Kaposis sarcoma in HIV-negative men having sex with men

Background:: Four epidemiologic forms of Kaposis sarcoma have been described, all of which are associated with the human herpesvirus-8. In western countries, human herpesvirus-8 is more prevalent in homosexual men than in the general population, and anecdotal cases of Kaposis sarcoma in HIV-negative homosexual men have been reported. Patients and methods:: We included HIV-negative homosexual and bisexual male patients with histologically proven Kaposis sarcoma in a retrospective study. Clinical data were collected using a standardized form. Risk factors for human herpesvirus-8 infection and for the development of Kaposis sarcoma were systematically recorded. Results:: Between 1995 and 2007, 28 men met the defined inclusion criteria. Mean age at first symptoms of Kaposis sarcoma was 53 years. Clinical presentation resembled classical Kaposis sarcoma, with limited disease in most patients. No cellular or humoral immunodeficiency was observed. Serologic tests for human herpesvirus-8 (latent immunofluorescence assay) were positive in 88% of patients, and only two patients displayed human herpesvirus-8 viremia at the time of Kaposis sarcoma diagnosis. Three patients developed lymphoproliferative disorders (Castleman disease, follicular lymphoma and Burkitt lymphoma). In this population, α-interferon was well tolerated and gave a complete response, but most patients require only local treatment, if any. Conclusion:: Kaposis sarcoma may develop in homosexual or bisexual men without HIV infection. This type of Kaposis sarcoma has clinical features in common with classical Kaposis sarcoma but occurs in younger patients. Its prognosis is good, as Kaposis sarcoma is generally limited, but clinicians should be aware of the association with lymphoproliferative diseases, which may affect prognosis. © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.