Highly Active Antiretroviral Therapy-Associated Flare of Oropharyngeal Kaposi Sarcoma

Kaposi sarcoma (KS) is a human herpesvirus 8-associated multifocal, angioproliferative tumor that occurs in cutaneous, mucocutaneous, and visceral locations.(1) The presentation of KS in the oral cavity is of prognostic importance as it may be the initial manifestation of generalized KS or even the sentinel clue to human immunodeficiency virus (HIV) infection and AIDS. Oral cavity KS is also associated with higher death rates when compared with cutaneous KS alone.(2) Furthermore, oral cavity KS is a prognostic marker of an individual's response to highly active antiretroviral therapy (HAART).(3) Despite the role of HAART in effecting stabilization, regression, and a significant reduction in the incidence and morbidity of KS,(4) adverse clinical events that are temporally associated with the onset of HAART are being increasingly recognized.(3) Immune reconstitution inflammatory syndrome (IRIS) is characterized by an exuberant immune-mediated inflammatory response to latent antigenic triggers after the initiation or resumption of HAART.(3) It results in the appearance or recurrence of previously treated or undetected opportunistic infections, the flare of viral infections, and the development of neoplasms.(3) To date, however, airway obstruction as a manifestation of a KS flare after HAART is undocumented in the global literature (to our knowledge).