Susan E. Krown, MD

In his article, Dr. Mitsuyasu concisely reviews a large body of data concerning the etiology, pathogenesis, epidemiology, and treatment of Kaposi’s sarcoma (KS) in the setting of the human immunodeficiency virus (HIV) infection. As he correctly points out, effective highly active antiretroviral therapy (HAART), with its consequent improvements in immune function and decrease in production of viral and cytokine cofactors that promote KS growth, has been partly responsible for the decline of KS incidence in areas with ready access to HIV therapy.

The need for an article such as the one by Little et al is a clear sign that progress is occurring in the treatment of AIDS-related Kaposi’s sarcoma (KS). Without such progress, there would be no urgent need to refine the tools currently used to evaluate the activity of KS treatment.

Since the first cases of AIDS-associated Kaposi’s sarcoma (AIDS/KS) were described in the medical literature in 1981,[1] various local and systemic therapies have been used in efforts to control this most common HIV-associated neoplasm. Many reviews have been published about the treatment of AIDS/KS, but almost all of them have been written by authors representing a single medical specialty, whether it be medical oncology, dermatology, or radiation oncology.

Kaposi’s sarcoma (KS) is an AIDS-defining neoplasm characterized by the development of lesions that histologically consist of proliferating spindle cells, vascular channels, and inflammatory cells.[1] The typical early presentation consists of painless pink, red, or purple macules or nodules on the skin surface or in the oral cavity. Although the presence of a few skin lesions is not life-threatening, even limited cutaneous KS can have an enormous psychosocial impact, particularly when the lesions occur on exposed areas.