Page 128 - AIDSBK23C

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sometimes microscopically--resemble KS. When uncertain of the diagnosis, it is best to be
conservative. If the lesions really are KS, they will progress over time.
A variety of single agent or combination chemotherapeutic regimens have been employed
against KS, including Adriamycin, doxorubicin, vinblastine, vincristine, vindesine, etoposide,
and bleomycin, as well as alpha interferon therapy. Radiation therapy has also been employed
for localized, bulky or painful KS lesions. A combination of doxorubicin, bleomycin, and
vindesine has shown partial or complete remission in most cases. The combination of
Adriamycin, vincristine, and bleomycin has shown effectiveness in treating pulmonary KS.
Survival, however, may not always increase because of concomitant AIDS-related diseases, and
granulocytopenia and toxicity is common. At autopsy, the response to therapy for skin lesions is
demonstrated to be greater than that for visceral lesions.[543,547,557]
Treated KS lesions may show absence of atypical spindle cells with only a focus of
collagenous connective tissue remaining. More often, treatment leads to only partial regression,
with decreased numbers of atypical spindle or epithelioid cells, along with fibrosis, round cell
infiltrates, hemosiderin, and irregular vascular spaces. Diagnosis of such lesions is difficult and
is suggested at low power by the presence of a localized nodule or infiltrate.
The presence of KS appears to accelerate the clinical course of HIV infection.
Opportunistic infections develop earlier and more often in patients with KS, with significantly
shorter survival. However, death directly related to lesions of KS occurs in a minority of persons
with AIDS carrying a diagnosis of KS, usually as a result of massive pulmonary involvement
(Table 5).[558,417] KS exhibits a less aggressive presentation in patients already receiving
antiretroviral therapy (ART) compared to patients who are not receiving ART at the time KS is
diagnosed. The natural history and outcome do not appear to be influenced by the initiation of
ART before the development of KS.[559]