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2018 AUG 11 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Research findings on Skin Diseases and Conditions - Kaposi Sarcoma are discussed [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S1055-3290(96)80055-0 Byline: Sarah C. Fogel (a), Mary L. Gillaspy (b) Abstract: Epidemic Kaposi's sarcoma, which has consistently been the most prevalent malignancy in people with HIV disease, frequently presents with lesions in the oral cavity. Guidelines for treating oropharyngeal lesions with radiotherapy are ubiquitous in the literature. Treatment indications include pain, dysphagia, and obstruction. Radiotherapy dosage and fractionation differ from that prescribed for non HIV-infected people. Current literature reveals better treatment outcomes for people infected with HIV if treatment is managed by practitioners experienced in HIV care. This article presents a review of the literature and a case study of a HIV-infected patient who experienced severe adverse effects of irradiation. Author Affiliation: (a) School of Nursing, Vanderbilt University Medical Center, Nashville, TN USA (b) The Learning Center, University of Texas M.D. Anderson Cancer Center, Houston, USA

Elevating the body temperature of HIV-infected people with Kaposi's sarcoma (KS) appears to be safe and may cause a regression of KS and a decrease in the amount of HIV in blood plasma. Six men with AIDS and KS underwent whole-body hyperthermia (WBHT), in which their core body temperature was raised to either 40 or 42 degrees Celsius for one hour. Researchers used heat blankets in combination with a system that pumped blood to and from the person's body to heat it while controlling its chemistry and fluid balance. No serious side effects occurred in the patients as a result of the treatment. Regression of KS occurred immediately after WBHT at both temperatures, but this effect was not observable 1 week after treatment. Plasma HIV RNA levels decreased after the 42-degree WBHT treatment, but this effect was also not maintained after 1 week. In the 40-degree WBHT group, CD4 immune cell numbers were reduced throughout an 8-week follow-up period.

Photodynamic therapy (PDT) for treatment of AIDS-related cutaneous Kaposi's sarcoma (KS) is not recommended because of side effects and a disfiguring result. Eight HIV-positive homosexual men received nine treatments of Photofrin and laser light on a total of 83 lesions. Side effects included swelling, muscle stiffness, blisters, pain, scarring, and increased pigmentation of the lesion. Itching and blistering resulted from an inflammatory reaction. Tumors on the head and neck tended to respond better to photodynamic therapy than tumors on the extremities, possibly because these lesions were younger tumors. Larger, raised lesions recurred more often which could be due to unsatisfactory light penetration. The response rate of PDT of 60-70% at five months in this study is considered on par with other treatments such as chemotherapy and radiotherapy, but the side effects prohibit recommendation.

The incidence of three malignancies has increased in conjunction with the epidemic of human immunodeficiency virus (HIV) disease, and they are currently considered acquired immunodeficiency syndrome (AIDS)-defining conditions. These are Kaposi's sarcoma, associated with AIDS since the onset of the epidemic in 1981; intermediate or high-grade B-cell lymphoma, which became AIDS-defining in 1985; and cervical carcinoma in HIV-infected women, formally recognized as an AIDS-defining diagnosis on January 1, 1993. Approximately 40% of all patients with AIDS have developed cancer during the course of HIV infection. Further, as survival has improved in HIV disease, the incidence of these malignancies has increased. It is thus expected that greater numbers of patients with AIDS-related lymphoma and cervical cancer will be diagnosed in the years ahead. The epidemiologic factors associated with neoplastic disease differ among patients with the three AIDS-related malignancies. The pathogenesis of neoplastic disease also differs. The specific etiologic steps in the development of AIDS-related Kaposi's sarcoma and lymphoma are currently unknown. However, a great deal of information has already been acquired, which may have bearing on the pathogenesis of malignant disease in general, as well as the elucidation of future therapeutic modalities. The specific epidemiologic, etiologic, and clinical characteristics of the AIDS-related malignancies will be described herein. It is hoped that this review will serve to outline our current understanding of this area, to introduce the questions and controversies which are apparent in the field, and to mention those areas in which future research might be focused.

Cryotherapy, or the application of very cold substances, such as liquid nitrogen, to the skin, has been used to destroy benign and malignant skin tumors. A phase II clinical trial was conducted to assess the treatment of skin lesions with liquid nitrogen in 20 patients with Kaposi's sarcoma (KS). KS is a type of cancer that can develop with human immunodeficiency virus (HIV) infection. (HIV is the virus associated with AIDS.) Subjects were treated every three weeks for approximately 11 weeks. Results revealed that 80 percent of the KS lesions were completely destroyed; the lesions lasted for a minimum of 6 weeks after the treatment period. An additional 5 percent of KS lesions responded partially. Response was not related to: the stage of HIV infection, as indicated by the number of CD4+ helper T cells (which are destroyed in later stages of infection); whether or not the individual was tolerant to the drug zidovudine, which is used in the treatment of HIV infection; the development of opportunistic infections during the treatment period; or previous treatment with other types of chemotherapy. However, subjects who did not have a history of opportunistic infections, which readily occur in patients with KS, responded better to the cryotherapy. (Opportunistic infections occur in patients with poor immune function, and are common among individuals with HIV infection.) Side effects of the treatment were minimal, and included blistering and limited local pain, which was treated with acetaminophen (Tylenol). However, when tissues from the treated area were examined microscopically, residual cancerous tissue was often seen, especially deep in the skin. This indicates that the lesions may reappear on the skin and cryotherapy may have to be continued. Therefore, cryotherapy with liquid nitrogen is recommended for KS lesions that respond slowly or have a poor cosmetic result after systemic treatment for KS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kaposi's sarcoma is characterized by the formation of several areas of cell proliferation, initially in the skin and, eventually, at other body sites, such as the internal organs and lymph nodes; these lesions may become cancerous. Kaposi's sarcoma was first described in 1872 and occurred most often in elderly Eastern European men. More aggressive forms of the disease were reported in young black men of Central Africa in the mid-twentieth century. Patients who are given drugs to suppress their immune system, such as kidney transplant recipients, also tend to develop Kaposi's sarcoma. In 1981, the increased incidence of an unusual widespread form of Kaposi's sarcoma detected in homosexual men in New York and California marked the beginning of the AIDS epidemic. Ninety-five percent of AIDS-related Kaposi's sarcoma (AIDS-KS) have occurred in homosexual men; the remaining 5 percent have occurred in other high-risk groups. The incidence of AIDS-KS in men decreased from more than 40 percent in 1981 to less than 20 percent in 1989. It is not clear why AIDS-KS remains prevalent among homosexual men. The cause of Kaposi's sarcoma is not known, but may be related to growth factors, cancer-causing genes, genetic predisposition, environmental factors, or a virus-like agent. Some methods used to treat Kaposi's sarcoma include radiation therapy; cryotherapy (cold treatments); electrocauterization (the destruction of tissue using an electric current); surgical removal; and various anticancer agents, including alpha-interferon. These treatments help to control the symptoms, but do not prolong survival. (Consumer Summary produced by Reliance Medical Information, Inc.)