Jpn. J. Infect. Dis., 53, 2000

Laboratory and Epidemiology Communications
Highly Active Antiretroviral Therapy f♭r the Treatment of

Kaposi's Sarcoma Associated with Primary HumanImmunodeficiency Virus Type‑ 1 Infection
Ikumi Genka, Akira Yasuoka, Kiyoshi Saitoh) and Shinichi Oka*AIDS Clinical Center and JDepartment of Pathology, International Medical Center ofJapan,
Toyama I‑21‑1. Shinjuku‑ku, Too/0 16218655
Communicated by Hiroshi Yoshikura(Accepted August 1 , 2000)

Kaposi's sarcoma (KS) is a well‑known symptom or
acquired immunodeficiency syndrome. KS can be present inpatients with wide‑ra車ng CD4十T cell c?unts (CD4 count)but becomes increaslngly common as Immune function

declines･ Highly actiYe antiretroviral therapy (HAART)

consisting of a human !mmunodeficiency viruStype‑ 1 (HIV‑1) protease inhibitor ln COmbination with two nucleosideanalogues has been shown to decrease the plasma viral load,

leading to an increase in the CD4 count. This reconstitutionof the immune function has been shown to be an effective

treatment for KS and obviates the need for a specific KS
therapy (1). In this study, we describe a patient who developed

KS shortly after primary HIV‑ 1 infection and who achieved

complete remission of the KS lesions by means or HAART.
Figure. Hematoxylin and eosin stain (X 70) ofa thin section of an

A 52‑year‑old homosexual male was admitted to a hosp血learly Kaposi's sarcoma on the back (10 × 5 rrm in size). Bl00d vessels

on May 22, 1998, with a history of headache, fever, muscle

and spindle cells proliferated irregularly inthe demiS. Mild erythrocyte

weakness of the lower extremities and difrlCultyin urination.

extravasation and lymphocyte infiltration were observed. The walls

He had sensory disturbances of the face, trunk, both lower

ofthe blood vessels are thin, and endothelial cells are slightly swelled

extremities, and weakness of both iliopsoas muscles. The

but not atypICal. The spindle cells showed mild atypla, and a few

cerebrospinal fluid (CSF) showed lymphocyte dominantmitotic figures were seen.

pleocytosis. He was suspected of having an inflammatory
radiculoneuropathy. Starting on June 5, he was treated fわr 2

and on the lower extremities. These tumors were diagnosed

Weeks with prednisolone at a dose of 60 mg/day, and thendoses were decreased by 10 mg every week to reach a doseas KS by skin biopsy (Figure). On a visit the fわllowing mon仇,of 20 mg/day 4 Weeks later. The dose was further decreased

the CD4 count was 177/〟1. HIV‑1 RNA in the plasma wasto 15 mg/day on July 21, and this level was maintained till

8.3 × 105 copies/ml. The p24, gp41, and gp120 bands werethe medication was stopped. On July 3, his blood and CSF
were tested for syphilis uslng the nuorescent treponemal

positive in Westem blot. These results suggested that thisOn July 27, he was found to be infected with HIV. HIV‑1

patient was experiencing a Prlmary HIV‑ 1 infection.
HAART with zidovudine, 1amivudine and indinavir wascommenced on October 6, and prednisolone was discontinued
on October 20. After 4 months of HAART, the CD4 countincreased to 558/LL 1 and HIV‑ 1 RNA in the plasma decreased
to 560 copies/ml. During this time, the oral KS lesionsdisap‑

RNA in the plasma was 7.5 × 105 copies/ml. His CD4 countpeared, and the anterior chest and leg lesions tuned into scars.

was 620/〟1. In Western blot, p24 was detected. He was

No specific treatment for KS had been glVen.

antibody abso叩tion test; both samples were positive. A

diagnosis of neurosyphilis was made; treatmentwith aqueous
crystalline penicillin G was commenced on July 6 andcontinued f♭r 10 days.

referred to our hospital on August 1 I. He had oral candidiasis.

The neurologlCal signs and symptoms seen in this patient

NeurologlCal丘ndings were nomal. His only medication wasincluded headache, muscle weakness, and lymphocyte

prednisolone at a dose of 15 mg/day. OnAugust 1 1, his CD4

dominant pleocytosis of the CSF. Though the symptoms werecount decreased to 158/Ill, and in Westem blot, gp160 and

first attributed to inflammatory neuropathy and late neuro‑

gp41 bands, in addition to the p24 band, became positive.

syphilis, they were probably due to a prlmary HIV‑ linfection

HIV‑1 RNA in仇e plasma remained at 7.5 × 105 copies/ml,(2,3)･ KS is the most co.mmon neoplasm affecting HIV‑1

however. One month later, hematoma‑like tumors appeared

infected individuals, partlCularly in the gay population. The

in the oral cavity, on the back, on the right side orthe chest,presence of human herpesviruS 8 (HHVl8) (4) and immune‑
suppression appeared to be important factors for the devell*Corresponding author: Telmax: +8 1 ‑3‑5273‑5 1 93, E‑mail: oka@

opment of KS (5). It is interesting to note that, in our patient,
the incubation time from theinfection to the development ofimcj.hosp.go.JP166

Jpn. J. Infect. Dis., 53, 2000
KS lesions was very short, only 4 months. A possible reason
for this rapid development of KS lesions was the use ofsteroids. Progressive KS is usually treated with interferon‑

2. Tindall, B. and Cooper, D. A.(1991): Primary HIV infec‑
tion: host responses and intervention strategleS. AIDS,

α and other cytotoxic drugs (6)･ Howevヲr, these therapies

3. Tindall, B., Baker, S., Donovan, a., Bames, T., Roberts,5, 1‑13.

often cause myelo‑ and immune‑suppressIVe Side effects. In
our case, HAART cured the KS lesions without any seriousJ., Kronenberg, C., Gold, ∫., Penny, 氏. and Cooper, D.

A･ (1 988): Characterization of the acute clinical illness

side effects. Recovery of immune responses produced byassociated with human lmmunOdeficiency virus infec‑

antiviral agents probably enabled tumor regression to occurtion. Arch. Intem. Med., 148, 945‑949.
4. Chang, Y., Cesarman, E., Pessin, M. S., Lee, F., Culpepper,J., KnOWles, D. M. and Moore, P. S. (1994): Identification(1 ,7). HAART should perhaps be the first choice of therapy
for early stage KS.

or he叩eSVims like DNA sequences in AIDS‑associatedKaposi's sarcoma. Science, 226, 1865‑1869.

This work was supported by the Ministry ofHea)th andWelfare of Japan. The authors thank Helen Fraser for carefully

5. Antiman, K. and Chang, Y (2000): K叩OSi's sarcoma･ N･reading and editing the manuscrlpt.

Engl. ∫. Med･, 342, 1027‑1038･

6･ Yarchoan, R･ (1999): Therapy for Kaposi's sarcomF:
recent advances and experimental approaches. J. Acqulr.

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