Analyses of Kaposi Sarcoma trends among adults establishing initial outpatient HIV care in Nigeria: 2006–2017

Abstract

Background The incidence of Human Immunodeficiency Virus (HIV)-associated Kaposi Sarcoma (KS) in the pre-antiretroviral therapy (ART) population remains high in several countries in sub-Saharan Africa. We examined trends of KS prevalence in adults, establishing initial outpatient HIV care from 2006 to 2017 in Nigeria. Methods We analyzed data of 16,431 adults (age ≥ 18 years) enrolled for HIV care from January 1, 2006, to December 31, 2017, in a large clinic in Jos, Nigeria. KS at enrollment was defined as KS recorded in the electronic health record within 30 days of clinic enrollment. Time trends were compared among four periods: 2006–2008, 2009–2011, 2012–2014, and 2015–2017 using logistic regression models. Annual trends were analyzed using join point regression and restricted splines. Results The study population had a mean age 35.1 (standard deviation, SD 9.5) years, and were 65.7% female (n = 10,788). The mean CD4 cell count was 220 (95% CI 117–223). The overall KS prevalence at entry was 0.59% (95% CI 0.48–0.72). Compared to 2006–2008, KS prevalence was significantly higher in 2009–2011 (adjusted odds ratio 5.07 (95% CI 3.12–8.24), p < 0.001), but remained unchanged in subsequent periods. Male sex and low CD4 T-cell count independently increased odds for KS. Conclusions Despite ART expansion, KS at enrollment showed no significant decline. The low CD4 cell count, across all periods, indicates delay in enrollment for HIV care, which increases KS risk. Interventions aimed at early HIV diagnosis and linkage to ART is critical to KS risk reduction in this population.

Cancer in patients with and without HIV infection in the national cancer registry of Rwanda

“…Given Rwanda's increased rates of viral load suppression across the PWH population in recent years, this finding could contribute to the consistent decline in Kaposi sarcoma with increasing ART use in the country that was found in this study [23]. Similar trends have been described from Uganda [24], although not every country or region of sub-Saharan Africa has experienced the same declines in incidence despite fairly widespread ART scale-up [25,26]. The fact that some countries have not experienced declines in Kaposi sarcoma incidence may point to significant gaps in HIV testing and ART coverage despite relatively broad population level ART coverage.…”

Incident Kaposi sarcoma during the expansion of antiretroviral therapy eligibility in Nigeria: a retrospective cohort study

“…To date, the impact of changes in HIV treatment guidelines on the risk for KS has not been systematically studied in Nigeria, despite its large HIV population and the endemicity for Human Herpes Virus type 8 (HHV8), the virus responsible for KS [ 18 , 19 ]. We had previously investigated changes in KS prevalence among adults initiating HIV care and did not find a significant difference in KS prevalence at enrollment over four periods (2006–2008, 2009–2011, 2012–2014, and 2015–2017) [ 20 ]. In this study, utilizing data from the same clinic cohort, we investigate the impact of ART eligibility expansion on the incidence of KS among adults initiating HIV care.…”