Background HIV-associated Kaposi sarcoma (KS) is commonly staged using the AIDS Clinical Trials Group criteria, which classify 3 variables-- tumor extent (T), immune status (I), and systemic symptoms (S) – into good risk (0) and poor risk (1). Although validated in the US and Europe, these criteria have not been systematically evaluated in sub-Saharan Africa (SSA), where the burden of KS is greatest. Methods We reviewed medical charts of adult patients with HIV-associated KS seen at the Uganda Cancer Institute from 1992–2007. Vital status at 2 years after KS diagnosis was determined from the medical chart, or by contacting the patient or next of kin. Survival estimates used Kaplan-Meier (KM) methods. Predictors were evaluated for 2 periods: 0–4 months and 4–24 months after diagnosis. Results At 2 years after diagnosis, 167 (41%) patients were alive, 156 (39%) had died, and 81 (20%) were lost to follow-up. The KM estimate of 2-year survival was 57%. S1 was associated with death in months 0–4 [HR 6.4, 95% CI (1.9–21.1)], while T1 was associated with death in months 4–24 [HR 4.0, 95% CI (1.4–11.5)]. Immune status was not associated with survival. Conclusions Systemic symptoms were strongly associated with death in the early period after KS diagnosis, while tumor status was most predictive of death in the 4–24 month period. These findings suggest that different processes may influence outcomes in early and late periods following KS diagnosis. Further studies are needed to confirm these observations and to identify better predictors of KS survival in SSA.

Objective:Improved understanding of the effect of HIV infection on Kaposi sarcoma (KS) presentation and outcomes will guide development of more effective KS staging and therapeutic approaches. We enrolled a prospective cohort of epidemic (HIV-positive; HIV+KS) and endemic (HIV-negative; HIV−KS) KS patients in Uganda to identify factors associated with survival and response.Methods:Adults with newly diagnosed KS presenting for care at the Uganda Cancer Institute (UCI) in Kampala, Uganda, between October 2012 and December 2019 were evaluated. Participants received chemotherapy per standard guidelines and were followed over 1 year to assess overall survival (OS) and treatment response.Results:Two hundred participants were enrolled; 166 (83%) had HIV+KS, and 176 (88%) were poor-risk tumor (T1) stage. One-year OS was 64% (95% confidence interval [CI] 57–71%), with the hazard of death nearly threefold higher for HIV+KS (hazard ratio [HR] = 2.93; P = 0.023). Among HIV+KS, abnormal chest X-ray (HR = 2.81; P = 0.007), lower CD4+ T-cell count (HR = 0.68 per 100 cells/μl; P = 0.027), higher HIV viral load (HR = 2.22 per log10 copies/ml; P = 0.026), and higher plasma Kaposi sarcoma-associated herpesvirus (KSHV) copy number (HR = 1.79 per log10 copies/ml; P = 0.028) were associated with increased mortality. Among HIV−KS, factors associated with mortality included Karnofsky score <70 (HR = 9.17; P = 0.045), abnormal chest X-ray (HR = 8.41; P = 0.025), and higher plasma KSHV copy number (HR = 6.21 per log10 copies/ml; P < 0.001).Conclusions:Although survival rates were better for HIV−KS than HIV+KS, the high mortality rate seen in both groups underscores the urgent need to identify new staging and therapeutic approaches. Factors associated with mortality, including high plasma KSHV, may serve as important targets of therapy.

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