ABSTRACT
Background: Stage at time of diagnosis and survival after diagnosis are critical parameters regarding the control of any cancer in any geographical setting. Unlike in resource-rich settings where publicly funded cancer surveillance routinely monitors these parameters, these data are non-existent through routine means in resource-limited areas. This is particularly relevant for Kaposi sarcoma (KS) in East Africa, for which recent changes in HIV treatment and chemotherapy guidelines as well as the COVID-19 pandemic dictate an update regarding stage and survival. Method(s): From October 2021 to August 2022, we evaluated HIV-infected adults (age >= 18 years) with a new diagnosis of KS made in 4 different primary care facilities (or their associated inpatient units) in Kenya and Uganda using a process of rapid case ascertainment. KS diagnosis was confirmed by pathology. Participants were examined, at time of biopsy, to document the extent of lesions and subsequently monitored longitudinally for vital status. Result(s): Among 180 HIV-infected adults identified with new onset KS, 31% were women, and the median (IQR) age was 35 (29-42) years. At time of KS diagnosis, 95% of the participants were taking ART, and the median (IQR) CD4+ T cell count was 197 (46-354) cells/mm3;46%, 20%, 11% and 23% had plasma HIV RNA of < 40, 40-1000, 1001-10,000 and >10,000 copies/ml, respectively. The median number of anatomic sites with KS lesions per participant was 7 (4-11);26% of participants had oral KS lesions that interfered with either eating or speaking, 74% had KS-associated edema, and 86% had ACTG stage T1 (advanced KS). Over a median follow-up of 2.6 months (IQR: 0.75 to 5.5), 56 participants died, and only 3 lost to follow-up. Cumulative incidence of death (95% CI), via Kaplan-Meier estimation, at 2 months, 6 months and 8 months following KS diagnosis was 24% (18%-31%), 33% (26%-42%), and 38% (29- 49%), respectively (Figure). Conclusion(s): In a recently assembled community-based sample of adults with newly-diagnosed HIV-related KS in East Africa, the majority have advanced KS at the time of KS diagnosis, and survival is poor. The findings are stark in absolute terms for the Treat-All era and unchanged from parameters obtained in the 5 years prior, indicating no improvement in these aspects of the control of KS in the region. Along with primary prevention of KS (i.e., reducing its incidence), novel approaches are needed for earlier detection, more efficient linkage to oncologic care, and more potent therapy. Survival Among Adults with HIV-Related Kaposi Sarcoma in East Africa.