Incidence Rate of Kaposi Sarcoma in HIV-Infected Patients on Antiretroviral Therapy in Southern Africa

Abstract

Background The risk of Kaposi sarcoma (KS) among HIV-infected persons on antiretroviral therapy (ART) is not well defined in resource-limited settings. We studied KS incidence rates and associated risk factors in children and adults on ART in Southern Africa. Methods We included patient data of six ART programs in Botswana, South Africa, Zambia, and Zimbabwe. We estimated KS incidence rates in patients on ART measuring time from 30 days after ART initiation to KS diagnosis, last follow-up visit, or death. We assessed risk factors (age, sex, calendar year, WHO stage, tuberculosis, and CD4 counts) using Cox models. Findings We analyzed data from 173,245 patients (61% female, 8% children aged <16 years) who started ART between 2004 and 2010. 564 incident cases were diagnosed during 343,927 person-years (pys). KS incidence rate overall was 164/100,000 pys (95% confidence interval [CI] 151–178). The incidence rate was highest 30 to 90 days after ART initiation (413/100,000 pys; 95% CI 342–497) and declined thereafter (86/100,000 pys[95% CI 71–105]>2 years after ART initiation). Male sex (adjusted hazard ratio [HR] 1.34; 95% CI 1.12–1.61), low current CD4 counts (≥500 cells/µL versus <50 cells/µL, adjusted HR 0.36; 95% CI 0.23–0.55) and age (5 to 9 years versus 30 to 39 years, adjusted HR 0.20; 95% CI 0.05–0.79) were relevant risk factors for developing KS. Interpretation Despite ART, KS risk in HIV-infected persons in Southern Africa remains high. Early HIV testing and maintaining high CD4 counts is needed to further reduce KS-related morbidity and mortality.

BALB/c mice immunized with a combination of virus-like particles incorporating Kaposi sarcoma-associated herpesvirus (KSHV) envelope glycoproteins gpK8.1, gB, and gH/gL induced comparable serum neutralizing antibody activity to UV-inactivated KSHV

“…KS is one of the most frequent malignancies seen in AIDS patients [17, 18]. It is a major cause of morbidity and mortality in adults in sub-Saharan Africa, where the prevalence of HIV/AIDS is high, and it is an emerging problem for children [19–21].…”

Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

“…Adult ART coverage rose from 5.1% in 2004 to 79% in 2011 [6,7] , and this improved ART coverage is reflected in the improved ART status of patients in the later ART period in our study. In spite of improved ART coverage, KS incidence in HIV-positive Southern Africans remains unacceptably high, even in patients on ART [23] because only patients with significant immune impairment were eligible for ART. This underscores the need and potential impact of the test-and-treat strategy that South Africa adopted from September 2016 [24] .…”

HIV-associated malignancies in sub-Saharan Africa

“…Similarly, in both China and Brazil, relative ADC declines and NADC increases are occurring as in high-income countries [16*, 17*]. Conversely, in most of SSA, ADC still dominate with incidence declines most consistently observed for KS, although KS incidence remains high throughout the region and is often among the most frequent cancers overall [15**, 18*, 19*, 20, 21**, 22]. HIVAM are therefore unlikely to recede as a public health problem in LMIC in the near term despite ART scale-up.…”