Characteristics of HIV-1-associated Kaposi's sarcoma among women and men in South Africa

Abstract

Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.

Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

“…We confirmed the findings of other studies that advanced KS stage [10,11,18,19] predicts mortality, while chemotherapy [8,20] increases the chance of survival in KS patients. Unlike other South African studies [16,21] , we found no gender differences in mortality. Our study showed that both chemotherapy and radiation therapy were associated with improved survival.…”

A Randomized Controlled Trial of Highly Active Antiretroviral Therapy Versus Highly Active Antiretroviral Therapy and Chemotherapy in Therapy-Naive Patients With HIV-Associated Kaposi Sarcoma in South Africa

“…Women had poorer 12-month survival not explained by ACTG prognostic factors or treatment arm. This finding builds on retrospective observations that women with HIV-KS have more aggressive disease and inferior outcomes than men 23-25 , and is the first prospective study demonstrating inferior outcomes in women despite comparable therapy.…”

Changes in the pattern of Kaposi’s sarcoma at Ocean Road Cancer Institute in Tanzania (2006–2011)

“…In South Africa, it was estimated that the incidence of KS has doubled in men, while increasing by seven folds in women since the early 1990’s. Furthermore, women are also more likely than men to present with oral lesions when diagnosed with KS 22 . Nigerian women presented with KS at a younger age (~35 years) than men (~38 years) at the time of the first visit 14 .…”