A 38-year-old HIV-positive man (CD4 count 220 cells/μL) presents with a 3-week history of painless, progressive, violaceous plaque on his left foot. He has no systemic symptoms. CD4 count 6 months ago was 240 cells/μL. He is not on ART. Biopsy confirms Kaposi sarcoma. What is the most appropriate next step in management?

• A Initiate ART alone and observe for immune reconstitution response ✓
• B Start systemic chemotherapy with liposomal doxorubicin immediately
• C Local radiation therapy to the lesion only
• D Surgical excision of the lesion

Explanation

For limited cutaneous Kaposi sarcoma in HIV, the first-line treatment is initiation of ART. Immune reconstitution often leads to regression of KS lesions. Systemic chemotherapy (liposomal doxorubicin or paclitaxel) is reserved for extensive cutaneous, visceral, or rapidly progressive disease. Local radiation is used for symptomatic or cosmetically concerning lesions but ART remains the foundation. Surgery is not standard for KS.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.