Epidemiology of Kaposi’s Sarcoma

Abstract

Kaposi’s sarcoma is an angioproliferative tumor caused by human herpesvirus 8 in the context of immunodeficiency, such as that induced by HIV infection or immunosuppressive therapy. Its incidence has dramatically fallen in patients living with HIV (PLHIV) since the introduction of potent antiretroviral combinations 25 years ago due to the restoration of immunity and better control of HIV replication. However, KS is still one of the most frequently occurring cancers in PLHIV, in particular in men who have sex with men and in sub-Saharan Africa, where it is still endemic. Even in the context of restored immunity, the risk of KS is still more than 30 times higher in PLHIV than in the general population. Recent evidence indicates that early initiation of antiretroviral treatment, which is recommended by current guidelines, may reduce the risk of KS but it needs to be accompanied by early access to care. This review mainly focuses on the recent epidemiological features of KS in the context of HIV infection.

Opportunistic Infections in the Immunocompromised: Hiv Vs Non-HIV Patients - A Narrative Review

“…Kaposi's sarcoma (KS) is caused by infection by the human herpesvirus-8 (HHV-8) which is an oncogenic virus. When alone, the HHV-8 infection is not sufficient for the development and progression of the KS, requiring an immune deficiency state 111,112 . HIV infection dramatically changes the prevalence of KS, which was a rare disease before its epidemic 113 .…”

“…KS is classified as: classic -typically in elderly men of the Mediterranean area or Jewish ancestry; endemic or African KS -common in the sub-Saharan Africa, affecting young adults and children; epidemic or AIDS-associated KS; iatrogenic KS and, KS that has been reported in men who have sex with men (MSM) without HIV infection [112][113][114][115] . The HHV-8 can be transmitted through the saliva, sexual contact, perinatal infection, hematogenous routes (like blood transfusion) or by reactivation of a latent infection in an organ donor, which can happen in iatrogenic KS 112,113,116 . It happens to be more frequent in men than in women (2.5:1 ratio), in MSM (with or without HIV) and in HIV patients 112,113,116 .…”

“…The HHV-8 can be transmitted through the saliva, sexual contact, perinatal infection, hematogenous routes (like blood transfusion) or by reactivation of a latent infection in an organ donor, which can happen in iatrogenic KS 112,113,116 . It happens to be more frequent in men than in women (2.5:1 ratio), in MSM (with or without HIV) and in HIV patients 112,113,116 . The risk factors for HHV-8 transmission are increased age, sexual activity with men, increased number of sexual contacts, medical history of sexually transmitted diseases, coinfection with other virus (like hepatitis B and herpes simplex virus) and immunodeficiency 116,117 .…”

“…Systemic treatment lies on chemotherapy reserved for the patients who are still symptomatic after other treatments and for the ones who have disseminated disease with or without visceral involvement 114 . The emergence of ART led to a substantial decline in its incidence, however, KS is still more frequent in PLWH 112,113 . Cases of KS are more frequent in HIV-1 infection compared to HIV-2 infection 115 and MSM typically diagnosed at an early age -40 years old for PLWH versus 60 years old for the general population 112 .…”

“…The emergence of ART led to a substantial decline in its incidence, however, KS is still more frequent in PLWH 112,113 . Cases of KS are more frequent in HIV-1 infection compared to HIV-2 infection 115 and MSM typically diagnosed at an early age -40 years old for PLWH versus 60 years old for the general population 112 . In HIV-patients viral load and the CD4 count appear to be important and independent factors for the development of KS 112 .…”