title: Predictive clinical factors in the diagnosis of gastrointestinal Kaposi's sarcoma and its endoscopic severity.
abstract: BACKGROUND
  The diagnosis of gastrointestinal (GI) involvement in Kaposi's sarcoma (KS) is important to make because the need for treatment depends on the extent of the disease. Moreover, severe GI lesions can cause serious complications. Endoscopy with biopsy is an extremely useful method to diagnose GI-KS. However, determining the indications for endoscopy is difficult because KS can occur without GI symptoms or cutaneous KS. This study sought to clarify predictive clinical factors for GI-KS and its severity on endoscopy.
  
  
  RESULTS
  A total of 1,027 HIV-infected patients who underwent endoscopy were analyzed. Sexual behavior, CD4 count, HIV RNA, history of highly active antiretroviral therapy (HAART), GI symptoms, and cutaneous KS were assessed. Endoscopic severity including bulky tumor, ulceration, and number of lesions were evaluated. Thirty-three patients had GI-KS and 46 patients cutaneous KS. Among the GI-KS patients, 78.8% (26/33) had no GI symptoms and 24.2% (8/33) had no cutaneous KS. Univariate analysis identified men who have sex with men (MSM), CD4 <100 cells/µL, HIV RNA ≥10,000 copies/mL, no history of HAART, and cutaneous KS were significantly associated with GI-KS. Among these factors, cutaneous KS was closely related to GI-KS on multivariable analysis. Among patients without cutaneous KS, MSM and CD4 count <100 cells/µL were the only independent clinical factors related to GI-KS. Bulky tumor was significantly associated with CD4 <100 cells/µL and large number of lesions was significantly associated with HIV-RNA ≥10,000 copies/mL.
  
  
  CONCLUSIONS
  To diagnose GI-KS, clinical factors need to be considered before endoscopy. The presence of GI symptoms is not useful in predicting GI-KS. MSM and CD4 count <100 cells/µL are predictive factors among patients without cutaneous KS. Caution should be exercised especially in patients with low CD4 counts or high HIV viral loads as they are more likely to develop severe GI-KS lesions.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. nnagata_ncgm@yahoo.co.jp
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yazaki
authors.forename: Naoki
authors.initials: N
authors.lastname: Asayama
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Katsuji
authors.initials: K
authors.lastname: Teruya
authors.forename: Toru
authors.initials: T
authors.lastname: Igari
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000032:analysis; D018791:CD4 Lymphocyte Count; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000821:virology; D005773:Gastroscopy; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000235:genetics*; D012514:Sarcoma, Kaposi / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000821:virology; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000821:virology; D047368:Tumor Burden; D019562:Viral Load
chemical_list: D015415:Biomarkers; D012367:RNA, Viral