Survival After Diagnosis of HIV-Associated Kaposi Sarcoma Among Adults in East Africa in the "Treat-All" Era.

BACKGROUND

HIV-associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan Africa in the "Treat All" era. Survival after KS diagnosis has historically been poor in Africa, but knowledge about whether survival has changed in the contemporary era has been limited by lack of community-representative surveillance and monitoring systems.

METHODS

We identified people living with HIV with a new diagnosis of KS made between 2016 and 2019 at primary care facilities in Kenya and Uganda using rapid case ascertainment. In a cohort study, they were subsequently followed for survival.

RESULTS

Among 411 participants with new KS diagnoses, 71% were men, median age was 34 (IQR: 30-41) years, and 91% had advanced KS. Over a median follow-up of 7.8 (IQR: 2.4-17.9) months, cumulative incidence of death (95% confidence interval) at months 6, 12, and 18 was 34% (30% to 39%), 41% (36% to 46%), and 45% (40% to 51%), respectively. Having the highest number of anatomic sites (11-16) with KS lesions compared with 1 to 3 sites (hazard ratio = 2.2; 95% CI: 1.3 to 3.8), presence of oral lesions (hazard ratio = 2.2; 95% CI: 1.4 to 3.3), lower hemoglobin, lower CD4 count, and higher plasma HIV RNA viral load, all measured at the time of diagnosis, were associated with higher mortality.

CONCLUSIONS

Among adult people living with HIV with new KS diagnoses in East Africa in the "Treat All" era, survival was poor and related to mucocutaneous extent of KS. The findings support need for better control of KS in Africa, including novel approaches for earlier detection, linkage to oncologic care, and more potent therapy.