Oropharyngolaryngeal manifestations of Kaposi’s sarcoma with airway obstruction and its management in patients with HIV/AIDS

Authors

  • Alfi Syahri Universitas Airlangga. Faculty of Nursing. Doctoral Program in Nursing. Surabaya, Indonesia; Institut Kesehatan Deli Husada. Faculty of Nursing. Department of Advanced Nursing. Deli Serdang, Indonesia; Indonesian Palliative Nurses Association. Indonesia https://orcid.org/0009-0009-8756-6288
  • Tintin Sukartini Universitas Airlangga. Faculty of Nursing. Department of Advanced Nursing. Surabaya, Indonesia; Universitas Airlangga. Faculty of Nursing. Research Group in Medical-Surgical Nursing. Surabaya, Indonesia https://orcid.org/0000-0003-3869-7897
  • Erna Dwi Wahyuni Universitas Airlangga. Faculty of Nursing. Department of Basic Nursing. Surabaya, Indonesia; Universitas Airlangga. Faculty of Nursing. Research Group in Critical Care, Emergency Care and Disaster Nursing. Surabaya, Indonesia https://orcid.org/0000-0001-5147-5151
  • Ninuk Dian Kurniawati Universitas Airlangga. Faculty of Nursing. Department of Basic Nursing. Surabaya, Indonesia; Universitas Airlangga. Faculty of Nursing. Research Group in Critical Care, Emergency Care and Disaster Nursing. Surabaya, Indonesia https://orcid.org/0000-0002-9457-3445
  • Fiki Muhammad Ridho Universitas Airlangga. Faculty of Dental Medicine. Department of Dental Medicine. Surabaya, Indonesia https://orcid.org/0000-0002-0187-8160

Keywords:

AIDS, Airway obstruction, HIV, Larynx, Oropharynx, Kaposi's sarcoma

Abstract

Introduction: Kaposi's sarcoma is one of the manifestations in HIV/AIDS patients which is found in the oropharyngolaryngeal region. This can be life-threatening because it can cause airway obstruction. Therefore, proper management is needed in handling HIV/AIDS patients with oropharyngolaryngeal Kaposi’s sarcoma manifestations.

Objective: To characterize clinical characteristics, airway interventions, and clinical outcomes of oropharyngolaryngeal Kaposi’s sarcoma in HIV-positive patients with airway obstruction.

Methods: This study was a systematic review followed PRISMA 2020 guidelines. Scopus, PubMed, Web of Science, and Cochrane Library were searched systematically. The JBI checklist was used for the quality assessment.

Results: Twenty-four studies were finally included. Patients were dominated by male with an adult age group. Symptoms that often appear include dyspnea, hoarseness, and stridor, with Kaposi’s sarcoma sites most commonly found in the supraglottis. In airway management, tracheotomy proved to be the most effective in the airway obstruction management.

Conclusions: This review concludes that tracheotomy is an effective option for airway management in patients with oropharyngolaryngeal Kaposi’s sarcoma. However, most patients' prognosis is poor due to the advanced stage of HIV infection and the accompanying complications.

Downloads

Download data is not yet available.

References

1. UNAIDS. Global HIV & AIDS statistics [Internet]. UNAIDS; 2023 [access: 09/05/2024]. Available at: https://www.unaids.org/en/resources/fact-sheet

2. World Health Organization. HIV - Global [Internet]. World Health Organization; 2023 [access: 09/05/2024]. Available at: https://www.who.int/data/gho/data/themes/hiv-aids/hiv-aids

3. Chu C, Selwyn PA. Complications of HIV Infection: A Systems-Based Approach [Internet]. afp. 2011 [access: 09/05/2024];83(4):395–406. Available at: https://www.aafp.org/pubs/afp/issues/2011/0215/p395.html

4. Luetkemeyer AF, Havlir DV, Currier JS. Complications of HIV disease and antiretroviral therapy [Internet]. Top Antivir Med. 2016 [access: 10/05/2024];20(2):48–68. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6148866/

5. Indrastiti RK, Wardhany II, Soegyanto AI. Oral manifestations of HIV: Can they be an indicator of disease severity? (A systematic review) [Internet]. Oral Diseases. 2020;26(S1):133–6. DOI: 10.1111/odi.13394

6. Lomelí-Martínez SM, González-Hernández LA, Ruiz-Anaya ADJ, Lomelí-Martínez MA, Martínez-Salazar SY, Mercado González AE, et al. Oral Manifestations Associated with HIV/AIDS Patients [Internet]. Medicina. 2022;58(9):1214. DOI: 10.3390/medicina58091214

7. Piersiala K, Weinreb SF, Akst LM, Hillel AT, Best SR. Laryngeal disorders in people living with HIV [Internet]. American Journal of Otolaryngology. 2022;43(1):103234. DOI: 10.1016/j.amjoto.2021.103234

8. Shija PS, Karaba JA, Philemon RN, Minja BL, Mtenga PP, Katundu DR. Prevalence of Ear Nose and Throat (ENT) Manifestations Among HIV Seropositive Patients at a Tertiary Hospital in Northern Tanzania: A Descriptive Cross-Sectional Study [Internet]. HIV. 2020;12(1):425–9. DOI: 10.2147/HIV.S260908

9. Tappuni AR. The global changing pattern of the oral manifestations of HIV [Internet]. Oral Diseases. 2020;26(S1):22–7. DOI: 10.1111/odi.13469

10. Etemad SA, Dewan AK. Kaposi Sarcoma Updates [Internet]. Dermatologic Clinics. 2019;37(4):505–17. DOI: 10.1016/j.det.2019.05.008

11. Grabar S, Costagliola D. Epidemiology of Kaposi’s Sarcoma [Internet]. Cancers. 2021;13(22):5692. DOI: 10.3390/cancers13225692

12. Fu L, Tian T, Wang B, Lu Z, Gao Y, Sun Y, et al. Global patterns and trends in Kaposi sarcoma incidence: a population-based study [Internet]. The Lancet Global Health. 2023;11(10):e1566–75. DOI: 10.1016/S2214-109X(23)00349-2

13. Liu Z, Fang Q, Zuo J, Minhas V, Wood C, Zhang T. The world‐wide incidence of Kaposi’s sarcoma in the HIV / AIDS era [Internet]. HIV Medicine. 2018;19(5):355–64. DOI: 10.1111/hiv.12584

14. Cesarman E, Damania B, Krown SE, Martin J, Bower M, Whitby D. Kaposi sarcoma [Internet]. Nat Rev Dis Primers. 2019;5(1):9. DOI: 10.1038/s41572-019-0060-9

15. Agaimy A, Mueller SK, Harrer T, Bauer S, Thompson LDR. Head and Neck Kaposi Sarcoma: Clinicopathological Analysis of 11 Cases [Internet]. Head and Neck Pathol. 2018;12(4):511–6. DOI: 10.1007/s12105-018-0902-x

16. Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations [Internet]. BMC Cancer. 2008;8(1):190. DOI: 10.1186/1471-2407-8-190

17. Barron K, Omiunu A, Celidonio J, Cruz‐Mullane A, Din‐Lovinescu C, Chemas‐Velez MM, et al. Kaposi Sarcoma of the Larynx: A Systematic Review [Internet]. Otolaryngol--head neck surg. 2023;168(3):269–81. DOI: 10.1177/01945998221105059

18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews [Internet]. bmj. 2021;372:n71. DOI: 10.1136/bmj.n71

19. Patow CA, Stark TW, Findlay PA, Steis R, Longo DL, Masur H, et al. Pharyngeal Obstruction by Kaposi’s Sarcoma in a Homosexual Male with Acquired Immune Deficiency Syndrome [Internet]. Otolaryngol--head neck surg. 1984;92(6):713–6. DOI: 10.1177/019459988409200621

20. Rothstein SG, Schneider KL, Kohan D, Persky MS, Holliday R. Emergencies in AIDS patients: The otolaryngologic perspective [Internet]. Otolaryngol-head neck surg. 1991;104(4):545–8. DOI: 10.1177/019459989110400422

21. Roy TM, Dow FT, Puthuff DL. Upper airway obstruction from aids-related Kaposi’s sarcoma [Internet]. The Journal of Emergency Medicine. 1991;9(1–2):23–5. DOI: 10.1016/0736-4679(91)90527-M

22. Tami TA, Sharma PK. Intralesional Vinblastine Therapy for Kaposi’s Sarcoma of the Epiglottis [Internet]. Otolaryngol--head neck surg. 1995;113(3):283–5. DOI: 10.1016/S0194-5998(95)70119-2

23. Beitler AJ, Ptaszynski K, Karpel JP. Upper Airway Obstruction in a Woman With AIDS-Related Laryngeal Kaposi’s Sarcoma [Internet]. Chest. 1996;109(3):836–7. DOI: 10.1378/chest.109.3.836

24. Tami TA, Ferlito A, Lee KC, Rinaldo A, Singh B. Clinicopathological Consultation Laryngeal Pathology in the Acquired Immunodeficiency Syndrome: Diagnostic and Therapeutic Dilemmas [Internet]. Ann Otol Rhinol Laryngol. 1999;108(2):214–20. DOI: 10.1177/000348949910800221

25. Belda J, Canalı́s E, Gimferrer JM, Xaubet A, Baldó X, Guelar A. Subglottic stenosis in an HIV positive patient: an exceptional form of clinical presentation in Kaposi’s sarcoma [Internet]. European Journal of Cardio-Thoracic Surgery. 1997;11(1):191–3. DOI: 10.1016/S1010-7940(96)01010-X

26. Alkhuja S, Menkel R, Patel B, Ibrahimbacha A. Stridor and Difficult Airway in an AIDS Patient [Internet]. AIDS Patient Care and STDs. 2001;15(6):293–5. DOI: 10.1089/108729101750279650

27. Watson JR, Granoff D, Thayer Sataloff R. Dysphonia due to kaposi’s sarcoma as the presenting symptom of human immunodeficiency virus [Internet]. Journal of Voice. 2004;18(3):398–402. DOI: 10.1016/j.jvoice.2004.04.007

28. Vinh D, Ahn A, Mohyuddin N. HIV-Positive Patient With an Obstructing Laryngeal Mass [Internet]. JAMA Otolaryngol Head Neck Surg. 2020;146(7):667. DOI: 10.1001/jamaoto.2020.0223

29. Osei N, Fletcher G, Showunmi A, Ahluwalia M. A Case of Non-cutaneous Kaposi Sarcoma [Internet]. Cureus. 2022;14(12):e32394. DOI: 10.7759/cureus.32394

30. Nasir F, Cajuste C, Bally K, Ayinla R. Isolated Kaposi Sarcoma of Pharynx and Larynx With Airway Obstruction: Timely Management of a Difficult Airway [Internet]. Am J Respir Crit Care Med. 2023;207(1):A5878. DOI: 10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A5878

31. Miner JE, Egan TD. An AIDS-Associated Cause of the Difficult Airway: Supraglottic Kaposi’s Sarcoma [Internet]. Anesthesia & Analgesia. 2000;90(5):1223–6. DOI: 10.1097/00000539-200005000-00043

32. Ares C, Allal AS. Long-term complete remission of laryngeal Kaposi’s sarcoma after palliative radiotherapy [Internet]. Nat Rev Clin Oncol. 2005;2(9):473–7. DOI: 10.1038/ncponc0294

33. Papagatsia Z, Jones J, Morgan P, Tappuni AR. Oral Kaposi sarcoma: a case of immune reconstitution inflammatory syndrome [Internet]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2009;108(1):70–5. DOI: 10.1016/j.tripleo.2009.02.035

34. Lawson G, Matar N, Kesch S, Levêque N, Remacle M, Nollevaux MC, et al. Laryngeal Kaposi sarcoma: case report and literature review [Internet]. B-ENT. 2010 [access: 25/07/2024];6:285–8. Available at: https://pubmed.ncbi.nlm.nih.gov/21302692/

35. Tahir JM, Gopalan K, Marina M, Putra SP. A rare case of laryngeal Kaposis sarcoma [Internet]. Bangladesh J Med Sci. 2010;9(2):107–9. DOI: 10.3329/bjms.v9i2.5660

36. Ribeiro C, Guedes F, Mota M, E Sá JM. Kaposi Sarcoma With Laryngeal, Tracheal, and Parenchymal Involvement [Internet]. Journal of Bronchology & Interventional Pulmonology. 2011;18(3):259–60. DOI: 10.1097/LBR.0b013e318222a1b8

37. Shao E, Ruhangisa F, Minja N, Nnko K, Katundu D, Semango G, et al. Atypical Kaposi Sarcoma of the Tongue in HIV Positive Tanzanian Female [Internet]. Case Reports in Infectious Diseases. 2015;2015:1–4. DOI: 10.1155/2015/851462

38. Yip E. A difficult airway in a child with Kaposi’s Sarcoma of the epiglottis [Internet]. Anaesthesia Cases. 2015;3(1):26–9. DOI: 10.21466/ac.ADAIACW.2015

39. Penjor D, Chong AW. A case of Kaposi’s sarcoma of tonsil with profuse bleeding in an HIV-positive patient [Internet]. SAGE Open Medical Case Reports. 2021;9:2050313X2110664. DOI: 10.1177/2050313X211066411

40. Nagano K, Yamada T, Ishii K, Fujinaga T, Shibuya M, Yanai Y, et al. A case of AIDS-associated Kaposi’s sarcoma occurring in the oral cavity and systemic lymph nodes [Internet]. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2022;34(4):536–41. DOI: 10.1016/j.ajoms.2021.11.009

41. Xie Y, Wang C, An Q, Wang D. Glottic Kaposi’s sarcoma [Internet]. AIDS. 2023;37(8):1343–4. DOI: 10.1097/QAD.0000000000003559

42. Mochloulis G, Irving RM, Grant HR, Miller RF. Laryngeal Kaposi’s sarcoma in patients with AIDS [Internet]. J Laryngol Otol. 1996;110(11):1034–7. DOI: 10.1017/S0022215100135698

43. Luo Q, Satcher Johnson A, Hall HI, Cahoon EK, Shiels M. Kaposi Sarcoma Rates Among Persons Living With Human Immunodeficiency Virus in the United States: 2008—2016 [Internet]. Clinical Infectious Diseases. 2021;73(7):e2226–33. DOI: 10.1093/cid/ciaa999

44. Lynch J, Crawley SM. Management of airway obstruction [Internet]. BJA Education. 2018;18(2):46–51. DOI: 10.1016/j.bjae.2017.11.006

45. Yiannakis CP, Hilmi OJ. Evaluation and management of acute upper airway obstruction [Internet]. Surgery (Oxford). 2018;36(10):560–8. DOI: 10.1016/j.mpsur.2018.08.007

46. Costa L, Matos R, Júlio S, Vales F, Santos M. Urgent tracheostomy: four-year experience in a tertiary hospital [Internet]. World Journal of Emergency Medicine. 2016;7(3):227. DOI: 10.5847/wjem.j.1920-8642.2016.03.011

47. Panda N, Donahue DM. Acute airway management [Internet]. Ann Cardiothorac Surg. 2018;7(2):266–72. DOI: 10.21037/acs.2018.01.15

48. Ciolofan MS, Anghelina F, Mogoantă CA, Vlăescu AN, Mitroi MR, Căpitănescu AN, et al. Kaposi’s sarcoma of the larynx: case series [Internet]. Rom J Morphol Embryol. 2023;64(4):559–65. DOI: 10.47162/RJME.64.4.13

49. Naimi Z, Mahjoubi K, Adouni O, Abidi R, Driss M, Nasr C. Kaposi’s sarcoma of the larynx: an unusual location in a HIV-negative patient case report. Pan Afr Med J [Internet]. 2020;37(206). DOI: 10.11604/pamj.2020.37.206.26175

50. Safia A, Farhat R, Avraham Y, Merchavy S. Kaposi sarcoma at the base of the tongue in a renal transplant patient [Internet]. BMJ Case Rep. 2023;16(3):e253899. DOI: 10.1136/bcr-2022-253899

Downloads

Published

2025-10-21

How to Cite

1.
Syahri A, Sukartini T, Wahyuni ED, Kurniawati ND, Ridho FM. Oropharyngolaryngeal manifestations of Kaposi’s sarcoma with airway obstruction and its management in patients with HIV/AIDS. Rev. cuba. med. mil [Internet]. 2025 Oct. 21 [cited 2025 Dec. 28];54(4):e025076774. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/76774

Issue

Vol. 54 No. 4 (2025): October - December

Section

Systematic Review

License

Copyright (c) 2025 Alfi Syahri, Tintin Sukartini, Erna Dwi Wahyuni, Ninuk Dian Kurniawati, Fiki Muhammad Ridho

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Authors who have publications with this Journal accept the following terms:

  • The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
  • The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
  • Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.