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ISRN AIDS  2012 

Anogenital Lesions: Kaposi's Sarcoma and Its Mimicks

DOI: 10.5402/2012/486425

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Kaposi's sarcoma (KS) is a low-grade vascular neoplasm associated with human herpes virus-8 (HHV-8) infection, and, in the epidemic form, with the human immunodeficiency virus (HIV). Although HHV-8 is present in all body fluids and is sexually transmitted, there are surprisingly few reports of anogenital KS. Clinically, especially in HIV/KS endemic areas, dark stained skin patches or nodules are prone to misdiagnosis, especially in dark-skinned individuals. Therefore, a biopsy is recommended. The histologic appearance spans a broad spectrum of KS and non-KS lesions; therefore, the final diagnosis should be confirmed by HHV-8 immunohistochemistry. We report a series of 36 anogenital biopsies from a group of 16 documented HIV-positive patients; in 20 the HIV serostatus was unknown. There were ten KS (five in HIV-positive patients), and 26 non-KS (11 in HIV-positive subjects) lesions. In the era of HIV/AIDS, anogenital lesions may be the first manifestation of KS in immunocompromised individuals and should be biopsied. The histological diagnosis should be confirmed by HHV-8 immunohistochemistry. 1. Introduction The human herpes virus-8 (HHV-8), also called Kaposi’s sarcoma herpes virus (KSHV), is the causative agent of all types of Kaposi’s sarcoma (KS), namely the classic, endemic, iatrogenic immunosuppression, and the epidemic/human immunodeficiency virus (HIV) related forms. The modes of acquisition of the KSHV and its transmission vary with age, gender, geography, and sexual practices [1]. Although the virus is omnipresent its incidence is highest in KS endemic regions such as sub-Saharan Africa (sSA). In Uganda, HHV-8 DNA was detected in 28 percent of oral swabs and 27 percent of blood samples of healthy asymptomatic subjects [2]. Hence, saliva is a potential source of transmission. KSHV is transmitted to children from maternal and nonmaternal sources in KS-endemic regions, and occurs via nonsexual routes [3–6]. It has been shown that, in sSA, infection occurs during childhood mainly via maternal saliva and breast milk [7, 8]. Anthropologic research in sSA has identified that premastication of foods of infants and children is traditional, and that saliva, semen, and vaginal fluids are used while engaging in nonsexual practices associated with childcare [9–11]. The sexual transmission of KSHV is more controversial. In the industrialized world, there is evidence of transmission between men having sex with men (MSM) via anal but not oroanal sex [7, 12, 13]. Heterosexual transmission is affirmed by some [14–18]. Others deny it [5, 19]. Since KSHV is


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