AIDS-associated Kaposiʼs sarcoma in female patients

Lassoued, Kaı̈ss; Clauvel, Jean‐Pierre; Fégueux, S.; Matheron, Sophie; Gorin, Isabelle; Oksenhendler, Éric

doi:10.1097/00002030-199107000-00013

Cited by 30 publications

(11 citation statements)

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“…Our finding that women had frequent oral KS lesions is in agreement with previous studies [9]. Notably, the presence of lesions on the hard palate was also associated with a greater hazard of improvement.…”

Section: Discussionsupporting

confidence: 93%

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Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda

et al. 2010

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IntroductionThe incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda.Methods and FindingsHIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to “improvement”, as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm3; IQR 11–156 cells/mm3) than men (124 cells/mm3; IQR 22–254 cells/mm3) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis.ConclusionsThe clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.

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Section: Discussionsupporting

confidence: 93%

“…Women in our study had significantly lower CD4 counts at KS diagnosis than men, as has been reported by others [8], [9]. The frequency of this finding across several studies suggests that greater immunosuppression may be an intrinsic part of the pathophysiology of KS in women.…”

Section: Discussionsupporting

confidence: 87%

Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda

et al. 2010

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“…7 Second, the high rate of KS in African women contrasts sharply with the extremely low KS incidence among women in resource-rich countries. 8–13 Third, patients frequently present with advanced HIV and other co-morbid diseases, including tuberculosis, which may impact survival. 14 Finally, KS outcomes in Africa are quite poor compared to the US and Europe, with 5-year survival rates less than 10% in some regions.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Predictive Staging Model for HIV-Associated Kaposi Sarcoma in Uganda

Okuku

Krantz

Kafeero

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background HIV-associated Kaposi sarcoma (KS) is commonly staged using the AIDS Clinical Trials Group criteria, which classify 3 variables-- tumor extent (T), immune status (I), and systemic symptoms (S) – into good risk (0) and poor risk (1). Although validated in the US and Europe, these criteria have not been systematically evaluated in sub-Saharan Africa (SSA), where the burden of KS is greatest. Methods We reviewed medical charts of adult patients with HIV-associated KS seen at the Uganda Cancer Institute from 1992–2007. Vital status at 2 years after KS diagnosis was determined from the medical chart, or by contacting the patient or next of kin. Survival estimates used Kaplan-Meier (KM) methods. Predictors were evaluated for 2 periods: 0–4 months and 4–24 months after diagnosis. Results At 2 years after diagnosis, 167 (41%) patients were alive, 156 (39%) had died, and 81 (20%) were lost to follow-up. The KM estimate of 2-year survival was 57%. S1 was associated with death in months 0–4 [HR 6.4, 95% CI (1.9–21.1)], while T1 was associated with death in months 4–24 [HR 4.0, 95% CI (1.4–11.5)]. Immune status was not associated with survival. Conclusions Systemic symptoms were strongly associated with death in the early period after KS diagnosis, while tumor status was most predictive of death in the 4–24 month period. These findings suggest that different processes may influence outcomes in early and late periods following KS diagnosis. Further studies are needed to confirm these observations and to identify better predictors of KS survival in SSA.

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“…A few studies in African populations demonstrate high rates of HHV‐8 detection in oral and plasma samples, but these reports are limited by cross‐sectional design and small sample size [Taylor et al, ; Johnston et al, ]. In addition, few studies have focused on women, who have a different epidemiology of KS and may have different clinical manifestations of KS compared to men [Benedetti et al, ; Lassoued et al, ; Cooley et al, ; Nasti et al, ; Lampinen et al, ; Phipps et al, ]. Because African women represent a unique and important population for the study of HHV‐8 transmission and KS pathophysiology, this study sought to characterize the frequency and quantity of HHV‐8 detection in the oropharynx of Kenyan women, and to identify factors associated with frequent and high quantity HHV‐8 replication.…”

Section: Introductionmentioning

confidence: 99%

Oral HHV-8 replication among women in Mombasa, Kenya

et al. 2014

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Human herpesvirus-8 (HHV-8) replication in the oropharynx may play an important role in HHV-8 transmission and contribute to the development of Kaposi sarcoma (KS) in some individuals. Studies in the United States and Europe report high rates of HHV-8 DNA detection in saliva of HHV-8 infected men, but little is known about the natural history of HHV-8 among persons in sub-Saharan Africa, where prevalence of HHV-8 infection and KS is greatest. To address this gap, this study evaluated oral HHV-8 replication in a cohort of 40 HHV-8 seropositive Kenyan women. Study clinicians collected daily oral swabs from participants for up to 30 consecutive days, and swab samples were tested for HHV-8 DNA using quantitative, real-time polymerase chain reaction. HHV-8 was detected at least once in 27 (68%) participants, and the overall shedding rate was 23%. On days with HHV-8 detection, mean HHV-8 quantity was 4.5 log10 copies/ml. Among HIV-infected women, CD4 count ≥500 cells/mm3 versus <500 cells/mm3 was associated with higher HHV-8 copy number (4.8 log10 copies/ml vs. 3.4 log10 copies/ml; coef 1.2 [95% CI, 0.5–1.9]; P=0.001) and a higher HHV-8 shedding rate (49% vs.12%; RR, 4.2 [95% CI, 0.8–21.4]; P=0.08). No other factors were associated with HHV-8 shedding rate or copy number. The study demonstrates high rates and quantity of HHV-8 in the oropharynx of HHV-8 seropositive African women. These findings support the observation that oral replication is an essential feature of HHV-8 infection, with likely implications for HHV-8 transmission and KS pathogenesis.

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AIDS-associated Kaposiʼs sarcoma in female patients

Cited by 30 publications

References 0 publications

Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda

Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda

Evaluation of a Predictive Staging Model for HIV-Associated Kaposi Sarcoma in Uganda

Oral HHV-8 replication among women in Mombasa, Kenya

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