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IMPAACT4HIV

Opportunistic Infections

On this page, explore how research drives progress in AHD care — with access to key studies, clinical trial results, guidelines, and insights shaping policy and practice across sub-Saharan Africa.

This page offers clinical resources, training tools, patient support, policy content, multimedia, and accessibility features — all designed to support comprehensive care and education.

Related Cancers

Kaposi Sarcoma (KS) is one of the most common cancers affecting people with Advanced HIV Disease (AHD), especially in regions where HIV prevalence is high. Caused by the human herpesvirus-8 (HHV-8), KS can be life-threatening when it spreads to internal organs or causes respiratory distress. Recognising and treating KS early is key to reducing HIV-related deaths.

Home > Kaposi Sarcoma

What is Kaposi Sarcoma?

Kaposi Sarcoma is a cancer that develops in the lining of blood and lymph vessels. In people with weakened immune systems, especially those with AHD, it can spread rapidly and affect the skin, mouth, lungs, gastrointestinal tract, and other organs. In people living with HIV, KS is considered an AIDS-defining illness and an important indicator of immune system failure.

KS can appear in various forms. Common symptoms include:

  • Skin lesions: Pink, purple, or brown spots or nodules on the skin or inside the mouth.
  • Swelling: Often in the legs, face, or genitals due to lymphatic obstruction.
  • Breathing problems: If KS affects the lungs, it may cause coughing, chest pain, or shortness of breath.
  • Gastrointestinal issues: Abdominal pain, nausea, or bleeding if KS spreads to internal organs.

In people with AHD, KS may be misdiagnosed as fungal or bacterial skin infections. Any suspicious lesions should be examined further.

Who is Most at Risk?

  • People with CD4 counts below 200 cells/mm³
  • Those not on antiretroviral therapy (ART) or with poor adherence
  • People co-infected with HHV-8, which is more prevalent in certain parts of Africa
  • Individuals with a history of immune suppression

KS diagnosis is based on:

  • Clinical exam: Visible lesions raise suspicion
  • Biopsy: Confirmatory tissue sampling from lesions
  • Endoscopy or bronchoscopy: If internal organ involvement is suspected
  • Imaging (e.g. chest X-ray or CT): To detect pulmonary KS

Treating KS requires a combination approach:

Intervention 

Details 

ART initiation or optimisation 

First-line intervention can lead to KS regression by restoring immune function 

Chemotherapy 

For advanced or symptomatic KS (e.g. liposomal doxorubicin or paclitaxel) 

Symptom management 

Includes pain relief, managing swelling, and treating secondary infections 

Nutritional support 

Vital to boost recovery and immune reconstitution 

Note: Rapid ART initiation is essential but must be monitored carefully to avoid immune reconstitution inflammatory syndrome (IRIS), especially in severe KS cases.

While there is no vaccine for HHV-8, KS can be prevented through:

  • Early HIV diagnosis and treatment: Starting ART before the immune system is compromised
  • Routine skin and oral exams for people with AHD
  • Education and awareness for both health workers and communities to recognize early signs

Kaposi Sarcoma is often underdiagnosed or diagnosed too late. In high-burden settings, it can go untreated due to lack of biopsy services or access to chemotherapy. IMPAACT4HIV works with countries and communities to:

  • Strengthen early identification of KS at primary care and community level
  • Improve referral systems to ensure timely treatment
  • Raise awareness among people living with HIV, caregivers, and health workers

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