The epidemiology of classic, African, and immunosuppressed Kaposi's sarcoma
Wahman, A.; Melnick, S.L.; Rhame, F.S.; Potter, J.D.
Epidemiologic Reviews 13: 178-199
1991
ISSN/ISBN: 0193-936X PMID: 1765111 DOI: 10.1093/oxfordjournals.epirev.a036068Document Number: 316871
The epidemiology of the 3 types of Kaposi's sarcoma, the endothelial tumor that occurs in classic, African, and immunosuppressed forms, associated pathological factors, potential causative agents, and a tentative model to explain the condition are contained in this review. Kaposi's sarcoma as classically described usually occurs in the lower limbs of elderly men, often from Mediterranean heritage, and progresses slowly. African Kaposi's sarcoma attacks the lymphatic system and viscera of all ages with a short survival time. Immunosuppressed people, especially AIDS sufferers, get a rapidly progressive but treatable form, that will regress if the immunosuppressive drug is withdrawn. Kaposi's sarcoma preceded the AIDS epidemic in the U.S., and it is apparently waning in AIDS patients. Factors linked to Kaposi's sarcoma include male gender, the HLA-DR5 genetic marker, abuse of nitrite drugs, exposure to semen or anal sex, or to several viruses. Cytomegalovirus is the most prominent of many viruses considered as a potential causal agent. Since many patients are free of CMV, it is now thought to be only a circumstantial factor because it is epidemic in Africa, is transmitted sexually, and causes immunosuppression. Several hypothetical models have been proposed to explain the phenomenon of Kaposi's, notably the multiple cofactor model, and the avian hemangiotosis retrovirus model, for an undiscovered sexually/enterically transmitted virus. It is possible that a single yet unknown agent, probably an oncogenic virus, with several routes of transmission, varying individual susceptibility, increased virulence for immune suppressed hosts, long latent period, and increasing endemicity is the infectious agent for Kaposi's sarcoma.