Abstract:
Background: Despite widespread access to antiretroviral therapy (ART) in the “Treat All” era, HIV-
associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan
Africa. Survival after KS diagnosis has historically been poor in Africa, but knowledge whether survival
has changed at the population level in the contemporary era has been limited by lack of community-
representative surveillance and monitoring systems.
Methods: We identified all adult persons living with HIV (PLWH) with a new diagnosis of KS made
between 2016 and 2019 during outpatient or inpatient care at prototypical primary care-providing
medical facilities in Kenya and Uganda using rapid case ascertainment. Participants were
subsequently followed for vital status, including community tracking for those who became lost to
follow-up.
Findings: Among 411 participants with newly diagnosed KS, 71% were men, median age was 34
(IQR: 30 to 41) years, and 91% had ACTG T1 tumor extent. Over a median follow-up of 7.8 (IQR: 2.4
to 17.9) months, cumulative incidence of death (95% CI) at months 6, 12 and 18 were 34% (30% to
39%), 41% (36% to 46%) and 45% (40% to 51%), respectively. Having the highest number of
anatomic sites (11 to 16) harboring KS lesions (hazard ratio 2.2 (95% CI: 1.3-3.8) compared to 1 to 3
sites) and presence of oral KS lesions (hazard ratio 2.2 (95% CI: 1.4-3.3)) were independently
associated with higher mortality. Lower hemoglobin and CD4 count as well as higher plasma HIV
RNA were also associated with higher mortality.
Interpretation: Among PLWH with newly diagnosed KS in East Africa in the “Treat All” era, survival
was poor and related to mucocutaneous extent of KS. The findings emphasize the need for better
control of KS in Africa, including novel approaches for earlier detection, better linkage to oncologic
care, and more potent therapy.
