Translational review of AIDS-related Kaposi's sarcoma

Approximately twice as many individuals are living with type 1 human immunodeficiency virus infection (HIV-1), as opposed to cancer and as such improved therapies for HIV-1 with an emphasis on availability of such medicines, is arguably the greatest medical problem of the 21st century. Importantly, these two conditions occur together and cancer remains a common cause of morbidity and mortality in the 60 million individuals infected with this retrovirus. In particular, there is a markedly increased risk of Kaposi's sarcoma, non-Hodgkin's lymphoma and invasive cervical cancer during the course of infection with this retrovirus. Treatment options are limited for patients with advanced acquired immunodeficiency syndrome related Kaposi sarcoma (AIDS-KS). The management of early stage cutaneous AIDS-KS has been revolutionised by the introduction of highly active anti-retroviral therapy (HAART) and for most patients HAART alone will control early stage AIDS-KS. However, patients with advanced stage KS with visceral disease, tumour-associated oedema or extensive oral disease require systemic chemotherapy in addition to their anti-retrovirals. Cytotoxic treatment is complicated however by underlying immunoparesis and options are often limited. Despite these difficulties, outcomes are improving and an increased appreciation of the biological mechanisms underlying viral tumorigenesis will hopefully delineate new therapeutic options and strategies.