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Patients are typically HIV-positive MSM who present with a rash composed of nodular, nontender, pink to violaceous papules and nodules.


  1. Caused by human herpes virus 8 (HHV 8) associated with HIV

  2. Most affected patients are MSMs. Individual lesions are pink, red, or purple, and nontender in most cases.

  3. Lesions on the extremities, trunk and face (Figure 5-11)

  4. With decreasing CD4TL, the number of lesions increases.

  5. Skin involvement is almost always present in Kaposi sarcoma.

  6. Extracutaneous involvement includes oral cavity, gastrointestinal tract, lymph nodes and lungs (Figure 5-12).

  7. Gastrointestinal involvement is common (40%) but usually asymptomatic. Bleeding and bowel perforation are uncommon complications.

  8. Pleuro-pulmonary involvement common in advanced Kaposi sarcoma

    1. Presentations of pulmonary Kaposi sarcoma include lung nodules, infiltrates, dyspnea, large pleural effusions, and respiratory failure.

    2. Patient survival is shortened.

  9. The incidence of Kaposi sarcoma has decreased dramatically, only in part due to the introduction of effective ART. A change in sexual behavior has also contributed to this decline.

Figure 5-11.

Kaposi sarcoma in an AIDS patient.

Figure 5-12.

Involvement of oral cavity in AIDS patient with Kaposi sarcoma.


  1. Skin biopsy shows the typical angioproliferation with slit-like vascular spaces and spindle cells.

  2. Immunohistochemistry detects HHV 8 in infected endothelial cells.

  3. Gastrointestinal Kaposi sarcoma: endoscopy is clinically suggestive, but the submucosal location of lesions makes tissue diagnosis difficult.

  4. Pulmonary Kaposi sarcoma: high-resolution chest CT suggestive; bronchoscopy may show the lesions


Effective ART is highly effective in early Kaposi sarcoma, but chemotherapy is required in pulmonary involvement.

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