We recommend annual influenza vaccination (level of evidence 1B). We recommend vaccination selleck products against pneumococcus and hepatitis B virus (level of evidence 1D). We recommend
that patients with antibodies against hepatitis B core antigen (HBcAb) should be treated with prophylactic antivirals in line with BHIVA hepatitis guidelines (level of evidence 1B). Kaposi sarcoma is still the most common tumour in people with HIV infection, is an AIDS-defining illness and is caused by the Kaposi sarcoma herpesvirus (KSHV). The diagnosis is usually based on the characteristic appearance of cutaneous or mucosal lesions and should be confirmed histologically since even experienced clinicians misdiagnose KS  (level of evidence 1C). Lesions are graded histopathologically into patch, plaque or nodular grade disease. Visceral disease is uncommon, affecting about 14% at diagnosis  and CT scans, bronchoscopy and endoscopy are not warranted in the absence of symptoms (level of evidence 2D). The AIDS Clinical Trial Group (ACTG) staging system for AIDS-related KS was developed in the pre-HAART Quizartinib price era to predict survival and includes tumour-related criteria
(T), host immunological status (I) and the presence of systemic illness (S) (see Table 3.1) [3,4]. The ACTG also established uniform criteria for response evaluation Protirelin in AIDS KS (see Table 3.2) . In the era of HAART, the prognostic value of this staging system has been questioned and one study suggested that only the T and S stages identify patients with poor survival , whilst another study from Nigeria found that I and S stages but not T stage were of prognostic significance . However, a comprehensive evaluation of prognostic factors in 326 patients diagnosed with AIDS KS in the era of HAART, externally validated on 446 patients from the US HIV/AIDS Cancer Match Study, has established
a prognostic scoring scheme  and more detailed immune subset analysis does not provide additional prognostic information . Having KS as the first AIDS-defining illness (-3 points) and increasing CD4 cell count (-1 for each complete 100 cells/μL in counts at KS diagnosis) improved prognosis, whereas age at KS ≥50 years old (+2) and S1 stage (+3) conveyed a poorer prognosis. On the basis of this index it was suggested that patients with a poor risk prognostic index (score >12) should be initially treated with HAART and systemic chemotherapy together, whilst those with a good risk (score <5) should be treated initially with HAART alone, even if they have T1 disease. Over time, there has been a rise in the CD4 cell count at diagnosis of KS, and the impact of initiation of treatment may also change [9–12].