Re: thanks. didn't think it could occur this early?

KS is among a handful of infections that frequently occur at higher CD4 counts (the risk of getting them is higher the lower the CD4 goes, but a relatively high CD4 count isn't always protective against it. Thrush and shingles can also occur early. Bacterial pneumonia and TB are also common at higher CD4 counts, even though they're not unique to HIV patients). Classic KS occurs in older men of certain ethnicities who are NOT immunosuppressed. It's really AGGRESSIVE epidemic KS (rather than mild KS - a few lesions limited to the skin) that is dangerous and specific to AIDS. I had a friend who had mild KS with an absolute CD4 count nearly twice as high as yours, and he's fine and alive to tell the tale (many years later)!

I'm far from an expert on KS, but I do know that KS is caused by HHV-8 (human herpesvirus 8). DQ doesn't seem to understand this - you can make the lesions go away, but there's no cure for the virus that causes them. This is because HHV-8, like other herpesviruses, is very good at hiding in your body. To get rid of the virus completely, you would have to destroy all the cells where it is hiding, and even the healthiest people are unable to do this. This is the same as with herpes simplex: you're not going to eliminate the virus, but you just want to keep it in check (so that you don't have outbreaks) - so long as it's hiding in your neurons, it's not really harming you. You just want to stop it from becoming activated and replicating. B-lymphomas, which are caused by EBV (also a herpesvirus, which hides in B-cells - Epstein Barr is a virus to which nearly all of us have been exposed, but our immune systems are usually good enough at keeping it in check), represent another opportunistic disease to which people with HIV are susceptible at higher CD4 counts.

KS happens in the context of HIV for more than one reason. One reason is, quite obviously, dysfunctional immunity (activation of some parts of the immune system, suppression of others). But another reason is that HIV-infected cells make a protein called tat (it's an accessory protein) which allows HHV-8 to replicate. Your immune system's attempts to fight HIV can, in various ways, give HHV-8 a boost (e.g. certain pro-inflammatory cytokines). There are genetic differences that make some people more susceptible to symptomatic disease, but they're too complicated for me to go into in the limited amount of time that I have. Yes, very little is simple!

KS can, and does, occur at all stages of HIV infection. So long as yours is not aggressive (not developing terribly quickly, not in any internal organs), I wouldn't worry a whole bunch about "what it means". If the cosmetic aspects are bugging you, talk to your doctor. There's some derivative of vitamin A (the name is escaping me at the moment) that can be injected into the lesions and is sometimes helpful, but takes a while to work. That's natural, even if it's not "alternative" (because it's accepted by mainstream scientists).

Has one of your lesions been biopsied? A lot of doctors will make presumptive KS diagnoses (because they've seen it a lot and know what it looks like), but imo, still best to do the biopsy, because there are other things that can look very similar. I'm a big fan of definitively diagnosing conditions (where possible) before treating.

Don't listen to DQ on CD4 counts - 600 is not anything to be concerned about (it's actually quite good! It's not "low normal", it's NORMAL! There are a lot more people with CD4 counts around 600 cells/ml than 1500. Also, ranges differ between labs on this. People with CD4 counts of 400 are usually perfectly healthy - 600 is just fine! With immune cells, until you get to the extremes, numbers are not everything - "it's not how many you've got, it's how well they're doing their job"). I would only be concerned if the CD4 % was dropping pretty rapidly (even though it's still high).

There's not really any such thing as "CD4 counts too high for HAART". The recommendations of initiating HAART at 350 only apply to ASYMPTOMATIC patients - certain symptoms, even at high CD4 counts, can be an indication for starting HAART. There are always pros and cons to starting HAART at higher CD4 counts, even in asymptomatic patients. From a strictly immunologic perspective, you would start HAART as early as possible, but from a pharmacologic or social perspective, a more conservative approach may make more sense. The pendulum has shifted on this before (from "hit early and hard" to "wait and see"), and it will shift again (among immunologists, it already has to some extent). I'm not saying you should go on HAART (I don't know enough of you situation to say what I would do, one way or the other). It often helps KS, though:
http://hivinsite.ucsf.edu/InSite-KB-ref.jsp?page=kb-06-02-03&rf=61


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