Asymmetric relapse of an HIV-associated Kaposi sarcoma

Excerpt

A 51-year-old woman with HIV-associated Kaposi sarcoma (KS) was treated in 2010 with one pulse of bleomycin followed by eight pulses of daunorubicin because of lymphoedema and recurrent soft tissue infections. The last pulse was in July 2012 and the patient had a very good clinical response. Antiretroviral treatment (ART) was initiated before KS treatment and monitoring of HIV viral load revealed good adherence to ART except between December 2014 and August 2015 when the patient stopped ART. CD4 cells decreased from 970/mm³ to 337/mm³, and viral load increased from undetectable (<20 copies/mm³) to 987 copies/mm³. Despite restarting ART and HIV control, the surface area and number of KS lesions increased progressively, and in April 2016, the patient presented with oedema of the left leg with multiple nodular lesions. Lesions were located on both legs but predominantly on the left. …