Bronchopulmonary Kaposi s sarcoma in 106 HIV 1 infected patients

Abstract

The objectives of this study were to describe the clinical and radiological features at presentation, and the natural history of HIV related bronchopulmonary Kaposi s sarcoma. A retrospective review of medical records and chest radiographs was performed in 106 HIV infected homosexual men with bronchopulmonary Kaposi s sarcoma diagnosed at bronchoscopy between September 1988 and November 1994. The majority of patients had evidence of advanced HIV disease at diagnosis median CD4 cell count was 15 106 l, range 0-288 , and 93 had had a diagnosis of cutaneous Kaposi s sarcoma for a median duration of 11 months prior to diagnosis of their bronchopulmonary disease. The most frequent symptoms at presentation were cough 92 , dyspnoea 69 , pleuritic pain 20 , haemoptysis 13 and wheezing 10 . The most common radiological finding in 73 of our series was of poorly defined and confluent opacities, with predominant middle and lower zone involvement. Median survival was 4 months range 0-37 months from diagnosis and 9 months range 1-25 from the onset of symptoms. Treatment with either chemotherapy or radiotherapy was associated with a significantly reduced risk of death hazards ratio HR =0.48, 95 CI=0.26-0.87 . Factors associated with a poor survival, after adjustment for treatment effect were older age HR=1.79, 95 CI=1.22-2.84 for each 10 year increase in age; a history of pleuritic pain HR=2.97, 95 CI=1.39-6.32 ; presence of pleural effusion on X ray HR=2.01, 95 CI=1.13- 3.59 and a prior diagnosis of cutaneous Kaposi s sarcoma HR=1.8, 95 CI=1.00, 3.24 . Bronchopulmonary Kaposi s sarcoma occurs mainly in patients with advanced HIV disease and a prior history of cutaneous disease. Survival is poor, and adverse prognostic factors include older age at diagnosis and the presence of pleural disease.