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Limited KS ART First — SCE Infectious Diseases MCQ

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EasyHIV MedicineLimited KS ART FirstSCE Infectious Diseases

A 40-year-old man with HIV (CD4 45) develops fever and a rapidly enlarging violaceous nodule on his hard palate. Biopsy confirms HHV-8-positive Kaposi sarcoma. He has additional cutaneous KS lesions but no visceral involvement on CT. He is not yet on ART. What is the initial treatment priority?

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Correct answer: B — Start ART — limited cutaneous/oral KS without visceral involvement may regress with immune reconstitution on ART alone

For KS limited to skin/oral cavity without visceral involvement or oedema (T0 stage — ACTG staging), initiating ART is the first priority. ART-induced immune reconstitution restores HHV-8-specific immunity and can cause KS regression in up to 80% of patients with limited disease. Systemic chemotherapy is reserved for: extensive cutaneous KS (>25 lesions), rapidly progressive disease, visceral KS, or KS with oedema. KS-IRIS (paradoxical KS worsening after ART) occurs in ~7% and is managed with ART continuation ± chemotherapy.

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