Kaposi sarcoma in children with HIV: a clinical series from Red Cross Children's Hospital.
OBJECTIVE
The study aimed to assess the clinical presentation, diagnosis, and treatment of Kaposi sarcoma in our HIV-positive paediatric population; analyse the increase in Kaposi sarcoma with the HIV epidemic; and look at unique surgical presentations and their implications for gastrointestinal surveillance. The incidence of Kaposi sarcoma, a herpesvirus 8-associated neoplasm of endothelial cells, has increased with the onset of the HIV epidemic. Surgical interest was prompted by a case of Kaposi sarcoma presenting with intussusception.


METHODS
All HIV-positive children with Kaposi sarcoma from 2003 to 2007 were included in the study. A retrospective analysis of clinical data was performed.


RESULTS
There were 9 children who ranged in age from 1 to 10 years (median, 7.1 years). Clinical presentations included oropalatal and laryngeal disease (5), pleural effusion (2), inguinoscrotal and skin disease (4), lymph node involvement (3), and gastrointestinal disease with haemorrhage (2), including one as a result of intussusception. Most patients presented with more than one clinical area involved. CD4 counts ranged from 14 to 2105. Two patients developed Kaposi sarcoma on antiretroviral treatment (ART); the remaining patients were started on antiretroviral treatment at presentation. Two patients died from overwhelming disseminated disease and one patient was lost to follow-up. Chemotherapy was required to achieve remission in the remaining 6. Before the HIV epidemic, this hospital treated one patient with Kaposi sarcoma every 4 years; the incidence has now increased to 2 patients per year.


CONCLUSIONS
Kaposi sarcoma is an increasingly important paediatric cancer in the era of the HIV epidemic. The clinical presentation in children is commonly oropalatal and inguinoscrotal disease. Gastrointestinal involvement was highlighted by a presentation with intussusception. The surgeon's role in diagnosis and management includes clinical recognition, biopsy, and definitive treatment.
Cairncross
Lydia L
LL
Department of Paediatric Surgery, School of Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Cape Town 7700, South Africa.
Davidson
Alan
A
Millar
Alastair J W
AJ
Pillay
Komala
K
D002648:Child; D002675:Child, Preschool; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery