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There is good evidence that liposomal doxorubicin is likely to be beneficial for the palliative treatment of advanced AIDS-related KS. In view of its better toxicity profile than conventional chemotherapy, liposomal doxorubicin should be used as first-line systemic therapy for patients with advanced AIDS-related KS who have poor immune function and significant mucocutaneous disease or visceral disease. However the liposomal anthracyclines are expensive and not readily available in the developing countries where most HIV-related disease occurs.

There have been no recent RCTs of chemotherapy in the other less common types of KS. However, previous uncontrolled studies and case series have suggested that patients with classical KS or African KS are at least as chemosensitive as those with AIDS-related KS without the underlying immune suppression.

Retinoids are a group of natural and synthetic vitamin A derivatives. They are active against KS cells in vitro and are used topically in the treatment of hyperkeratotic skin conditions.76,77 We found two RCTs of the use of topical retinoids in the treatment of cutaneous AIDS-related KS.78 79 No placebo-controlled clinical trials of the use of oral retinoids in the treatment of any of the clinical variants of KS were found.

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