Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
J Acquir Immune Defic Syndr. 2021 Aug 15;87(5):1119-1127. doi: 10.1097/QAI.0000000000002699.
Although many patients with Kaposi sarcoma (KS) in sub-Saharan Africa are diagnosed with AIDS Clinical Trials Group (ACTG) T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detailed disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa.
We performed rapid case ascertainment on people living with HIV, aged 18 years or older, newly diagnosed with KS from 2016 to 2019 at 3 clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria and detailed measurements that are not captured in the current staging systems.
We performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. The study was 68% men with median age 35 years and median CD4 count 239. Most of the patients had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO severe/symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor-associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having 2 T1 qualifying symptoms and 3% having 3 or more.
Most of the patients newly diagnosed with KS had advanced stage disease, even in the current antiretroviral therapy "treat-all" era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy.
尽管撒哈拉以南非洲的许多卡波西肉瘤（KS）患者被诊断为艾滋病临床试验组（ACTG）T1 期疾病，但 T1 分期并不能充分捕捉晚期 KS 的临床异质性。本研究使用具有代表性的社区为基础的样本，详细描述了诊断时的疾病严重程度，为撒哈拉以南非洲的 KS 分期和治疗提供信息。
我们对 2016 年至 2019 年在肯尼亚和乌干达的 3 个诊所新诊断为 KS 的年龄在 18 岁及以上的 HIV 感染者进行了快速病例确定，以尽可能接近诊断时确定疾病分期。我们使用 ACTG 和世界卫生组织（WHO）分期标准以及当前分期系统未包含的详细测量值来报告 KS 严重程度。
我们对 389 例疑似 KS 的成年患者中 241 例新诊断为 KS 的成年人在 1 个月内进行了快速病例确定。研究对象为 68%的男性，中位年龄为 35 岁，中位 CD4 计数为 239。大多数患者患有晚期疾病，82%符合 ACTG T1 期，64%符合 WHO 严重/有症状 KS 期。最常见的 ACTG T1 分期标准为水肿（79%）、肿瘤相关溃疡（24%）、广泛口腔 KS（9%）、肺 KS（7%）和胃肠 KS（4%）。T1 KS 期内存在明显的异质性，25%的患者有 2 个 T1 期的症状，3%的患者有 3 个或更多。
即使在目前的抗逆转录病毒治疗“普遍治疗”时代，大多数新诊断为 KS 的患者也患有晚期疾病。我们观察到晚期患者存在很大的临床异质性，这引发了一个问题，即是否所有患有晚期 KS 的患者都需要相同的治疗策略。
