The Diagnosis and Treatment of HIV and Kaposi's Sarcoma

Classic presentation of raised Kaposi's sarcoma (KS) nodules.
OpenStax College

At the beginning of the AIDS epidemic of the early-to-late-1980s, a rare skin cancer called Kaposi's sarcoma (KS) became the tell-tale sign of HIV infection. That, along with severe weight loss, defined what many considered to be the "AIDS look." We saw it such films such as Philadelphia, where Tom Hank's thin, drawn frame was speckled with dark KS lesions.

Today, we see KS much less than before thanks to the widespread use of antiretroviral drugs, but it still something can be seen in less developed countries or in individuals who are not treated for their disease.

Kaposi's sarcoma (also referred to as Kaposi sarcoma) is a tumor caused by human herpesvirus (HHV8) that primarily presents on the skin and mouth, but can also affect internal organs. KS typically presents as small bruise-like areas that are neither painful or itchy. Particularly in the early stages, they are often mistaken for simple bruises.

If isolated to the skin, KS is not considered life-threatening. However, if the lesions spread to the intestinal tract, lungs, brain or other internal organs, it can become serious and potentially fatal.


HHV8 is transmitted through sexual contact, saliva, blood transfusions, and organ transplants. "Deep kissing" is considered an effective means of transmission, although the rate among gay men is as much as eight times higher than other population groups. The good news is that while KS is common, the incidence seems to be decreasing.

Signs and Symptoms

KS lesions generally appear as discolored, darkened areas on the skin or inside of the mouth. Their bruise-like appearance sometimes makes them difficult to identify. As they progress, they can darken and appear as raised nodules.

An easy test to differentiate a KS lesion from a bruise is to press the area with one finger. A bruise's dark color will go away with finger pressure, but KS lesions will not.

However, the only way to definitively diagnose KS is by performing a biopsy. A biopsy entails the removal of a small sample of the lesion, which is then examined under a microscope.

When KS spread to the internal organ, it can present in several ways depending on the site of infection.

KS of the Intestinal Tract

  • Abdominal pain
  • Diarrhea
  • Intestinal obstruction
  • Weight loss
  • Nausea/vomiting
  • Bloody stools
  • Vomiting of blood

KS of the Respiratory Tract

  • Cough
  • Chest pain
  • Shortness of breath
  • Difficulty breathing
  • Pulmonary blockage
  • Coughing up blood
  • Chest pain


While KS cannot be "cured," it can be effectively treated. The restoration of immune function can effectively reverse the condition by implementing antiretroviral therapy (ART) at the time of diagnosis. In persons with advanced disease, it may take time but can generally improve the condition should daily ART be adhered to.

If ART alone can treat the lesions, other treatments can be used in conjunction with ART. These can include:

  • Anti-cancer chemotherapy agents have been used to treat and shrink KS lesions, particularly those of the respiratory and gastrointestinal tracts. Side effects can be severe, with nausea, vomiting, anemia, and hair loss.
  • Cryogenically freezing skin lesions with liquid nitrogen is considered effective with smaller lesions, although less effective with hardened, raised nodules.
  • Surgical removal of the lesions is sometimes performed, although it is generally not recommended as the scarring can be widespread with pronounced, visible edges.

It is important to note that KS lesions can re-emerge, particularly in persons with severe immune suppression, if ART is not adhered to.


Given the mode of transmission and the lack of HHV8 screening tools, there is little way to actively avoid infection. With that being said, the early diagnosis and treatment of HIV can ensure that a person's immune defenses remain intact, thereby reducing the risk of KS to almost negligible levels.

Was this page helpful?

Article Sources