Kaposi Sarcoma Still a Major Contributor to Morbidity Mortality in Certain HIV Populations

Outcome disparities need to be addressed

Kaposi Sarcoma Still a Major Contributor to Morbidity, Mortality in Certain HIV Populations

BY LEAH LAWRENCE

Kaposi sarcoma (KS) continues to play a significant part in morbidity and mortality among Black patients with HIV living in the South.

A recent study showed Black patients with HIV-associated KS had double the mortality of white or Hispanic patients with HIV-associated KS (AIDS 2021 Dec 22. doi:10.1097/ QAD.0000000000003155).

“There seems to be this notion that Kaposi sarcoma is no longer a disease of interest or concern in the United States because clinicians don’t see it as much as they did in the preART [antiretroviral therapy] era, and outcomes have improved because we have such effective treatment for HIV these days,” said study author Sheena Knights, MD, of The University of Texas Southwestern Medical Center, in Dallas. “While these points are true, our study highlights the fact that not only is Kaposi sarcoma still prevalent in certain areas of the U.S., but there are outcomes disparities that need to be addressed to improve outcomes in this HIV population.”

5-Year Survival Rate for Kaposi Sarcoma

• Blacks 69% • Whites 78% • Hispanics 81%

Black race was found to be independently associated with mortality.

Source: AIDS. 2021 Dec 22. doi:10.1097/QAD.0000000000003155

History of Kaposi Sarcoma

In the 1980s and 1990s, before ART, the presence of KS was how AIDS was diagnosed, explained Dirk P. Dittmer, PhD, of the UNC Lineberger Comprehensive Cancer Center, in Chapel Hill. It was one of the defining conditions of AIDS.

“Then came highly active ART and that led to a decline in KS,” Dr. Dittmer said. “With ART, we all of a sudden no longer had people who were severely immune suppressed.”

Rates of KS were much lower but still three to five times higher than before the 1980s, Dr. Dittmer said.

“Now we have a background level of KS that you cannot treat with just ART,” Dr. Dittmer said. “We now see KS in people that still have AIDS but don’t take ART, have had their ART disrupted or have become resistant, and in people who do take ART and have no detectable disease, but are older now.”

Dr. Dittmer said the results of the study by Dr. Knights’ team was not surprising to him, as he sees similar trends in North Carolina.

“There was an ascertainment bias that KS had gone away, which was driven by HIV providers that saw mostly white patients in San Francisco, New York City or Chicago,” Dr. Dittmer said. “That number is going down, not because there is no more KS but because many of the patients are African American and living in more rural areas.”

Differences Seen by Race and Ethnicity

Dr. Knights and her colleagues reviewed the electronic health records of patients diagnosed with HIV and KS from