Trends in Kaposi sarcoma prevalence at HIV care initiation in adults at a large HIV treatment program in Jos, Nigeria

Abstract

Background: Improved access to antiretroviral therapy (ART) significantly reduced the prevalence of Kaposi Sarcoma (KS) among patients initiating care for Human Immunodeficiency Virus (HIV) care in western nations. A similar pattern has not been universally documented across sub-Saharan Africa where the majority of people with HIV reside. This study examined trends in KS prevalence among adults initiating HIV care in Nigeria from 2006 to 2017.Methods: Data of patients 18 years or older, who initiated HIV care at the Jos University Teaching Hospital HIV clinic Jos, Nigeria from 2006 and 2017, were analyzed. Prevalence of KS over three consecutive four-year periods of increased ART coverage: 2006-2009, 2010-2013 and 2014-2017 were estimated. Logistic regression models were used to compare age- and sex-adjusted trends in KS prevalence rates at HIV care initiation over the three-time periods, and determine independent predictor of KS.Results: Among 16,431 adults who initiated HIV care from January 2006 to Decemeber 2017, mean age 35.1 (9.5) years, 65.7% female, and 51.1% with CD4 T-cell count < 200 cells/mm3; the overall prevalence of KS was 0.59 % (95% CI 0.48-0.72). KS prevalence was lowest at the time of HIV care initiation from 2006-2009 (0.39%; 95% CI 0.29-0.53), peaked at 1.12% (95% CI 0.82-1.52) from 2010-2013 and declined to 0.72% (95% CI 0.42-1.20) from 2014-2017. Compared to 2006-2009, age- and sex-adjusted odds for KS were 2.81 (95% CI 1.83-4.34, p<0.01) for 2010-2013 and 1.74 (95% CI 0.95-3.30, p=0.07) for 2014-2017. Independent predictors of KS were period of enrollment, male sex and low CD4 T-cell count. Conclusion: Expansion of ART access was not associated with a decline in KS prevalence among adults initiating ART in Nigeria.