人类免疫缺陷病毒（HIV）阳性患者中的Kaposi肉瘤（KS）在许多设有KS相关疱疹病毒的国家中是最常见的癌症。治疗方法在过去20年几乎没有改变，但疾病表现已有所不同。该前瞻性队列研究在马拉维于2017年至2019年间招募了122名HIV阳性的KS患者。参与者接受了博来霉素、长春新碱和联合抗逆转录病毒疗法（当地标准护理方式）的治疗。一年的总生存率为61％，无进展生存率为58％。48周的完全缓解率为35%。RNA测序（n=78）区分了两种类型的KS损伤，一种具有明显的内皮特征，另一种富含炎性转录物。这表明不同的KS损伤处于不同的疾病状态，与已知治疗的临床反应的异质性一致。与早期队列相比，我们研究中的KS患者的血浆HIV病毒载量变异很大。25％的参与者未检测到HIV，但所有人均检测到KSHV病毒载量。我们的研究确认了当前许多KS病例发生在HIV感染得到很好控制的患者中，而且不同的KS损伤具有不同的分子组成。进一步的研究需要为该疾病开发预测性生物标志物。 © 2023 UICC.

Kaposi sarcoma (KS) is the most common cancer in people living with HIV (PLWH) in many countries where KS-associated herpesvirus is endemic. Treatment has changed little in 20 years, but the disease presentation has. This prospective cohort study enrolled 122 human immunodeficiency virus (HIV) positive KS patients between 2017 and 2019 in Malawi. Participants were treated with bleomycin, vincristine and combination antiretroviral therapy, the local standard of care. One-year overall survival was 61%, and progression-free survival was 58%. The 48-week complete response rate was 35%. RNAseq (n = 78) differentiated two types of KS lesions, those with marked endothelial characteristics and those enriched in inflammatory transcripts. This suggests that different KS lesions are in different disease states consistent with the known heterogeneous clinical response to treatment. In contrast to earlier cohorts, the plasma HIV viral load of KS patients in our study was highly variable. A total of 25% of participants had no detectable HIV; all had detectable KSHV viral load. Our study affirms that many KS cases today develop in PLWH with well-controlled HIV infection and that different KS lesions have differing molecular compositions. Further studies are needed to develop predictive biomarkers for this disease.© 2023 UICC.