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, Wools-Kaloustian Kara, Kambugu Andrew, Martin Jeffrey
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
J Acquir Immune Defic Syndr. 2025 Jul 28. doi: 10.1097/QAI.0000000000003733.
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.
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.
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.
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.
在“全面治疗”时代，与HIV相关的卡波西肉瘤（KS）仍是撒哈拉以南非洲最常见的恶性肿瘤之一。在非洲，KS诊断后的生存率历来较低，但由于缺乏具有社区代表性的监测系统，关于当代生存率是否发生变化的了解有限。
我们通过快速病例确诊，在肯尼亚和乌干达的基层医疗设施中，识别出2016年至2019年间新诊断为KS的HIV感染者（PLWH）。在一项队列研究中，随后对他们进行生存随访。
在411例新诊断为KS的参与者中，71%为男性，中位年龄为34岁（四分位间距：30 - 41岁），91%患有晚期KS。在中位随访7.8个月（四分位间距：2.4 - 17.9个月）期间，第6、12和18个月时的累积死亡发生率（95%置信区间）分别为34%（30% - 39%）、41%（36% - 46%）和45%（40% - 51%）。在KS诊断时，与1至3个病损部位相比，KS病损部位数量最多（11至16个）（风险比（HR）=2.2；95%置信区间：1.3 - 3.8）、存在口腔病损（HR = 2.2；95%置信区间：1.4 - 3.3）、血红蛋白水平较低、CD4细胞计数较低以及血浆HIV RNA病毒载量较高与较高的死亡率相关。
在“全面治疗”时代东非新诊断为KS的成年PLWH中，生存率较低且与KS的皮肤黏膜累及范围有关。这些发现支持在非洲更好地控制KS的必要性，包括采用新方法进行早期检测、与肿瘤治疗建立联系以及采用更有效的治疗。
