Systemic therapy

• Interferon alfa is likely to be a beneficial systemic treatment for good prognosis AIDS-related KS. Interferon can be safely combined with antiretroviral therapy and is most suitable as first-line therapy for patients with CD4 counts >200 x 106 cells/litre, no "B" symptoms and no history of prior opportunistic infection.

• We found good evidence that liposomal doxorubicin is more effective in AIDS-related KS than standard combination chemotherapy containing bleomycin + vincristine, with or without an anthracycline. Unlike conventional anthracyclines, liposomal anthracyclines do not appear to be associated with significant cardiotoxicity.

• Newer single-agent cytotoxic therapies such as paclitaxel, vinorelbine and gemcitabine have shown activity in AIDS-related KS in uncontrolled phase II trials. Future RCTs comparing these agents with the liposomal anthracyclines are required.

• Classical KS and endemic (African) are likely to be at least as chemosensitive as AIDS-related KS but are less common variants which have not been the subject of large randomised phase III studies.

• Antiretroviral therapy is reasonable initial therapy for minimally symptomatic cutaneous AIDS-related KS, although the response to therapy is unpredictable. It may be combined with other systemic therapies.

• Antiherpetic therapy for CMV disease is associated with a reduced risk of developing KS in HIV-positive patients. There is insufficient evidence to assess the value of cidofovir, ganciclovir or foscarnet as treatment for established AIDS-related KS.

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