Incidence of HIV-related Kaposi’s sarcoma not improving in East Africa
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Key takeaways:
- The incidence of Kaposi’s sarcoma and related death in East Africa has not improved in the last 5 years.
- In a recent study, 86% of participants had advanced Kaposi’s sarcoma and more than 25% died.
SEATTLE — People in East Africa with HIV-related Kaposi’s sarcoma often have advanced disease and a poor survival outlook — and the situation has not improved in the last 5 years, a study found.
People with HIV are at increased risk for Kaposi’s sarcoma (KS), a cancer of the cells lining blood or lymphatic vessels that is linked to herpesvirus infection, and incidence rates are higher in some parts of sub-Saharan Africa.
Findings from the new study, which were presented recently at the Conference on Retroviruses and Opportunistic Infections, indicate a need for improved primary prevention of KS, as well as methods for earlier detection and better treatments researchers said.
Such improvements would allow for better measurement of cancer stages at diagnosis and survival after diagnosis, both key parameters for controlling cancer “in any geographical setting,” said Helen Byakwaga, MBChB, PhD, a research scientist at Makerere University’s Infectious Diseases Institute, during an oral abstract session at CROI.
“Unlike in resource-rich setting, where publicly funded cancer surveillance routinely monitors these parameters, these data are nonexistent through routine means in resource-limited areas,” Byakwaga said. “This is particularly relevant for KS in East Africa, for which recent changes in HIV treatment and chemotherapy guidelines, as well as the COVID-19 pandemic, dictate need for an update regarding stage and survival.”
From October 2021 through August 2022, Byakwaga and colleagues enrolled 180 HIV-infected adults aged 18 years or older at four primary care facilities in Kenya and Uganda who were diagnosed with KS. Participants had a median age of 35 years, and 31% were women, According to Byakwaga, none of the facilities were cancer treatment facilities.
At time of diagnosis, 95% of participants were taking ART and had a median CD4+ T-cell count of 197. The researchers split the body into 16 anatomical sites, and the median number of KS lesion sites per participant was seven. Of the participants, 26% had oral lesions that interfered with eating or speaking, 74% had KS-associated edema and 86% had advanced KS.
During a median follow-up period of 2.6 months, 56 study participants died and three were lost to follow-up. Among the participants who died, 24% died 2 months after KS diagnosis, 33% died 6 months after KS diagnosis and 38% died 8 months after KS diagnosis.
“The implications of our study findings are far-reaching,” Byakwaga said, at least partially because the study’s stage and survival findings were unchanged from a similar study 5 years ago, “indicating no improvement in these aspects of control of KS in the region.”
“In resource-limited settings where public health surveillance is not available, researchers need to play a leading role in monitoring the basic epidemiology of the life-threatening complications of HIV infection,” she said. “Along with primary prevention of KS — for example, use of vaccines — novel approaches are needed for earlier detection and efficient linkage to care and potent therapy.”
Perspective
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Kaposi’s sarcoma is a most unusual cancer. It’s associated with a herpes virus — human herpesvirus-8, or Kaposi’s sarcoma herpesvirus — and absent HIV coinfection, KS is rarely a significant problem, appearing as painless pigmented skin lesions, especially on the lower extremities.
When seen with HIV and significant immune suppression, KS can be a systemic and rapidly progressing disease affecting essentially any organ system but almost always appearing on the skin.
KS has become an uncommon and less aggressive condition since the advent of effective ART. The diagnosis is straightforward if suspected with punch biopsy revealing typical proliferation of abnormal blood vessels and red blood cell extravasation. KS often responds to successful initiation of HIV therapy with CD4 cell count recovery.
Some control of large symptomatic plaque lesions was occasionally of some value in the early AIDS epidemic, but systemic chemotherapy today is rarely indicated.
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Byakwaga H, et al. HIV-related Kaposi’s sarcoma in East Africa: Contemporary update on stage and survival. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 19-22, 2023; Seattle.
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