Kaposi sarcoma:no longer an AIDS-defining illness? A retrospective study of Kaposi sarcoma cases with CD4 counts above 300/mm(3) at presentation

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/mm(3) and undetectable viral loads.Aims: To investigate the characteristics of HIV-positive patients with CD4 counts of >300cells/mm(3) 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 >300cells/mm(3) 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 (Conclusions: We report seven cases of KS in patients with CD4 count >300/mm(3), most of whom were HAART-naive at the time of KS diagnosis. Contemporary data indicate that KS presenting with CD4 counts >300/mm(3) usually occurs in patients established on HAART, which is not borne out by the results of our study.