Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy.
Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
HIV Res Clin Pract. 2024 Dec;25(1):2393057. doi: 10.1080/25787489.2024.2393057. Epub 2024 Aug 25.
Kaposi Sarcoma (KS) has been historically associated with HIV, especially in people with advanced immunosuppression. Its prevalence decreased over time, but management remains difficult especially when the diagnosis is late and there is a visceral involvement. Bone localization, and particularly the vertebral one, is rare. We herein present a case of vertebral localizations of KS and performed a review literature to assess demographic, clinical characteristics and treatment outcomes in people with HIV.
The systematic review was carried out by following the PRISMA guidelines and registering the protocol in PROSPERO database (n. registration: CRD42024548626). We included all cases of vertebral localizations of KS from January 1rst 1981 to December 31rst, 2023.
Twenty-two cases, including ours, were ever reported in people with HIV, mostly males (95.4%), with a median age of 35 years (IQR: 32-44), median CD4+ T cell count of 80 cell/mm (IQR 13-111), 31.8% with high HIV viral load. Five people received HIV and KS diagnosis simultaneously. In all cases, but one, there were multiple sites involved. Most spine lesions were localized at thoracic and lumbar levels (59.1%), causing pathological fractures in 2 cases. Chemotherapy and radiotherapy were performed in 50% and 18.2% cases, respectively. 22.7% persons died, stability and improvement/disease regression were reported for 13.6% and 22.7% persons, respectively, while 9.9% had a significant disease progression and a person was lost to follow-up.
Despite progresses in treatment, late presentation of KS, especially with spine involvement may have a poor prognosis. More efforts are needed to promote access to HIV testing, especially when indicating conditions are present.
卡波西肉瘤（KS）历史上与 HIV 相关，尤其是在免疫抑制严重的人群中。随着时间的推移，其发病率有所下降，但管理仍然困难，尤其是在诊断较晚且存在内脏受累的情况下。骨骼定位，特别是脊柱定位，较为罕见。我们在此介绍一例 KS 的脊柱定位病例，并对 HIV 感染者的人口统计学、临床特征和治疗结局进行文献回顾。
本系统评价按照 PRISMA 指南进行，并在 PROSPERO 数据库中注册方案（注册号：CRD42024548626）。我们纳入了 1981 年 1 月 1 日至 2023 年 12 月 31 日期间所有 HIV 感染者的脊柱 KS 定位病例。
共报道了 22 例病例，包括我们的病例，这些病例均发生在 HIV 感染者中，大多数为男性（95.4%），中位年龄为 35 岁（IQR：32-44），中位 CD4+T 细胞计数为 80 个细胞/mm（IQR：13-111），31.8%的人 HIV 病毒载量较高。有 5 人同时诊断出 HIV 和 KS。在所有病例中，但有 1 例外，均有多个部位受累。大多数脊柱病变位于胸腰椎（59.1%），导致 2 例病理性骨折。分别有 50%和 18.2%的病例接受了化疗和放疗。22.7%的人死亡，13.6%和 22.7%的人病情稳定或改善/疾病缓解，9.9%的人疾病进展显著，1 人失访。
尽管治疗取得了进展，但 KS 的晚期表现，尤其是脊柱受累，可能预后较差。需要进一步努力促进 HIV 检测的普及，特别是在存在指征的情况下。
