Date Published: September 12, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Razia A. G. Khammissa, Liron Pantanowitz, Liviu Feller.
Background. Kaposi sarcoma (KS) is one of the most common neoplasms diagnosed in HIV-seropositive subjects. Oral involvement is frequent and is associated with a poor prognosis. The aim of this study was to characterize the features of oral HIV-KS in patients from Ga-Rankuwa, South Africa. Methods. All cases with confirmed oral HIV-KS treated at the oral medicine clinic in Ga-Rankuwa from 2004 to 2010 were included in this retrospective study. Differences between males and females with oral HIV-KS in relation to HIV infection status, to oral KS presentation and to survival rates were statistically analysed. Results. Twenty (54%) of the 37 patients in the study were females and 17 (46%) were males. In 21 patients (57%), the initial presentation of HIV-KS was in the mouth. Other than the fact that females presented with larger (≥10 mm) oral KS lesions (P = 0.0004), there were no statistically significant gender differences. Significantly more patients presented with multiple oral HIV-KS lesions than with single lesions (P = 0.0003). Nine patients (24%) developed concomitant facial lymphoedema, and these patients had a significantly lower CD4+ T-cell count (28 cells/mm3) compared to the rest of the group (130 cells/mm3) (P = 0.01). The average CD4+ T-cell count of the patients who died (64 cells/mm3) was significantly lower (P = 0.0004), there were no statistically significant gender differences. Significantly more patients presented with multiple oral HIV-KS lesions than with single lesions (P = 0.016) at the time of oral-KS presentation than of those who survived (166 cells/mm3). Conclusions: In Ga-Rankuwa, South Africa where HIV-KS is prevalent, oral KS affects similarly males and females. A low CD4+ T-cell count at the time of oral HIV-KS diagnosis and the development of facial lymphoedema during the course of HIV-KS disease portends a poor prognosis.
Kaposi sarcoma (KS) is a multicentric angioproliferative disorder of endothelial origin [1, 2]. KS predominantly affects mucocutaneous sites, but may also affect visceral organs. KS is characterized microscopically by angiogenesis, the presence of spindle-shaped tumour cells, an inflammatory cell infiltrate dominated by mononuclear cells, extravasated erythrocytes, and oedema [3, 4].
Approval of the study was obtained from the Medical Research and Ethics Committee of the University of Limpopo, Medunsa campus, Pretoria, South Africa (MREC 0/212/2010 : PG). All the files of patients with histologically and clinically confirmed oral HIV-KS treated in the Department of Periodontology and Oral Medicine, School of Oral Health Sciences, University of Limpopo, Medunsa campus, from January 2004 until November 2010 were retrieved.
The study population comprised 37 patients diagnosed with oral HIV-KS, all of whom were black persons. The mean age at the time of oral HIV-KS diagnosis was 33.4 years (Table 1). Two patients were children aged 10 and 11 years. Seventeen males (46%) and 20 females (54%) were affected (M : F = 1 : 1.2). Nine patients had a history of smoking tobacco (Table 1).
There was a significantly higher number of patients with multiple oral lesions at the time of oral HIV-KS diagnosis than patients who had single lesions (Table 1). With decreasing order of frequency, the gingiva, hard palate, oropharynx (upper and lower retromolar area, and soft palate), alveolar mucosa, and the dorsum of the tongue (Figures 1, 2, 3, 4, and 5) were the sites most commonly affected (Table 2), conforming to other reports in the literature [4, 21]. In none of the 37 patients included in this study was the floor of the mouth or the ventral/lateral surface of the tongue affected. It is unknown why HIV-KS has the tendency to affect only certain oral sites, but not others.
In the Ga-Rankuwa area of South Africa where HIV-KS is prevalent, oral KS affects similarly males and females. In this population, a low CD4+ T-cell count at the time of oral HIV-KS diagnosis is associated with a poor prognosis. The development of facial lymphoedema during the course of HIV-KS disease portends a very poor prognosis. Owing to the small number of patients who received treatment, it was not possible to determine what the best treatment modality was for oral HIV-KS.