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Limited KS Management — SCE Infectious Diseases MCQ

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ModerateHIV MedicineLimited KS ManagementSCE Infectious Diseases

A 30-year-old woman with HIV on ART develops a painless violaceous nodule on her gingiva. Biopsy shows spindle cells with slit-like vascular spaces. HHV-8 immunohistochemistry is positive. She has well-controlled HIV (CD4 420, VL <50). The lesion is solitary and 1 cm. What is the initial management?

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Correct answer: E — Continue ART and monitor — a solitary small KS lesion in well-controlled HIV may regress with continued ART; local treatment (intralesional chemotherapy, radiation) can be offered for cosmetic reasons

For limited cutaneous/mucosal KS (T0 stage — localised, no oral involvement, no oedema, no visceral disease) in a patient with well-controlled HIV on effective ART, observation with ART continuation is a reasonable initial approach. Limited KS lesions may regress with immune reconstitution alone. If lesions persist or are cosmetically bothersome, local treatments (intralesional Vinblastine, radiation therapy, cryotherapy) can be offered. Systemic chemotherapy (liposomal Doxorubicin) is reserved for extensive cutaneous, oedematous, or visceral KS.

Reference: BHIVA 2022 – HIV-associated malignancy; NICE 2023 – KS