Kaposi's Sarcoma

Human Herpes Virus 8

Dr.T.V.Rao MD
 Moritz Kaposi
(1837 - 1902),

●
Moritz Kaposi (Hungarian: Kaposi Mór)
(b. 23 October 1837 in Kaposvár,
Hungary; d. 6 March 1902 in Vienna,
Austria) was an important Hungarian
physician and dermatologist, discoverer of
the skin tumor that received his name.
 Moritz Kaposi, 1872
identifies as incurable condition
●
The disease leads to
death, and it does so
within a short period of
two to three years...The
disease must, from our
present experience, be
considered from the
onset not only as
incurable but also as
deadly.“
Moritz Kaposi
 HIV infection Brings Kaposi’s
Sarcoma in prominence
●
Kaposi's sarcoma (KS) occurs more often
in men than in women and HIV-1-
associated KS has a high occurrence in
homosexual men (over 30%). Most
cultures of KS tumours yield cells with
properties of hyperplasic (not malignant)
endothelial cells under the control of
several cytokines.
Identified as AIDS defining illness
●
It became more
widely known as one
of the
AIDS defining illnesses
in the 1980s. The
viral cause for this
cancer was
discovered in 1994.
●
Identfied as latest
Human tumour virus
 Virology - KSV
●
KSHV is a herpes virus,
and is a large double-
stranded DNA virus with
a protein covering that
packages its nucleic
acids, called the capsid,
which is then surrounded
by an amorphous protein
layer called the tegument
, and finally enclosed in a
lipid envelope derived in
part from the cell
membrane.
Virology
●
KSHV is a lymph tropic
and more closely related
to EBV and herpes virus
saimiri.
●
The KSHV genome (165
kbp) contain numerous
genes related to cellular
regulatory genes
involved in cell
proliferation, apoptosis,
and host response
contributing to
pathogenesis.
 Secretions transmit Infection
●
KSHV appears to be shed in saliva
independent of subjects immune status
●
Viral DNA is detected in breast milk
samples in African patients.
●
HSHV 8 infects dividing B cells
CD45+phase

Dr.T.V.Rao MD
 Routes of Transmission
●
Sexaully transmitted
among men who have
sex with men. Who have
higher prevalence ( 30-
60%)
●
Infections are common in
Africa (>50%) with
infections acquired early
in life by nonsexual
routes, through contact
with oral secretions
 KSHV in organ recipients

●
The virus are
transmitted through
organ
transplantation, and
places the recipients
at risk of KSHV
related diseases.
 Prominent manifestations with
KSHV infections
●
Causes Kaposi’s sarcoma
●
Vascular tumors of mixed cellular
composition and is involved in
pathogenesis of body cavity based
lymphomas occuring in AIDS patients and
of multicentric Castleman”s disease.

Dr.T.V.Rao MD
 Types of Kaposi’s lesions

●
Kaposi’s tumours are divided into three groups,
based on appearance, with much overlap.
1 Nodular lesions are of varying size and thickness. They
are purple and will at times have a halo of brown or
yellow pigment around them.
2 Infiltrating lesions may be quite large, may be raised,
or grow downward beneath the skin.
3 Lymphatic lesions can mimic other causes of swollen
lymph nodes and may require a biopsy to rule out
infection.
 Kaposi’s sarcoma present with
varied lesions
●
Localised nodular
●
Locally aggressive
●
Generalised lymphadenopathy
●
Patch stage
●
Localised plaques
●
Infiltrative plaques
●
Disseminated cutaneous and visceral disease
●
Telangiectatic
●
Keloidal
●
Ecchymotic
●
Lymphangioma-like / cavernous disease
Purplish lesions of Kaposi's
sarcoma. Credit: NIH
Typical Lesions Of Kaposi's
Sarcoma
KSHV infection involving Oral cavity
KSHV infection presenting as
Dermal lesions
 Clinically Important Disease
●
A relatively rare type of skin malignancy that
tends to afflict elderly people or, especially,
those with an abnormal immune system as in
AIDS. Kaposi sarcoma is a highly vascular
("angioblastic") tumor of the skin characterized
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. In AIDS patients,
these tumours can also develop internally and
cause severe internal bleeding
Epidemic (AIDS-related) Kaposi
sarcoma
●
The most common type of Kaposi sarcoma (KS)
in the United States is epidemic or AIDS-related
KS. This type of KS develops in people who are
infected with HIV, the virus that causes AIDS. A
person infected with HIV (that is, who is HIV-
positive) does not necessarily have AIDS. The
virus can be present in the body for a long time,
typically many years, before causing major
illness. The disease known as AIDS begins
when the virus has seriously damaged the
immune system,
Classic (Mediterranean) Kaposi
sarcoma
●
Classic Kaposi sarcoma (KS) occurs in
elderly people of Mediterranean, Eastern
European, and Middle Eastern heritage.
Classic KS is more common in men than
in women. Patients typically have one or
more lesions on the legs, ankles, or the
soles of the feet. In comparison with other
types of KS, the lesions in this type do not
grow as quickly, and new lesions do not
develop as often.
 Endemic (African) Kaposi
sarcoma
●
Endemic Kaposi sarcoma (KS) occurs in
people living in Equatorial Africa and is
sometimes called African KS. KS herpes
virus infection is much more common in
Africa than in other parts of the world,
increasing the chance of KS developing.
Iatrogenic (transplant associated) Kaposi
sarcoma
●
When Kaposi sarcoma (KS) develops in
people whose immune systems have
been suppressed after an organ
transplant it is called iatrogenic, or
transplant-associated, KS. Most
transplant patients take drugs to keep the
immune system from rejecting (attacking
and killing) the new organ.
Frequency of Kaposi's sarcoma
as reported to CDC
●
Homosexual men — 20 to 30 percent
●
Heterosexual injection drug users (IDU)
— 3 percent
●
Transfusion recipients — 3 percent
●
Women or children — 3 percent
●
Haemophiliacs —1 percent
 Diagnosis
●
Viral DNA can be
detected in patient
specimens using PCR
assays.
●
Viral culture is
impractical
●
Serology
Antibodies to KSHV
Indirect
Immunofluorescence
Western Blot
ELISA methods
 Epidemiology
●
5 variants A – E
●
B type predominantly in Africa
●
Rates of seroconversion are higher risk
groups for Kaposi’s sarcoma
●
30% of the Gay men are seropositive
 Treatment
●
Several drugs were in trail or use
Foscarnet.
Gancilovir,
Cidofovir
With use of Above drugs KSHV replication
is reduced.
Antiretroviral drugs in Kaposi’s
Sarcoma

●
The rate of new
Kaposi's sarcoma is
markedly reduced in
HIV- positive patients
on effective
Antiretroviral therapy
Created for Medical and
Paramedical students in
Developing World
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com