Incidenceprevalence

Classical KS is rare; it is much more common in men than in women, with a ratio of up to 15:1. The peak age of onset is 50-70 years. Endemic (African KS) is a common tumour in equatorial Africa and in 1971 comprised up to 9% of all cancers seen in Uganda.2 Since the beginning of the AIDS epidemic, KS has become the most frequently occurring tumour in central Africa, in human immunodeficiency virus (HlV)-negative and HIV-positive men, accounting for up to 50% in some countries.3 Since the introduction of highly active antiretroviral therapy (HAART), the proportion of patients with AIDS-related KS is decreasing but it remains the most common AIDS-associated malignancy, affecting 20-40% of homosexual men who are HIV positive.4 In published series of organ transplant recipients, between 0-5% and 5-3% have developed KS; in one study the mean period between transplantation and development of KS was 12-5 months (range 1-37 months).5-7

Table 29.1 AIDS Clinical Trials Group (ACTG) staging classification

Good risk (0) (all of the following) Poor risk (1) (any of the following)

Table 29.1 AIDS Clinical Trials Group (ACTG) staging classification

Good risk (0) (all of the following) Poor risk (1) (any of the following)

Tumour (T)

Confined to skin and/or lymph nodes and/or

Tumour-associated oedema or ulceration

minimal oral diseasea

Extensive oral KS

Gastrointestinal KS

KS in other non-nodal viscera

Immune system (I)

CD4 count >200 x 106/litre

CD4 count <200 x 106/litre

Systemic Illness (S)

No history of opportunistic infections or thrush

History of opportunistic infections and/or thrush

No "B" symptomsb

"B" symptoms present

Performance status >70% (Karnofsky)

Performance status <70%

Other HIV-related illness (for example

neurological disease, lymphoma)

aMinimal oral disease is non-nodular KS confined to the palate.

b"B" symptoms are unexplained fever, night sweats, >10% involuntary weight loss or diarrhoea persisting for more than 2 weeks.

aMinimal oral disease is non-nodular KS confined to the palate.

b"B" symptoms are unexplained fever, night sweats, >10% involuntary weight loss or diarrhoea persisting for more than 2 weeks.

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