Kaposi sarcoma: no longer an AIDS-defining illness? A retrospective study of Kaposi sarcoma cases with CD4 counts above 300/mm³ at presentation.

Summary Background Historically, Kaposi sarcoma (KS) has been considered to occur in patients infected with human immunodeficiency virus (HIV) who have low CD4 counts and high viral loads. However, merging data show that KS also occurs in HIV-positive patients with CD4 counts of > 300/mm3 and undetectable viral loads. Aims To investigate the characteristics of HIV-positive patients with CD4 counts of > 300 cells/mm3 and presence of KS. Methods This was a retrospective study of 23 cases of histologically confirmed KS in HIV-positive patients presenting to King's College Hospital between 2005 and 2011. Results Of the 23 cases, 7 (30%) had a CD4 count of > 300 cells/mm3 at diagnosis of KS; 2 were being treated with highly active antiretroviral therapy (HAART) at the time of KS diagnosis, while the remaining 5 patients were HAART-naive. All 7 patients were men, and all had a lower median age, higher recorded CD4 counts and more recent HIV diagnosis than the 16 patients with lower CD4 counts (< 300/mm3) at the time of KS diagnosis. Conclusions We report seven cases of KS in patients with CD4 count > 300/mm3, most of whom were HAART-naive at the time of KS diagnosis. Contemporary data indicate that KS presenting with CD4 counts > 300/mm3 usually occurs in patients established on HAART, which is not borne out by the results of our study.