Clinical Manual for Management of the HIV-Infected ... - myCME.com

Treatment
Treatment of KS is not considered curative, and no
single therapy is completely efficacious. ART is a
key component of the treatment of KS and should
be initiated (or maximized) in all persons with KS,
unless contraindicated (for further information, see
chapter Antiretroviral Therapy). KS often regresses and
sometimes resolves in patients treated with effective
ART. Other treatment modalities may be used
concurrently, depending on the severity of KS and the
speed of progression. Consult with a KS-experienced
oncologist or dermatologist.
Specific treatment of KS depends on various factors
such as the number, extent, severity, and location
of lesions; cosmetic considerations; and presence of
visceral involvement. The goals of therapy may also vary
according to the clinical presentation and may include
controlling symptoms, improving cosmetic appearance,
reducing edema, eliminating pain, and clearing lesions.
Local treatment (preferably in conjunction with
ART) is usually given to patients who have a few
small lesions causing only minor symptoms. Systemic
therapy (in conjunction with ART) is needed for
more extensive or more severe disease, including
symptomatic visceral disease, widespread skin
involvement, significant edema, and rapidly progressive
KS.
Local treatment of limited disease
Options for local treatment of limited disease include
the following:
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ART followed by observation for response
(limited, stable cutaneous disease may require no
specific treatment)
Topical treatment with alitretinoin gel
(Panretin) 0.1%
Intralesional chemotherapy (eg, vinblastine)
Radiation therapy, for localized or facial lesions
(may cause mucositis when used
for oropharyngeal lesions)
Cryotherapy
Laser therapy
Section 6—Disease-Specific Treatment | 6–57
Treatment of extensive or rapidly progressing disease
Extensive or rapidly progressing disease may include
lymphedema, intraoral or pharyngeal disease that
interferes with eating, pulmonary KS, and painful or
bulky lesions. Options for treatment include:
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Intralesional chemotherapy (eg, vinblastine)
Systemic chemotherapy (eg, liposomal formulations
of doxorubicin or daunorubicin, vincristine,
paclitaxel [Taxol], etoposide [VP16], or bleomycin;
these agents can be used alone or in combination for
visceral or extensive cutaneous disease)
Interferon-alfa
Patient Education
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KS often responds to treatment. Educate patients
that ART is a cornerstone of treatment; encourage
them to start and adhere to ART.
Swollen or edematous lesions increase the risk of
cellulitis, whereupon lesions can become infected
and progress rapidly. Advise patients to avoid
injuring swollen or edematous lesions, to keep them
clean, and to call their health care provider if lesions
appear to be spreading or if swelling worsens.
Advise patients to return to the clinic if respiratory
or gastrointestinal symptoms develop.
Patients may use cosmetic preparations to cover
facial lesions. Refer patients to support groups or
counseling services if they are having difficulty
coping with their physical appearance.