Shi Jinchuan, Ying Gaoxiang, Zhang Zhongdong
The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People's Republic of China.
Infect Drug Resist. 2023 Sep 27;16:6367-6374. doi: 10.2147/IDR.S428945. eCollection 2023.
As a malignant tumor derived from vascular endothelial cells, Kaposi's sarcoma (KS) is quite common in AIDS patients. Nonspecific clinical symptoms often lead to timely diagnosis or wrong treatment, leading to recurrent disease and poor prognosis. Anti-retroviral therapy (ART) could significantly reduce its morbidity and aggressiveness. As one of the ARTs, liposome anthracyclines are the preferred chemotherapy regimen for disseminated KS with multiple organs or tissue invasion. The curative effect is highly related to the degree of immunosuppression. This is the first case of AIDS with Kaposi's sarcoma, who was cured after ART and two consecutive chemotherapy with doxorubicin liposome without recurrence. This case may provide new ideas and methods for the clinical management of AIDS with Kaposi's sarcoma.
The patient, a male aged 60 years, was hospitalized on 21/11/2018 following having a cough, expectoration, and difficulty breathing. He was infected with HIV eight years ago and presented symptoms of blood-stained sputum. The patient complained that he had not received ART before. After admission, he was diagnosed as KS with disseminated AIDS after multiple biopsies and histopathological examinations. The patient was treated with ten months of ART (lamivudine+tenofovir+dolutegravir) and 14 times of chemotherapy with doxorubicin liposome (20 mg/m, three times per week, seven times per course of treatment). The patient's disease was finally alleviated, and there was no recurrence during the follow-up.
The reconstitution of immune function and consecutive chemotherapy with doxorubicin liposome play a vital role in treating KS. In addition, for the early general symptoms of AIDS patients, such as thrombocytopenia and hemorrhagic purple papules, it is necessary to increase vigilance and obtain the results of histopathological verification as soon as possible to diagnose KS patients at an earlier stage and realize clinical intervention in time.
卡波西肉瘤（KS）是一种起源于血管内皮细胞的恶性肿瘤，在艾滋病患者中较为常见。非特异性的临床症状常导致诊断不及时或治疗错误，进而导致疾病复发且预后不良。抗逆转录病毒疗法（ART）可显著降低其发病率和侵袭性。作为ART之一，脂质体蒽环类药物是治疗多器官或组织受侵的播散性KS的首选化疗方案。其疗效与免疫抑制程度高度相关。这是首例经ART及连续两次使用阿霉素脂质体化疗后治愈且未复发的艾滋病合并卡波西肉瘤患者。该病例可为艾滋病合并卡波西肉瘤的临床治疗提供新思路和方法。
患者为60岁男性，因咳嗽、咳痰及呼吸困难于2018年11月21日入院。八年前感染HIV，出现痰中带血症状。患者自述此前未接受过ART治疗。入院后，经多次活检及组织病理学检查，诊断为播散性艾滋病合并KS。患者接受了十个月的ART治疗（拉米夫定+替诺福韦+多替拉韦）及14次阿霉素脂质体化疗（20mg/m²，每周三次，每疗程七次）。患者病情最终缓解，随访期间未复发。
免疫功能重建及连续使用阿霉素脂质体化疗在治疗KS中起着至关重要的作用。此外，对于艾滋病患者早期出现的血小板减少及出血性紫丘疹等一般症状，有必要提高警惕，尽快获取组织病理学检查结果，以便更早诊断KS患者并及时实施临床干预。
