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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: ♦ ♦ ♦ ♦ ♦ ♦ 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: ♦ ♦ ♦ 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 ♦ ♦ ♦ ♦ 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.
6–58 | Clinical Manual for Management of the HIV-Infected Adult/2006 References ♦ ♦ ♦ ♦ ♦ ♦ Centers for Disease Control and Prevention, National Institutes of Health, HIV Medicine Association/Infectious Diseases Society of America. Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents. MMWR Recomm Rep. 2004 Dec 17; 53(RR15);1-112. Available online at aidsinfo.nih.gov/Guidelines/GuidelineDetail. aspx?GuidelineID=14. Accessed June 16, 2006. Jones JL, Hanson DL, Dworkin MS, et al. Incidence and trends in Kaposi’s sarcoma in the era of effective antiretroviral therapy. J Acquir Immune Defic Syndr. 2000 Jul 1;24(3):270-4. Kaplan LD, Northfelt DW. Malignancies Associated with AIDS. In: Sande MA, Volberding PA, eds. The Medical Management of AIDS, 6th Edition. Philadelphia: WB Saunders; 1999:467-496. Paparizos VA, Kyriakis KP, Papastamopoulos V, et al. Response of AIDS-associated Kaposi sarcoma to highly active antiretroviral therapy alone. J Acquir Immune Defic Syndr. 2002 Jun 1;30(2):257-8. Saif MW, Little RF. AIDS-Related Malignancies. In: Abraham J, Allegra CJ, Gulley J, eds. Bethesda Handbook of Clinical Oncology; 2nd ed. New York: Lippincott, Williams and Wilkins; 2005:356-357. Tam HK, Zhang ZF, Jacobson LP, et al. Effect of highly active antiretroviral therapy on survival among HIV-infected men with Kaposi sarcoma or non-Hodgkin lymphoma. Int J Cancer. 2002 Apr 20;98(6):916-22.
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Table of Contents Clinical Manual f
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Clinical Manual for Management of t
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Preface—About this Manual | Clini
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Previous Editions Atlanta Contribut
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♦ ♦ ♦ ♦ ♦ | Clinical Manu
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Initial Physical Examination Backgr
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Genitals/Rectum • Inspect the gen
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Initial and Interim Laboratory and
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Section 1—Testing and Assessment
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Patient Education ♦ ♦ ♦ ♦ D
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Section 2—Health Maintenance and
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References ♦ ♦ ♦ ♦ ♦ ♦
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Occupational Postexposure Prophylax
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P: Plan Laboratory Testing Provide
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For hepatitis C, no recommended pro
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as hepatitis C or another sexually
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for treatment is appropriate, and b
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contact with the patient. Patients
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tablet daily of trimethoprim-sulfam
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Opportunistic Infection Prophylaxis
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Discontinuing Primary Prophylaxis P
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Latent Tuberculosis Background Late
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INH may cause liver toxicity and it
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Patient Education ♦ ♦ ♦ ♦
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Reducing Maternal-Infant HIV Transm
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Some states require written informe
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contraindicated during pregnancy be
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Section 3—Antiretroviral Therapy
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Nelfinavir (Viracept) Adequate drug
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Patient Education ♦ ♦ ♦ ♦
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Section 4—Complications of Antire
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♦ ♦ ♦ Toronto General Hospita
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Adverse Reactions to HIV Medication
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♦ ♦ ♦ ♦ ♦ Vital signs: No
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egimen, symptoms of fatigue could i
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Recreational Drugs and Antiretrovir
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Section 4—Complications of Antire
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LSD, Mescaline, Psilocin, and Methy
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Immune Reconstitution Syndrome Back
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A: Assessment In the appropriate cl
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♦ ♦ ♦ ♦ ♦ Navas E, Martin
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Eye Problems Background The immunos
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of
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Fever Background Although fever may
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Headache Background Headache may ha
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Lymphadenopathy Background Lymphade
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Treatment Treatment will depend on
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Neurologic Symptoms Background The
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Pulmonary Symptoms Background Short
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Treatment Once the diagnosis is mad
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Candidiasis, Oral and Esophageal Ba
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Page 246 and 247: Cervical Dysplasia Background Cervi
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Page 338 and 339: Toxoplasmosis Background Toxoplasma
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♦ Atovaquone 1,500 mg orally twic
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Linear Gingival Erythema Background
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Background Necrotizing ulcerating p
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Oral Health Background Examination
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Maxillary Tori; Mandibular Tori S:
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Periodontal Disease Background The
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Oral Hairy Leukoplakia Background O
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Oral Ulceration Background Oral ulc
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Oral Warts Background Oral warts ar
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Anxiety Disorders Background Anxiet
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Patient Education ♦ ♦ Behaviora
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Insomnia Background Insomnia is a c
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Suicidal Ideation Background Transi
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Section 8—Neuropsychiatric Disord
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P: Plan ♦ ♦ ♦ ♦ ♦ Check t
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Correctional Settings Background Ca
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Adherence Adherence is one of the m
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Karnofsky Performance Scale Backgro
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