Kaposi Sarcoma on the rise

By Michael Tambo
March 2012
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The HIV/Aids pandemic has brought with it serious social and psychological challenges as it does not only affect the infected people but also affects families, friends and relatives of the infected thereby making it a global epidemic.

HIV causes what are called opportunistic infections; these are infections, which take advantage of the opportunity offered by a weakened immune system.

This is one of the rare sicknesses of these opportunistic infections that is now related to HIV/Aids also associated with a virus called Kaposi’s Sarcoma Herpes Virus (KSHV) or Human Herpes Virus 8 (HHV8).

Kaposi Sarcoma is a highly vascular tumor of the skin characterised by soft purplish plaques and papules that form nodules, which typically start on the feet and ankles and then slowly spread across the skin of the legs, hands and arms.

It is caused by an overgrowth of blood vessels, which causes pink or purple spots or small bumps on the skin.

Kaposi Sarcoma in stage IV but it is unlikely to be serious as long as the CD4 cell count is above 250. People with lower CD4 counts are more likely to develop Kaposi Sarcoma that affects internal organs, such as the lymph nodes or lungs, with potentially life-threatening consequences.

KS can also affect some HIV-negative people and the first cases reported dates back as far as 1872 where a non-dangerous or benign form of the cancer in HIV-negative elderly patients of eastern Mediterranean was recorded.

According to Dr Peggy Emvula a Radiation Oncologist from the Radiotherapy Department at Windhoek Central Hospital, the condition can also occur inside the body, especially inside the intestines, lymph nodes and lungs and this can be fatal. She says this type of cancer differs from other cancers in that it starts in several areas of the body at once, while other forms of cancers start in one place and then spread.

Statistics from the Cancer Association of Namibia indicate that over the past six years there has been an increase in the number of people diagnosed with Kaposi Sarcoma and shows that the cancer mostly affects men as compared to women. The recorded figures for the years 2005 to 2011 for Kaposi Sarcoma shows that 309 cases were reported in 2005 and reduced in 2006 to 222, increased to 329 in 2008, to 440 cases in 2009, 274 cases in 2010 and in 2011, a total of 251 cases were reported of which 163 where men and 88 were women.

According to Dr Annelle Zietsman, the Head of Department at the Cancer Care Centre in Namibia, Kaposi Sarcoma ranks top amongst the other four types of cancer affecting many people in Namibia and among the people who come to the Cancer Care Centre for treatment.

The five types of cancer ranking from their order of commonality are Kaposi Sarcowa caused by HIV + Human Herpes Virus 8, skin cancer (caused by exposure to Ultra-violate rays from the sun), breast cancer (lifestyle), prostate cancer (lifestyle), cervix cancer (HIV-related) and colorectal (bowel) cancer, (lifestyle) respectively.

Dr Emvula says Kaposi Sarcoma is now far more common and spreads more aggressively through the body among patients with Acquired Immune Deficiency Syndrome (Aids), adding that Kaposi Sarcoma mainly affects people within the ages of 18 to 45 years.

“We normally receive 10 to 15 Kaposi Sarcoma patients per week and 99% of them are HIV-positive. Kaposi Sarcoma can also affect people who are HIV-negative if they have a lung infection,” says Dr Emvula.

Because of the HIV/Aids epidemic, Kaposi Sarcoma has left its obscure oncologic niche and entered into the daily lives of people since the 1990s.

Some of the common signs that can be noted in a person who is at a risk of being infected with this disease are dark spots, which can develop anywhere on the body and sometimes in the groin or armpits, according to Dr Emvula.

Research has also proven that the mouth is involved in about 30% of the cases for Kaposi Sarcoma and it is the initial evidence in 15% of Aids-related Kaposi Sarcoma. This disease mostly affects the hard palate, followed by the gums and if an infected person has developed lesions in the mouth, they may be easily damaged by chewing and end up bleeding or sufferring from secondary infection as well as interfere with the patient’s feeding patterns or their speech.

Dr Emvula also says most people come for treatment when the cancer is already at an advanced stage and the majority of them will be HIV-positive, thus they have to put them on the antiretroviral treatment.

The best way to diagnose Kaposi Sarcoma is by taking a sample from a skin lesion although experienced doctors may diagnose the cancer simply by looking at it. Kaposi Sarcoma inside the body can often be detected using X-rays and fibre-optic viewing instruments.

In many cases, the best initial approach to treating it is to lower the viral load and boost the patient’s immune system using HIV treatment. Like most other opportunistic infections, Kaposi Sarcoma often improves or disappears once HIV treatment is started. Also some anti-HIV drug combinations that include either protease inhibitors (PIs) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) can also be equally effective at treating and preventing Kaposi Sarcoma.

There is also a range of specific Kaposi Sarcoma treatments. If it only affects your skin, you may be able to use ‘topical’ therapies such as gels or creams, localised radiation therapy, injections of chemotherapy drugs into the lesions, or methods that freeze or burn them.

However Dr Emvula encourages members of the public to be very responsible and practice protected sex whenever they get into sexual contact with their partners as this can only be the remedy to curb and keep in control of the cancerous disease. PF