Monthly Archives: March 2016

First Ever Liver & Kidney Transplants from HIV Positive Donor to HIV Positive Patients

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Dr. Dorry Segev, left, and Dr. Christine Durand answer questions about the first ever HIV-positive liver transplant in the world during a news conference.

When a Connecticut woman who was HIV-positive died earlier this month, her family decided to donate her organs to others who needed them.

Doctors in Maryland announced Wednesday that they performed two landmark, successful surgeries with her kidney and liver — transplanting the organs to HIV-positive patients.

Story via NPR
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This is a big deal, because there continues to be an overall shortage of organs available for transplant, and people living with HIV have an increased risk of kidney and liver failure. Though HIV-positive organs will only go to recipients who have HIV, the ability to use these organs should help reduce the waiting time for all transplant candidates, HIV-positive or not, physicians say.

Dr. Dorry Segev, a transplant surgeon with the Johns Hopkins University School of Medicine, led the team that performed the surgery, and says that he and colleagues first started talking about doing such a procedure six years ago.

“It occurred to us that there are thousands of patients with HIV in need of kidney transplants, liver transplants, who were waiting on waiting lists and suffered high risks of dying while waiting for these organs,” says Segev. “And at the same time, we were throwing away organs from donors infected with HIV just because they were infected with HIV. These were potentially perfectly good organs for these patients.”

But back in 1988, a law had made it illegal for people with HIV to donate organs when they died.

“At that time, in the 1980s, this made sense,” Segev says, “because HIV/AIDS was deadly disease.” And medical accidents with HIV had made transplant teams skittish.

“The virus had been transmitted inadvertently in quite a number of patients with solid-organ transplants,” says Dr. Peter Stock, a transplant surgeon at the University of California, San Francisco.

Stock says there was another reason doctors were reluctant to use the virus-infected organs. In order for anyone’s body to adopt a new heart, liver or kidney as its own, the organ recipient must take certain drugs that suppress the immune system. But AIDS also suppresses the immune system, and surgeons worried that an organ transplant in someone infected with the AIDS virus might actually do more harm than good.

“It didn’t make sense,” Stock says. “We were afraid we would cause rapid progression of HIV to AIDS and death.”

But by the 1990s, better treatment allowed people with HIV to live a lot longer than they used to. And that also meant that a lot more of them needed organ transplants.

In a 2010 study, Stock and other scientists found that transplant recipients with HIV did about as well as recipients who were HIV-negative. By that point, doctors in South Africa — where nearly 20 percent of adults under age 50 have HIV — had started successfully transplanting HIV-positive organs.

In November 2013, President Obama reversed the 1980s legal ban on such transplants in the U.S. — with bipartisan support.

Segev, who conducted the U.S. surgeries earlier this month, says the time just seemed right to start doing the transplants at Hopkins.

First, his team had to come up with safety protocols and, among other things, get approval from the United Network for Organ Sharing and from an institutional review board to do the procedure.

“It all came together,” Segev says. “So, this was a six-year challenge that involved identifying a problem that affected our patients, doing the research to better understand that problem, taking that to the Hill, getting the bill passed.”

Now he and his colleagues are working to make sure that the two patients who got these organs stay healthy. One is already at home, the other recovering in the hospital. The doctors also are working with 30 other hospitals in the U.S. to get similar surgeries going across the country.  Transplant candidates can still opt to wait for an HIV-negative organ if they prefer, Segev notes.

“We want to make sure,” he says, “that we don’t take people who have a relatively non-resistant form [of HIV] and then give them something from a donor who had pretty high-resistance patterns, thereby requiring them to make major changes to their regimen, and maybe even have an HIV that would be less easy to control.”

Because of that concern, the Hopkins transplant team is only accepting HIV-positive organs at this point from people whose virus strains match those of the recipients.

Many people with HIV are expected to opt for the shorter wait period that getting an HIV-positive organ may entail. And that should slightly shorten the wait period for all transplant candidates, Stock says.  “Our waiting lists are off the charts,” he adds. “If you’re in the Bay Area and you’re waiting for a kidney for specific blood types, you’re waiting seven to eight years, so anything we can do to increase the organ supply is so important.”

If all works as planned, Segev estimates this new source of organs might be enough for an additional thousand transplants across the U.S. each year.

Members of the Johns Hopkins medical team announced the first successful HIV-positive liver transplant.

 

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Roadworks affecting drivers to LASS.

roadworks easter 2016

Leicester is one of the oldest cities in England, with a history going back over 2,000 years.  Did you know the traffic one-way system remains unchanged to this day.  Many people find Leicester’s one-way system confusing and that’s especcilly the case when roadworks impact your journey.

Access to to LASS via car (from the City direction) are undergoing roadworks, here’s what you need to know..

As part of the Welford Road Footway and Cycleway Scheme, Leicester City Council will be undertaking the reconstruction of part of Mill Street.  They will also be working on the section of Welford Road between Marlborough Street & Regent Road.

The works will require a road closure of Mill Street at the junction with Welford Road.  The closure is in place from Today (29th March 2016) until Sunday, 10th April 2016.  During this period, traffic will be diverted via Marlborough Street, Duke Street and King Street.

It will also be necessary to suspend parking on Marlborough Street and along part of King Street to allow larger vehicles to use the diversion route. For more details please see the diversion plan (here) and follow the signs provided during the closure.

Between now and Sunday 17th April 2016, Welford Road will be operating with two traffic lanes. This applies to the section between Marlborough Street and Regent Road.

If you get stuck trying to get to us, please call us on 0116 2559995 and we’ll be happy to guide you.

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Book Review: Chronic Pain & HIV: A Practical Approach

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Recent studies suggest many individuals with HIV have chronic pain. Estimates range from 39 percent all the way to 85 percent. Chronic pain is an important co-morbid condition in individuals with HIV, as it is common and causes substantial disability.

In the current HIV treatment era, HIV is a chronic disease with a near-normal life expectancy. However, individuals with HIV can have higher rates of other health problems than the general population.

A new reference guide for HIV care providers, “Chronic Pain and HIV: a practical approach,” offers insight into the assessment, diagnosis, testing and management of various chronic pain problems in patients with HIV.

Lead editor Jessica Merlin, M.D., an assistant professor in the University of Alabama at Birmingham School of Medicine Division of Infectious Diseases and Division of Geriatrics, Gerontology and Palliative Care, says the guide addresses issues that HIV care providers have when trying to provide relief to HIV patients with chronic pain, including pharmacological and non-pharmacological therapies.

“Chronic pain is increasingly recognized as an important co-morbidity in HIV-infected patients, and may influence adherence to antivirals and retention in care,” Merlin said. “Individuals with HIV also have higher rates of mental illness and addiction than the general population. HIV, mental illness and addiction are all highly stigmatized health problems, further compounding patients’ suffering.”

HIV and the medications once used to treat the disease can lead to nerve pain in the hands and feet in as many as 40 percent of patients. Also, for reasons that are not well-understood, patients with HIV may have a high burden of musculoskeletal pain, like joint pain, back pain and more widespread pain.

Non-pharmacologic treatments are an important mainstay of therapy, including graded exercise, complementary and alternative therapies, and behavioral therapies. Importantly, behavioral therapies are among the safest and most effective treatments for chronic pain. In 2014, Merlin was awarded a K23 Career Development Award from the National Institute of Mental Health. She is working on developing and pilot-testing a behavioral intervention that is specifically tailored to improving chronic pain in individuals with HIV.

Ideally, when medications are used, they should be prescribed alongside non-pharmacologic therapies.

“A multimodal approach is the most effective approach,” Merlin said. “Our book helps front-line HIV primary care providers use this approach with their patients.”

Medications such as opioids may not be as effective, and carry significant risks.

“Chronic pain can be challenging to manage to begin with, and even more challenging to manage in the setting of mental health and addiction problems found in individuals with HIV,” Merlin said. “Long-term treatment with opioids, such as morphine, oxycodone and others, has been commonly used to treat chronic pain in general and in individuals with HIV. Opioid therapy carries risks such as worsening of mood, development of addiction and overdose, and these risks can be heightened in the presence of pre-existing mental illness and addiction.”

Studies suggest that HIV care providers may feel unprepared to treat chronic pain.

“Managing chronic pain is rewarding; but it can be challenging, and is often not taught in HIV providers’ medical training,” Merlin said. “This book is the first practical guide on the topic for HIV care providers, and fills an important need.”

Chronic Pain & HIV: A Practical Approach is available from 22nd April 2016, available at Amazon.

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Today is World Tuberculosis Day. What could this mean for you?

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World Tuberculosis Day is marked every year on 24 March, highlighting one of the world’s top health challenges. With nine million new cases and 1.5 million deaths each year, tuberculosis is an ongoing epidemic.

For World TB Day 2015, the United Nations, the Stop TB Partnership and the World Health Organization are calling on all governments and health organisations to mobilise political and social commitment for further progress towards eliminating the disease as a public health burden. The theme this year is “Reach the 3 Million: Reach, Treat, Cure Everyone” – aimed at securing care for the three million who fail to be treated every year.

The date commemorates the day in 1882 when Dr Robert Koch, the German physician and pioneering microbiologist, announced to the University of Berlin’s Institute of Hygiene that he had discovered the cause of tuberculosis. His discovery marked a turning point in the story of the virulent human infectious disease.

Yet over a century on, the disease continues to be a public health problem, with the highest rates in Sub-Saharan Africa. A report by the European Centre for Disease Prevention and Control and WHO found that 1,000 people a day throughout Europe develop the disease and although the continent has experienced an annual 6% decline, Europe will not be TB-free until the next century.

There has been a sustained decline in cases over the last decade but rates of multi-drug resistant tuberculosis, MDR-TB, remain at very high levels.

WHO regional director for Europe, Zsuzsanna Jakab, said only 50% of an estimated 75,000 multi-drug resistant TB patients were found in 2013 and just half were successfully cured.

“Multi-drug resistant TB is still ravaging the European region, making it the most affected area of the entire world,” he said.

TB & HIV Co-infection

When people have a damaged immune system, such as people with HIV who are not receiving antiretroviral treatment, the natural history of TB is altered. Instead of there being a long latency phase between infection and development of disease, people with HIV can become ill with active TB disease within weeks to months, rather than the normal years to decades.

The risk of progressing from latent to active TB is estimated to be between 12 and 20 times greater in people living with HIV than among those without HIV infection. This also means that they may become infectious and pass TB on to someone else, more quickly than would otherwise happen. Overall it is considered that the lifetime risk for HIV negative people of progressing from latent to active TB is about 5-10%, whereas for HIV positive people this same figure is the annual risk.

Many people living with HIV are now taking antiretroviral treatment for their HIV infection. This helps their immune system, but the risk of developing active TB is still higher than in people without HIV infection. Also, there are reports from some African countries that people are starting to become infected with drug resistant HIV. This makes it much more difficult to provide them with effective antiretroviral therapy, and this in turn could result in millions more, of the estimated 40 million people thought to be living with HIV worldwide, developing active TB in the next few years.

Find out how the body reacts to tuberculosis here

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Leicester Healthcare Hubs & GP practices open over Easter weekend

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LASS will be closed over the Easter Break.  We re-open on Tuesday, 29th March.  More on our Easter opening times (and some free days out over Easter) by clicking here >>>

Many GP surgeries and health care centres are also closed over the break so here’s some details on the City healthcare hubs and a small selection of GP practices in Leicester City who are open to offer medical advice over the Easter weekend.

Patients that are registered with any Leicester City GP practice can use any of the four hubs between 6:30pm and 10:00pm Monday to Friday and 9:00am to 10:00pm this bank holiday.

They can get an appointment with a GP or an advanced nurse practitioner by calling 0116 366 0560 or NHS 111, or they can just walk in to any of four hubs. It is the same number to call for all four hubs.

The healthcare hubs are located in four areas of the city:

  • Willows Medical Centre
    184 Coleman Road
    Leicester, LE5 4LJ (Map)
  • Westcotes Medical Practice
    Westcotes Health Centre
    Fosse Road South
    Leicester, LE3 0LP (Map)
  • Brandon Street Surgery
    Belgrave Health Centre
    52 Brandon Street
    Leicester, LE4 6AW (Map)
  • Saffron Surgery
    612 Saffron Lane
    Leicester, LE2 6TD (Map)

Four GP practices in Leicester City will also remain open including the 8-8 SSAFA Walk in Centre..

FRIDAY 25 MARCH SATURDAY 26 MARCH MONDAY 28 MARCH
Dr Arolker & Partners, Manor Medical Centre, 577 Melton Road, Leicester LE4 8EA (NOT Parker Dr)  

Closed

 

Open

8am – 1pm

 

Closed

Dr Roy, Fosse Family Practice Closed Open

9am – 12 noon

Closed
The Practice – Beaumont Leys Closed Open

8am – 10am

Closed
SSAFA Care Health Centre, Merlyn Vaz, 1 Spinney Hill Road (also open on Sunday 27 March 8am – 8pm) Open 8am – 8pm Open 8am – 8pm Open 8am – 8pm

 

GPs from Leicester City Clinical Commissioning Group are urging people across Leicester, Leicestershire and Rutland to get prepared for the Easter bank holiday and also make sure they have sufficient stock of any prescription medicine they might need.

As the majority of GP surgeries will not be open from Good Friday (25 March) to bank holiday Monday (28 March), it is important that those who make use of repeat prescriptions check now to ensure that their supply will last until at least Tuesday 29 March.

Dr Tony Bentley GP and Clinical Lead for Leicester City CCG, said: “It is important that people check all their medications to make sure that they have a reasonable supply which will last over the bank holiday period. It is likely that Tuesday 29 March will be a busy day for GP surgeries following the holiday break, so I urge everyone to make sure that they have enough medication to last them until towards the end of the week.”

It is also recommended that people keep a well-stocked medicine cabinet so they can deal with any minor injuries and illnesses that occur in the holiday period, or to visit their local pharmacist for advice about the right treatment.

Dr Bentley continued: “Encouraging self-care is extremely important, as it allows people to take control of their own health and wellbeing. This includes taking responsibility for their medications, as well as treating their own minor illnesses using over the counter medicines when appropriate. I urge people to stay away from A&E, unless it really is a life-threatening accident or emergency. By choosing self-care or using one of the other services available, people will be able to get the right treatment at the right time and allow medical staff in A&E to concentrate on treating patients who are seriously ill or injured.”

Out of hours services will be available for those with an urgent need to see their GP as well as urgent care centres, which can treat minor burns, cuts and wounds, infections and rashes, as well as stomach ache, vomiting and diarrhoea, and health advice is also available by calling NHS 111, which is available 24 hours a day.

For further information on the services available in their local area we recommend visiting www.choosebetter.org.uk or www.nhs.uk/Service-Search/

Giving antibodies to infant macaques exposed to an HIV-like virus could clear the infection

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Scientists at the Oregon National Primate Research Centre have revealed that infant rhesus macaques treated with antibodies within 24 hours of being exposed to SHIV, a chimeric simian virus that bears the HIV envelope protein, were completely cleared of the virus. The study, published on Monday in Nature Medicine shows that antibodies given after a baby macaque has already been exposed to SHIV can clear the virus, a significant development in the HIV scientific community.

SHIV-infected nonhuman primates can transmit SHIV to their offspring through milk feeding, just as humans can transmit HIV from mother to child through breastfeeding and during childbirth (and only rarely during pregnancy). In humans, a combination of measures for mothers and infants, including antiretroviral therapy (ART), Cesarean section delivery and formula feeding (rather than breastfeeding), have decreased the rate of mother-to-child HIV transmission from 25 percent to less than 2 percent since 1994. Despite this decrease, approximately 200,000 children are infected with HIV each year worldwide, primarily in developing countries where ART is not readily available.

“We knew going into this study that HIV infection spreads very quickly in human infants during mother-to-child transmission,” said Nancy L. Haigwood, Ph.D., senior author of the paper, and director and senior scientist, Oregon National Primate Research Center at Oregon Health & Science University. “So we knew that we had to treat the infant rhesus macaques quickly but we were not convinced an antibody treatment could completely clear the virus after exposure. We were delighted to see this result.”

Haigwood and colleagues administered the anti-HIV-1 human neutralizing monoclonal antibodies (NmAb) subcutaneously on days 1, 4, 7 and 10 after the macaques were exposed to SHIV orally. The SHIV virus was found in multiple body tissues on day 1 in macaques without antibody treatment. Conversely, they observed an immediate impact of a single dose of antibodies at the start of the infection, with a significant difference in treated versus non-treated macaques. Early short-term administration of powerful antibodies effectively cleared the virus by day 14, with no virus detected at this time. Using highly sensitive methods, they did not detect the virus in any part of the body in 100 percent of the antibody-treated infant macaques for at least six months.

Typically, HIV infection rapidly expands and spreads in humans to local draining lymph nodes before disseminating throughout the entire body one week after a person is infected. This study showed that, at least in this model system of oral SHIV exposure in newborn macaques, virus replication is detected in lymphatic tissues 24 hours after exposure and is not locally restricted, as has been suggested previously for humans, due to delays of 5 to 7 days before detection in the blood.

The study showed that: 1) antibodies delivered subcutaneously are swiftly distributed to blood and tissues and maintain neutralizing activity at various sites, and, 2) that antibodies are effective at clearing the virus, a different mechanism than that of ART, which is a combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself in the body.

“Other nonhuman primate studies with antiretroviral therapy suggest that treatment as early as three days after infection is too late to prevent establishment of the HIV reservoir,” said Jonah B. Sacha, Ph.D., study co-author and assistant scientist, Oregon National Primate Research Center at OHSU. “So using antibodies to clear the virus after infants have already been exposed could save thousands of lives” if the approach works in human infants.

The researchers noted that treating human babies with ART during the last month of gestation, the few days after delivery, and during breastfeeding timeframes, is recommended. However, risks remain, including toxicities associated with long-term ART use, the development of drug-resistant viral variants, and lack of access to prenatal care prior to delivery.

This discovery indicates that using new methods, such as antibodies, to limit infection after exposure in newborns could be advantageous.

The study authors acknowledge that several relevant questions remain unanswered for treatment of HIV-infected newborns and children born to HIV-positive mothers. These include practical and cultural issues of treating breastfeeding mothers and babies, if the antibodies will work in human infants exposed to HIV, as well as what the optimal antibody formulations will be.

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Worried about Cancer / Kaposi’s Sarcoma?

Macmillian

The Macmillan mobile bus is in Leicester (Humberstone Gate) today.  It’s an information centre which visit communities, high streets and events to bring free support as well as confidential information to everyone.

Whether you’ve been affected by cancer, are visiting on behalf of a friend or relative or would just like to find out more about what Macmillan do, you’re welcome to visit them and you don’t need an appointment.

They are parked up in Humberstone Gate, Leicester until 5pm today, why not pop down and have a chat?  For more information on the mobile bus visit Macmillan here.

a HIV blog talking about Cancer – Why?

Kaposi’s sarcoma is a rare type of cancer caused by a virus. It can affect the skin and internal organs.

It’s mainly seen in people with a poorly controlled or severe HIVinfection. It can also affect some people who have a weakened immune system for another reason, as well as people who have a genetic vulnerability to the virus.

The following information is via
NHS Choices

Signs and symptoms

The most common initial symptom is the appearance of small, painless, flat and discoloured patches on the skin or inside the mouth. They’re usually red or purple and look similar to bruises.

Over time, the patches may grow into lumps known as nodules and may merge into each other.

Internal organs can also be affected, including the lymph nodes, lungs and the digestive system, which can cause symptoms such as:

The rate at which symptoms progress depends on the type of Kaposi’s sarcoma you have. Most types get worse quickly in a matter of weeks or months without treatment, but some progress very slowly over many years.

When to seek medical advice

You should see your GP if you have any worrying symptoms you think could be caused by Kaposi’s sarcoma. If you have HIV, you can also contact your local HIV clinic if you have any concerns.

Your doctor will ask about your symptoms and examine your skin to look for the characteristic discoloured patches. If they suspect Kaposi’s sarcoma, they will refer you for further tests to confirm the diagnosis.

These tests may include:

  • an HIV test – a blood test to confirm whether or not you have HIV (if you haven’t already been diagnosed with the condition)
  • a skin biopsy – where a small sample of cells is removed from an affected area of skin and checked for Kaposi’s sarcoma cells
  • an endoscopy – where a thin, flexible tube called an endoscope is passed down your throat to see if your lungs or digestive system are affected
  • computerised tomography (CT) scan to see if your lymph nodes or other parts of your body are affected

What causes Kaposi’s sarcoma?

Kaposi’s sarcoma is caused by a virus called the human herpesvirus 8 (HHV-8), also known as the Kaposi’s sarcoma-associated herpesvirus (KSHV). This virus is thought to be spread during sex, through saliva, or from a mother to her baby during birth.

HHV-8 is a relatively common virus and the vast majority of people who have it will not develop Kaposi’s sarcoma. It only seems to cause cancer in some people with a weakened immune system and in some people who have a genetic vulnerability to the virus.

A weakened immune system allows the HHV-8 virus to multiply to high levels in the blood, which increases the chance it will cause Kaposi’s sarcoma.

The virus appears to alter the genetic instructions that control cell growth. This means some cells reproduce uncontrollably and form lumps of tissue known as tumours.

Types of Kaposi’s sarcoma and their treatment

There are four main types of Kaposi’s sarcoma. These types affect different groups of people and are treated in different ways.

HIV-related Kaposi’s sarcoma

Although it’s not as common as it used to be, Kaposi’s sarcoma is still one of the main types of cancer to affect people with HIV.

HIV-related Kaposi’s sarcoma can progress very quickly if not treated. However, it can usually be controlled by taking HIV medication – known as combination antiretroviral therapy (cART) – to prevent HIV multiplying and allow the immune system to recover. The immune system can then reduce the levels of HHV-8 in the body.

Read more about treating HIV.

Some people may also require treatment with radiotherapy (where high-energy rays are used to destroy cancer cells) or chemotherapy(where powerful medications are used to destroy cancer cells), depending on the site and extent of the cancer and what symptoms it’s causing.

Classic Kaposi’s sarcoma

Classic Kaposi’s sarcoma mainly affects middle-aged and elderly men of Mediterranean or Ashkenazi Jewish descent. Ashkenazi Jews are descended from Jewish communities that lived in central and eastern Europe. Most Jewish people in the UK are Ashkenazi Jews.

It’s thought people who develop classic Kaposi’s sarcoma were born with a genetic vulnerability to the HHV-8 virus.

Unlike the other types of Kaposi’s sarcoma, the symptoms of classic Kaposi’s sarcoma progress very slowly over many years and are usually limited to the skin.

Immediate treatment isn’t usually required because, in many cases, the condition doesn’t affect life expectancy. You’ll usually be monitored carefully and only treated if the symptoms get significantly worse.

Radiotherapy is often used if treatment is required, although small skin patches or nodules may be removed using minor surgery or cryotherapy (freezing).

Transplant-related Kaposi’s sarcoma

Transplant-related Kaposi’s sarcoma is a rare complication of an organ transplant. It occurs because the immunosuppressant medication used to weaken the immune system and help prevent the body rejecting the new organ can allow a previous HHV-8 infection to reactivate, which means levels of the virus increase as it starts multiplying again.

Transplant-related Kaposi’s sarcoma can be aggressive and usually needs to be treated quickly. It’s normally treated by reducing or stopping the immunosuppressants, if this is possible. If this is unsuccessful, radiotherapy or chemotherapy may be used.

Endemic African Kaposi’s sarcoma

Endemic African Kaposi’s sarcoma is common in parts of Africa and is one of the most widespread types of cancer in that region.

Although this type of Kaposi’s sarcoma is classified separately from HIV-related Kaposi’s sarcoma, many cases may actually result from an undiagnosed HIV infection. All suspected cases therefore must have an HIV test, as the most effective treatment in these cases is HIV medication.

In cases not caused by HIV infection, this type of Kaposi’s sarcoma may be the result of a genetic vulnerability to HHV-8. These cases are usually treated with chemotherapy, although sometimes radiotherapy may be used.

Outlook

With proper treatment, Kaposi’s sarcoma can usually be controlled for many years. Deaths from the condition are uncommon in the UK.

The discoloured patches of skin will often shrink and fade with treatment, although they may not ever disappear completely.

A complete cure for any type of Kaposi’s sarcoma isn’t always possible, and there’s a chance the condition could recur in the future. If you think this is happening, contact your HIV clinic, hospital specialist or GP as soon as possible.

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