Oral Kaposi sarcoma development is associated with HIV viral load, CD4+ count and CD4+/CD8+ ratio

Abstract

Background Kaposi’s sarcoma (KS) is an uncommon, multifocal and angioproliferative lesion, which demonstrates a poor prognosis. The aim of the present research was to explore the association of HIV viral load, CD4+ and CD8+ counts and the CD4+/CD8+ ratio on the risk of oral Kaposi’s sarcoma (KS) development. Material and Methods A total of 62 patients were retrieved from March 2008 to October 2020 from the files of two oral pathology centres. Clinical, laboratory and follow-up data were retrieved from their medical files. Poisson regression was used to explore the role of history of immunosuppression and its association with oral KS development. A P-value <0.05 was considered significant. Results Sixty-two patients were included in the present study (32 with oral KS and 30 with no presentation of lesions anywhere on the body). Patients with oral KS presented a mean age of 32.6 years, and male patients were more affected. The hard palate (15 cases; 46.8%) was the main anatomical site affected. The lesions were mostly presented as swellings (13 cases; 40.6%) and nodules (12 cases; 37.5%). Systemic manifestations were also observed, including candidiasis (4 cases; 12.5%), bacterial infection (3 cases; 9.3%), tuberculosis (3 cases; 9.3%), herpes simplex (3 cases; 9.3%) and pneumonia (3 cases; 9.3%). A significant correlation was observed between HIV viral load, CD4+ count and the CD4+/CD8+ ratio with oral KS development. Conclusions HIV viral load, CD4+ count and the CD4+/CD8+ ratio are associated with oral KS development. Key words: Cancer, oral, Kaposi’s sarcoma, diagnostic.

HIV Infection and Oral Manifestations: An Update

“…They are usually located in the palate or alveolar process and can lead to bone destruction, tooth mobility, and invariably tooth loss. Histologically, this neoplasm presents fusiform tumor cells, similar to smooth muscle, fibroblasts, and myofibroblasts [108,[112][113][114].…”

“…That is, the literature indicates that the amount and severity of OL is also directly associated with immunosuppression, so the tendency is to have a high prevalence of OL in patients with a low CD4+ cell count (<200 cells/mm 3 ) and high viral load (>55,000 copies/ mL). In cases of ART-naïve or newly diagnosed individuals, the presence of moderate or severe OL and a CD4+ cell count below 200 cells/mm 3 , it is necessary to start treatment with ART and dental treatment [75,[108][109][110][111].…”

“…The treatment of Kaposi's sarcoma consists of excisional biopsy, radiation therapy, or chemotherapy [108,[112][113][114].…”

Relação da alta incidência do sarcoma de Kaposi em pacientes soropositivos para o HIV/AIDS

“…A evolução e proliferação do sarcoma de Kaposi, na sua forma mais agressiva, se deram depois da década de 80, onde o surto de AIDS (síndrome da imunodeficiência adquirida) foi iniciado, principalmente em homens homossexuais ou bissexuais (Tancredi et al, 2017). Para mais, o SK foi classificado em: clássico, endêmico, iatrogênico, e o relacionado ao HIV (Sousa et al, 2021). Além disso, nos anos 90, a terapia antirretroviral foi colocada em uso e se fez muito eficaz contra o HIV, o que consequentemente diminui a atividade do SK, porém, essa lesão ainda é muito presente em pacientes soropositivos (Sousa et al, 2021).…”

“…Para mais, o SK foi classificado em: clássico, endêmico, iatrogênico, e o relacionado ao HIV (Sousa et al, 2021). Além disso, nos anos 90, a terapia antirretroviral foi colocada em uso e se fez muito eficaz contra o HIV, o que consequentemente diminui a atividade do SK, porém, essa lesão ainda é muito presente em pacientes soropositivos (Sousa et al, 2021).…”