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

Abstract

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 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 (PLWH) 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% CI) at months 6, 12 and 18 were 34% (30%-39%), 41% (36%-46%) and 45% (40%-51%), respectively. At time of KS diagnosis, having the highest number of anatomic sites (11 to 16) with KS lesions compared to 1 to 3 sites (hazard ratio (HR)=2.2; 95% CI: 1.3-3.8), presence of oral lesions (HR=2.2; 95% CI: 1.4-3.3), lower hemoglobin, lower CD4 count and higher plasma HIV RNA viral load were associated with higher mortality.

Conclusion: Among adult PLWH 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.