
==== Front
medRxiv
MEDRXIV
medRxiv
Cold Spring Harbor Laboratory

10.1101/2024.08.26.24312536
preprint
1
Article
Survival Following Diagnosis of HIV-Associated Kaposi Sarcoma Among Adults in East Africa in the “Treat-All” Era
Byakwaga Helen
Semeere Aggrey
Laker-Oketta Miriam
Busakhala Naftali
Freeman Esther
Rotich Elyne
Wenger Megan
Kadama-Makanga Philippa
Kisuya Job
Semakadde Matthew
Mwine Bronia
Kasozi Charles
Mwebesa Bwana
Maurer Toby
Glidden David V.
Kaloustian Kara Wools-
Kambugu Andrew
Martin Jeffrey
28 8 2024
2024.08.26.24312536https://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.
http://medrxiv.org/lookup/doi/10.1101/2024.08.26.24312536
nihpp-2024.08.26.24312536.pdf
Abstract

Background

Despite widespread access to antiretroviral therapy (ART) in the “Treat All” era, HIV-associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan Africa. Survival after KS diagnosis has historically been poor in Africa, but knowledge whether survival has changed at the population level in the contemporary era has been limited by lack of community-representative surveillance and monitoring systems.

Methods

We identified all adult persons living with HIV (PLWH) with a new diagnosis of KS made between 2016 and 2019 during outpatient or inpatient care at prototypical primary care-providing medical facilities in Kenya and Uganda using rapid case ascertainment. Participants were subsequently followed for vital status, including community tracking for those who became lost to follow-up.

Findings

Among 411 participants with newly diagnosed KS, 71% were men, median age was 34 (IQR: 30 to 41) years, and 91% had ACTG T1 tumor extent. Over a median follow-up of 7.8 (IQR: 2.4 to 17.9) months, cumulative incidence of death (95% CI) at months 6, 12 and 18 were 34% (30% to 39%), 41% (36% to 46%) and 45% (40% to 51%), respectively. Having the highest number of anatomic sites (11 to 16) harboring KS lesions (hazard ratio 2.2 (95% CI: 1.3-3.8) compared to 1 to 3 sites) and presence of oral KS lesions (hazard ratio 2.2 (95% CI: 1.4-3.3)) were independently associated with higher mortality. Lower hemoglobin and CD4 count as well as higher plasma HIV RNA were also associated with higher mortality.

Interpretation

Among PLWH with newly diagnosed KS in East Africa in the “Treat All” era, survival was poor and related to mucocutaneous extent of KS. The findings emphasize the need for better control of KS in Africa, including novel approaches for earlier detection, better linkage to oncologic care, and more potent therapy.
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pmc
