Re: Re: KS risks. 17 August 2004
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Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY

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Re: Re: Re: KS risks.

I'm afraid I cannot answer all of James Whitehead's questions, but agree that his anecdotal and the peer-reviewed and non-reviewed literature he cites does make a case for antioxidants being of particular interest in KS (and likely not just AIDS-KS). I would like to point out though that some of the literature cited does date from the time when HIV was thought to cause KS, and these are anti-HIV articles seeking a non-infectous (drug) cause of KS and by extension AIDS. Such issues have been dealt with seperately. [1 and many other longitudinal studies]

I would add though that KS is one of the "outlier" opportunistic infections, as I understand it. It is known to occur at far higher CD4 counts than many others, up to 600 or so. The normal range in healthy individuls is 500-1500 per ul, with AIDS-defining of course being below 200 (treatment is recommended to be initiated at two consecutive counts of 350 or less in the UK, in the abscence of an AIDS-defining illness). This implies that a lower degree of immune suppression is required, perhaps fitting with the Mediterranean KS seen in older men.

I am not aware of a higher rate in Kidney transplant patients over any others, but Mr Whitehead presents ample evidence suggesting that this is so, and may be due to the drugs used. Without being an expert in transplant disease I'm inclined to agree with that analysis!

CMV retinitis is actually an inflammatory disease, whereas KS is a form of tumour, but it does appear that some case of "flare" after HAART occur with KS. It is perhaps more likely to occur with lower CD4 counts at the initiation of HAART, a delayed response to HAART, and a younger patient. The vast majority of flares seem to be skin diseases. In one study 50% were genital herpes, 24% were HPV warts, versus 1 of 199 being KS. [2]

On a personal note, I wonder what is going to happen to the lesions now that Mr Whitehead is off HAART but restarting antioxidants, and whether HAART plus antioxidants would work well. These are perhaps issues he can raise with his own doctor.

I have no idea why Mr Whitehead's particular KS seems fortunately indolent: speaking purely from a researcher's point of view, it would be extremely interesting to compare his anti-HHV8 immune responses with those of his friends with worse KS.

Ref.

1. M. Ascher et al. Nature 362, 103; 1993

2. Thevarajan I. et al. Epidemiology Of immune reconstitution inflammatory syndrome (IRIS) in an ethnically diverse HIV infected cohort Ninth European AIDS Conference, Warsaw, abstract F4/4, 2003. (report on abstract found online at http://www.aidsmap.com/en/news/53C08FA7-9970-4907 -93F1-83AF79C00C06.asp

Competing interests: None declared