Kaposi sarcoma in HIV-positive children: what are the symptoms and pathophysiology?

Abstract

Background Introduction: Kaposi Sarcoma (KS) is a tumour caused by human herpesvirus 8 (HHV-8). It is more prevalent in Oriental Africa when compared to countries in the western world, and it is more aggressive in children, with a death rate close to 60%. Aims: clarify the symptoms and pathophysiology of the paediatric KS associated with human immunodeficiency virus (HIV), given the poor scientific production on the topic, and the fact that the knowledge of this disease on children is only an extrapolation of what is known in the adult. Methods Materials and methods: integrative review based on articles found in PubMed database, using the MeSH-indexed descriptors: ‘Children’ AND ‘Kaposi sarcoma’ AND ‘HIV infections’. Results Results: the seven selected studies show that, in HIV-positive children with KS, the prevalent symptoms are: skin lesions in multiple or unique sites, either isolated or associated with other lesions, such as oral and visceral, with the possibility of gastrointestinal bleeding, which could be deadly; lymphadenopathy in axillary, inguinal and cervical regions; respiratory symptoms; and anasarca. As for the pathophysiology, the most common occurrences are: cytopenia (anaemia and thrombocytopenia), both varying from moderate to severe; increased levels of CD4+ lymphocytes, which could act as predicting factor for lymphadenopathy; immunosuppression, a possible indicator for death; and increase in interleukin- 6 (IL-6) and IL-10 levels. Conclusions Conclusions: KS, caused by HHV-8, most prevalent in Africa, tends to be more aggressive in children, with main symptoms including lymphadenopathy and skin lesions, and main pathophysiological aspects including cytopenia and increase in IL-6 and IL-10.