Mortality disparities among patients with HIV-associated Kaposi's sarcoma in the southern United States

Knights, Sheena; Lazarte, Susana; Kainthla, Radhika; Chiao, Elizabeth Y.; Nijhawan, Ank E.

doi:10.1097/qad.0000000000003155

Cited by 4 publications

(7 citation statements)

References 26 publications

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“…We did not find a difference in KSHV seroprevalence between race/ethnicities to explain the disparities in clinical Kaposi sarcoma previously described [ 8 ]. Previous data have been mixed regarding the relationship between KSHV seroprevalence and race/ethnicity.…”

Section: Discussioncontrasting

confidence: 82%

“…Despite an overall decrease in KS incidence and mortality in the combination antiretroviral therapy (ART) era [ 2 ], certain subpopulations, particularly young Black men in the southern US, have not experienced the same decline in disease and in fact in some regions have faced an increase in KS diagnoses during this time period [ 3–7 ]. This disparity also extends to disease outcomes, as seen among people with HIV with KS in Dallas between 2009 and 2018, where mortality among Black patients was twice as high as non-Hispanic White and Hispanic patients within the same hospital system [ 8 ].…”

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confidence: 99%

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High Seroprevalence of Kaposi Sarcoma–Associated Herpesvirus in Men Who Have Sex With Men With HIV in the Southern United States

Knights

Salyards

Kendall

et al. 2023

Open Forum Infectious Diseases

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Background Disparities in mortality in HIV-associated Kaposi’s sarcoma have been described, particularly in Black men in the southern United States. It is unclear if there are racial/ethnic differences in the seroprevalence of Kaposi’s sarcoma-associated Herpesvirus (KSHV) that may be contributing. Methods This is a cross-sectional study of men who have sex with men (MSM) and transgender women (TGW) with HIV. Participants were recruited from an outpatient HIV clinic in Dallas, Texas for a one-time study visit and were excluded from analysis if they had any history of KSHV disease. Plasma was tested for antibodies to KSHV K8.1 or ORF73 antigens, and KSHV DNA was measured in oral fluids and blood by PCR. KSHV seroprevalence and viral shedding in blood and oral fluids were calculated. Additionally, independent risk factors for KSHV seropositivity were assessed by multivariable logistic regression analysis. Results 205 participants were included in our analysis. Overall, KSHV seroprevalence was high (68%) with no significant difference between racial/ethnic groups. Among seropositive participants, KSHV DNA was detected in 28.6% of oral fluids and 10.9% of peripheral blood specimens, respectively. The factors most strongly associated with KSHV seropositivity were oral-anal sex (odds ratio [OR] 3.02), oral-penile sex (OR 4.63), and methamphetamine use (OR 4.67). Conclusions High local seroprevalence of KSHV is likely a key driver of the high burden of KSHV-associated diseases regionally, though it does not explain the observed disparities in KSHV-associated disease prevalence among racial/ethnic groups. Our findings support that KSHV is primarily transmitted via exchange of oral fluids.

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Section: Discussioncontrasting

confidence: 82%

mentioning

confidence: 99%

High Seroprevalence of Kaposi Sarcoma–Associated Herpesvirus in Men Who Have Sex With Men With HIV in the Southern United States

Knights

Salyards

Kendall

et al. 2023

Open Forum Infectious Diseases

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“…Previous studies have shown more than 90% of patients with Kaposi sarcoma in North America were male. 8,10,11 Additionally, epidemiological analysis of KSHV itself has shown a higher prevalence in MSM, particularly those with HIV. 12 While KSHV seroprevalence has been described as 4%-7% in the general blood donating population, it has been as high as 30%-70% in MSM with HIV.…”

Section: Discussionmentioning

confidence: 99%

“…This study is a retrospective electronic health record (EHR) review of patients diagnosed with HIV‐associated PEL and/or MCD at Parkland Health, a large, safety‐net hospital system located in Dallas, Texas. Review of EHR charts from January 1, 2009 (start of integrated inpatient and outpatient EHR at Parkland) to December 31, 2018 was conducted using ICD‐9 and ICD‐10 codes similar to our previously published work 8 . Cases were identified if they had a diagnosis of HIV by ICD 9 codes 042 or V08, ICD 10 codes B20 or Z21, and either MCD (identified by ICD‐9 code 238.79 or ICD‐10 code D47.Z2) or PEL.…”

Section: Methodsmentioning

confidence: 99%

“…6 Historical data suggest the median survival for untreated MCD is 2 years. 7 We have previously described a large cohort with HIV-associated KS, 8 and additionally described an unexpectedly high KSHV seroprevalence in the Dallas, Texas area in men who have sex with men (MSM) with HIV. 9 Given the locally high KSHV seroprevalence in this at-risk population, we aimed to evaluate our local cases of KSHV-associated MCD and PEL to describe its epidemiology and clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes in Kaposi's sarcoma‐associated herpesvirus ‐associated primary effusion lymphoma and multicentric Castleman's disease in patients with human immunodeficiency virus (HIV) in a safety‐net hospital system

Lopez,

Kainthla,

Lazarte

et al. 2023

European J of Haematology

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ObjectiveTo describe cases of Kaposi's sarcoma‐associated herpesvirus (KSHV)‐associated multicentric Castleman's disease (MCD) and primary effusion lymphoma (PEL) in patients with HIV from a large, safety‐net hospital system in Dallas, Texas, USA.MethodsWe conducted a retrospective review of patients with HIV‐associated PEL and/or MCD.ResultsTwelve patients with PEL and 10 patients with MCD were identified. All patients were male and 17 of 20 were men who have sex with men; 66.7% of PEL patients and 50% of MCD patients had concurrent KS at the time of diagnosis; 42% of patients with PEL and 20% of patients with MCD died during the follow‐up period. We noted improved survival in our cohort compared to previous studies, particularly in our PEL patients with a median survival of 11.4 months compared to 3–6‐month median survival historically. Median follow‐up time for MCD patients was 17.5 months. This improved survival is despite suboptimal antiretroviral therapy (ART) adherence at diagnosis, with only 50% of patients on ART at the time of MCD/PEL diagnosis.ConclusionThese data highlight the importance of early recognition of PEL and MCD, and the larger‐scale efforts needed to better understand the pathogenetic drivers of clinical outcomes in patients affected by KSHV‐related diseases.

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Mortality and Associated Risk Factors Among People Living With HIV With Kaposi Sarcoma: A5263/AMC066 and A5264/AMC067

Chagomerana,

Moser,

Kang

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: AIDS-related Kaposi sarcoma (AIDS-KS) remains a leading cause of morbidity and mortality among people living with HIV (PLWH) in Africa. Mortality among people with AIDS-KS on ART remains high compared to people on ART who do not have AIDS-KS. Setting: PLWH with KS who participated in two randomized trials (A5263/AMC066 (advanced stage) and A5264/AMC067 (mild-to-moderate stage)) conducted by ACTG/AMC in low and middle income countries. Methods: We estimated mortality rates over the trial period. Cox proportional hazards regressions were used to identify baseline characteristics associated with mortality and compared mortality rates between participants who had Kaposi sarcoma progression within 12 weeks of treatment initiation (early KS-PD) and those who did not. Results: Of the 329 and 189 eligible participants in A5263/AMC066 and A5264/AMC067, 71 (21.6%) and 24 (12.7%) died, respectively. In both trials, hypoalbuminemia was associated with increased hazards of death compared to normal albumin; A5263/AMC066: mild hypoalbuminemia (adjusted hazard ratio (aHR)=3.01; 95% CI: 1.42–6.29), moderate hypoalbuminemia (aHR=5.11; 95% CI: 2.54–10.29), and severe hypoalbuminemia (aHR=14.58; 95% CI:6.32–35.60), and A5264/AMC067: mild hypoalbuminemia (aHR=5.66; 95% CI: 1.90–16.93) and moderate hypoalbuminemia (aHR=7.02; 95% CI: 2.57–19.15). The rate of death was higher among participants who had early KS-PD than those without early KS-PD in A5263/AMC066 (HR=5.09; 95% CI: 1.71–15.19) but not in A5264/AMC067 (HR=1.74; 95% CI:0.66–4.62). Conclusions: Albumin measurements may be used to identify individuals at higher risk of death after initiating KS treatment and for evaluation of interventions that can reduce AIDS-KS mortality.

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Mortality disparities among patients with HIV-associated Kaposi's sarcoma in the southern United States

Cited by 4 publications

References 26 publications

High Seroprevalence of Kaposi Sarcoma–Associated Herpesvirus in Men Who Have Sex With Men With HIV in the Southern United States

High Seroprevalence of Kaposi Sarcoma–Associated Herpesvirus in Men Who Have Sex With Men With HIV in the Southern United States

Outcomes in Kaposi's sarcoma‐associated herpesvirus ‐associated primary effusion lymphoma and multicentric Castleman's disease in patients with human immunodeficiency virus (HIV) in a safety‐net hospital system

Mortality and Associated Risk Factors Among People Living With HIV With Kaposi Sarcoma: A5263/AMC066 and A5264/AMC067

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