**4. Kaposi's sarcoma**

Kaposi's sarcoma (KS) was first described in 1872 by Moritz Kaposi as "pigmented idiopathic sarcoma of the skin" before the advent of the AIDS epidemic. Kaposi's sarcoma was classified as: classic KS, involving men of European origin, mainly residents of eastern Europe and the Mediterranean Sea, with a preferential location in the lower limbs; African endemic KS occurring in black and young men in equatorial Africa; SK iatrogenic, related to immunosuppressive therapy in transplanted patients. But this epidemiological profile is altered with the first reports of AIDS, because there was an explosion of cases of KS, which was then called epidemic KS [17].

SK is the most common neoplasm in patients with AIDS. The incidence has been declining from 40% at the beginning of the epidemic to less than 15% today. The reason for this is not fully known, but it may be related to the greater preventive care, effectiveness of highly potent antiretroviral therapies and earlier diagnoses, as well as safer sexual practices in the community of men who have sex with men [18].

In some regions of Africa, the incidence of KS in women is much higher, occurring in 40% of all KS cases related to HIV infection. In these patients, SK tends to be more indolent, with a course similar to that observed in classic KS. The pathogenesis of KS is related to human herpes virus type 8 (HHV-8) or herpes virus associated with Kaposi's sarcoma (SK-HV). This virus is transmitted through sexual contact, which explains the prevalence in men who have sex with men in the US and in heterosexual women in Africa. The clinical characteristics are variable, usually beginning as erythematous, violet or brownish, asymptomatic macules that develop into papules, plaques, nodules or tumor lesions.

must associate in the differential diagnosis ulcerated lesions of long duration of infectious dis-

Its prevalence and incidence is greatest in individuals over 40 years of age, smokers and alco-

The relationship of the dentist to the patient's physician should result in knowledge of modifying factors that may interfere with dental treatment. See **Table 1**, which highlights these factors.

Treatment of human papilloma virus can be surgical (incisional biopsy) or cryotherapy, high-

application of 90% trichloroacetic acid (ATA) or medications such as Wartec®-Podofilotoxin

In relation to Kaposi's sarcoma, the biopsy is predominant to establish the diagnosis. Treatment of KS includes antiretroviral drugs, since the lesions usually regress with improved immune compromise. Localized destructive treatments may be indicated for isolated or sporadic injuries, such as cryotherapy with liquid nitrogen. Radiation therapy is effective for painful lesions of palms and plants and when there is edema. Intralesional injection of vinblastine may be effective if the patient has few lesions, but the method is associated with pain caused by the injection. The combination of traditional chemotherapeutic agents, such as vinblastine, etoposide (VP-16) and adriamycin, produces regression of SK lesions, but these drugs are myelosuppressive and potentially immunosuppressive. Vincristine and bleomycin, nonmyelotoxic drugs, can be used with good results. Interferon can be used both intralesional

and systemically. Doxorubicin and liposomal daunorubicin are also effective [17–19].

Hematological status Neutrophils and granulocytes (<300 mm3

Coagulation—platelets (Thrombocytopenia <15,000 mm3

Drug interactions Adverse effects of HAART Opportunistic diseases Related to immunosuppression

**Table 1.** Medical factors modifying dental treatment.

Treatment of Non-Hodgkin lymphoma may be via prophylaxis with infiltration into the central nervous system of cytarabine or methotrexate medications. Also noteworthy is the study of the use of antiviral, and growth factors should be observed, and the administration of prophylaxis for the treatment of *Pneumocystis carinii* (*jirovecii*) should be considered [17].

Epidermal carcinoma shows the main locations are the lower lip, tongue border, floor of mouth and gum. There are important factors and determinants of risks such as: heredity, sex,

), topical application of 25% podophylline alcoholic solution, topical

Oral Neoplasms in HIV Positive Patient http://dx.doi.org/10.5772/intechopen.78764 165

)

)

eases such as tuberculosis, syphilis, histoplasmosis and paracoccidioidomycosis [20, 21].

holics. The male gender is more affected than the female in the proportion of 3:1.

**7.1. Evaluation of medical factors modifying the dental treatment**

**7. Discussion and recommendations**

and Aldara® Cream-Imiquimod Gel [8, 13–15, 22].

power laser therapy (CO<sup>2</sup>

The manifestations of KS can compromise mucous membranes, such as the oral cavity and viscera, gastrointestinal tract, lungs and lymph nodes. Lesions in their evolution may grow, coalesce, form large plaques and envelop lymphatic vessels, leading to lymphoedema in the affected limb. KS can occur as the first manifestation of AIDS, concomitant with other manifestations or late in the course of the disease.

Initially they manifest themselves with enlarged and enlarged blood vessels in the dermis, with large endothelial cells, protruding into the lumen. There is perivascular infiltrate composed of lymphocytes, plasma cells and some macrophages, and groups of extravagant erythrocytes and hemosiderin deposits can be visualized. Several skin lesions, both inflammatory and neoplastic, should be included in the differential diagnosis: purpura, hemangiomas, bacillary angiomatosis, lichen planar dermatofibroma, pink pityriasis, fungal mycosis, nevi, malignant melanoma, cutaneous lymphoma and secondary syphilis were reported as SK simulators [19].
