Abstract
Kaposi's sarcoma (KS) became a critical health issue with the emergence of acquired immunodeficiency syndrome (AIDS) in the 1980s. Four clinical-epidemiological forms of KS have been described: classical KS, endemic KS, iatrogenic KS, and AIDS-associated KS. In 1994, Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus type 8 was identified by Chang and colleagues, and has been detected worldwide at frequencies ranging from 80 to 100%. The aim of the present study was to evaluate the frequency of KSHV infection in KS lesions from HIV-positive and HIV-negative patients in Brazil, as well as to review the current knowledge about KS transmission and detection. For these purposes, DNA from 51 cases of KS was assessed by PCR: 20 (39.2%) cases of classical KS, 29 (56.9%) of AIDS-associated KS and 2 (3.9%) of iatrogenic KS. Most patients were males (7.5:1, M/F), and mean age was 47.9 years (SD = +/- 18.7 years). As expected, HIV-positive KS patients were younger than patients with classical KS. On the other hand, patients with AIDS-associated KS have early lesions (patch and plaque) compared to classical KS patients (predominantly nodular lesions). This is assumed to be the result of the early diagnose of KS in the HIV-positive setting. KSHV infection was detected by PCR in almost all cases (48/51; 94.1%), irrespectively of the clinical-epidemiological form of KS. These results show that KSHV is associated with all forms of KS in Brazilian patients, a fact that supports the role of this virus in KS pathogenesis.
Highlights
In 1872, Kaposi’s sarcoma (KS) was described by Moritz Kaposi [1] as a rare and indolent angioproliferative neoplasm, mainly present as a skin lesion [2]
Based on clinical and histopathological data, the cases were divided as follows: 20 (39.2%) cases of classical KS, 29 (56.9%) of acquired immunodeficiency syndrome (AIDS)-associated KS and 2 (3.9%) of iatrogenic KS
Skin biopsies with normal histology (N = 8) were used as negative controls for Kaposi’s sarcoma-associated herpesvirus (KSHV) infection
Summary
In 1872, Kaposi’s sarcoma (KS) was described by Moritz Kaposi [1] as a rare and indolent angioproliferative neoplasm, mainly present as a skin lesion [2]. Three other clinical-epidemiological forms are known: endemic KS, affecting children and young men in Central Africa [4]; iatrogenic KS, observed in some patients under immu-. Nosuppressive therapy [5], and AIDS-associated KS, an aggressive form of KS that occurs mainly in homosexual and bisexual men [6]. In 1994, Chang and co-workers [7] identified unique herpesvirus DNA sequences in KS lesions from HIV-positive patients. The new virus, Kaposi’s sarcoma-associated herpesvirus (KSHV) or human herpesvirus type 8 (HHV-8), is demonstrable in tumors other than KS [8,9,10,11]. The viral genome encodes several products that share structural and functional homology with human proteins that have pivotal role in cell proliferation, which may explain the viral contribution to a malignant transformation (1218)
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