemotherapy.”
Although she said there is still no good, reliable method of detecting Kaposi's that has spread and is systemic, Dr. Maurer offered a suggestion to those checking Kaposi's lesions on the legs: Look for edema in the appendage because that is a sign of systemic disease. Systemic disease has a high mortality rate, about 25%; those patients need more than just antiretrovirals.
Physicians who've seen patients on HAART who have had a recurrence of Kaposi's sarcoma should contact Dr. Maurer by e-mail at maurert@derm.ucsf.edu
SAN FRANCISCO — Some HIV-infected patients who are well managed on highly active antiretroviral therapy are developing Kaposi's sarcoma, Dr. Toby A. Maurer said at a meeting on HIV management sponsored by the University of California, San Francisco.
In this trend, which has been identified in San Francisco by Dr. Maurer and her associates, patients often have CD4 counts of 300 and even 600 cells/mcL and low viral loads. Yet they have the telltale purple blotches of Kaposi's, said Dr. Maurer, chief of dermatology at San Francisco General Hospital.
Dr. Maurer said that these are not flares of Kaposi's, which can sometimes happen at the start of highly active antiretroviral therapy (HAART). Rather, these are occurrences in patients who are fairly well maintained on the therapy.
The main question is whether these patients have developed abnormal T-cell function over time on HAART, despite high CD4 cell counts, thus causing the loss of immunologic control of their Kaposi's sarcoma; or, alternatively, whether their systemic disease was not detected and treated.
“We're really trying to understand these patients and, more importantly, clinically we are trying to decide what to do with these patients because antiretrovirals don't seem to do it,” Dr. Maurer said. “And, [the patients] are not sick enough nor do they have evidence of systemic KS to warrant chemotherapy.”
Although she said there is still no good, reliable method of detecting Kaposi's that has spread and is systemic, Dr. Maurer offered a suggestion to those checking Kaposi's lesions on the legs: Look for edema in the appendage because that is a sign of systemic disease. Systemic disease has a high mortality rate, about 25%; those patients need more than just antiretrovirals.
Physicians who've seen patients on HAART who have had a recurrence of Kaposi's sarcoma should contact Dr. Maurer by e-mail at maurert@derm.ucsf.edu