From the Research
Intestinal Kaposi sarcoma (KS) is a relatively uncommon condition, occurring in approximately 40-50% of patients with AIDS-related KS, as noted in various studies 1, 2, 3, 4, 5. The most recent and highest quality study, published in 2025, provides a comprehensive approach to managing patients with Kaposi sarcoma, including those with intestinal involvement 1. Key points to consider include:
- Intestinal KS is most frequently seen in immunocompromised individuals, particularly those with HIV/AIDS who have low CD4 counts (typically below 200 cells/mm³) 2, 3.
- The gastrointestinal tract is the second most common site of KS involvement after the skin, with the stomach and duodenum being the most frequently affected areas 3, 4.
- Many cases of intestinal KS are asymptomatic and discovered incidentally during endoscopy or autopsy, while symptoms can include abdominal pain, bleeding, diarrhea, obstruction, or malabsorption 2, 4.
- The prevalence of intestinal KS has decreased significantly since the introduction of highly active antiretroviral therapy (HAART) for HIV, as immune reconstitution often leads to regression of KS lesions 1, 5.
- Treatment typically involves HAART for HIV-positive patients, along with systemic chemotherapy (commonly liposomal doxorubicin or paclitaxel) for extensive disease, with the goal of reducing morbidity and mortality 1, 5. Some studies suggest that the addition of chemotherapy to HAART may be beneficial in reducing disease progression compared to HAART alone in patients with severe or progressive Kaposi's sarcoma 5. However, the choice of chemotherapy regimen may not significantly impact outcomes, with liposomal doxorubicin, liposomal daunorubicin, and paclitaxel showing similar efficacy 5. Overall, the management of intestinal KS should prioritize the restoration of immunity through HAART, alongside careful consideration of chemotherapy options and individualized treatment plans.