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Dinh S, Malmström S, Möller IK, Yilmaz A, Svedhem V, Carlander C. Extracutaneous Kaposi sarcoma risk remains higher in people with HIV in the post-ART era. AIDS 2023; 37:2041-2048. [PMID: 37451428 PMCID: PMC10552821 DOI: 10.1097/qad.0000000000003658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To assess Kaposi sarcoma (KS) by HIV-status in Sweden 1983-2017, with particular focus on extracutaneous KS. DESIGN Population-based study linking the Total Population Registry, the Swedish HIV Registry InfCareHIV, and the Swedish Cancer Registry. METHODS We included all Swedish residents, born in or outside Sweden between 1940 and 2000 ( n = 8 587 829), assessing the annual incidence of KS, adjusted hazard ratios (adjHR), and odds ratios (adjOR) in the pre and postcombination antiretroviral therapy (ART) eras. RESULTS KS was found in 324 individuals of whom 202 (62%) were people with HIV (PWH). While the incidence of KS decreased in PWH, it remained higher compared to HIV-negative at end of follow-up (28 vs. 0.09 per 100 000 person-years, P < 0.001). In the post-ART era, PWH still had an increased risk of both cutaneous [adjHR 616, 95% confidence interval (CI) 410-926] and extracutaneous KS (adjHR 2068, 95% CI 757-5654), compared to HIV-negative individuals, although there were no cases of extracutaneous disease among virally suppressed PWH. In the post-ART era, the relative risk for KS remained higher in men, particularly men who have sex with men, and viral suppression was associated with lower odds of KS (adjOR 0.05, 95% CI 0.03-0.09). CONCLUSIONS KS remained increased in PWH in the post-ART era, with a particularly high risk for extracutaneous disease compared to HIV-negative individuals. Notably, there were no cases of extracutaneous disease among virally suppressed PWH, suggesting a less aggressive disease in this population. Further studies on KS in virally suppressed PWH are warranted.
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Affiliation(s)
- Sofia Dinh
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Stina Malmström
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | | | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Veronica Svedhem
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Christina Carlander
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Department of Infectious Diseases, Karolinska University Hospital
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Libson K, Himed S, Dunlop H, Nusbaum KB, Korman AM, Kaffenberger BH, Trinidad J. A description of Kaposi sarcoma risk factors and outcomes in HIV-positive and HIV-negative patients at a tertiary care medical center from 2005 to 2020. Arch Dermatol Res 2023; 315:2159-2162. [PMID: 36856854 DOI: 10.1007/s00403-023-02552-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 03/02/2023]
Abstract
Kaposi sarcoma (KS) is a low-grade vascular malignancy caused by human herpesvirus-8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV). There are four established subtypes of KS, which are described by unique risk factors, presentation, and disease course. A "non-epidemic" variant to describe HIV-negative men who have sex with men (MSM) is emerging as a fifth subtype. We retrospectively examined patients with KS at an academic medical center in central Ohio, USA. To our knowledge, this is the first US-based report to describe KS risk factors and outcomes in the context of HIV status. Data were extracted from patient charts including demographic information, history at time of KS diagnosis, and information about KS disease course. HIV-positive and HIV-negative patients were grouped into established categories. HIV-negative patients who did not fit an existing subtype were described as "Unclassified-KS-Type." Demographic characteristics for AIDS-KS patients in our cohort match established trends in this subtype, such as male, MSM, and younger age at diagnosis compared to HIV-negative patients. Most Unclassified-KS-Type patients fit well into the emerging "non-epidemic KS" subtype. These patients are described as healthy, middle-aged, HIV-negative MSM with lower extremity lesions. This descriptive report provides an updated view of KS risk factors and outcomes to improve detection and treatment in dermatology.
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Affiliation(s)
- Karissa Libson
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sonia Himed
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hayley Dunlop
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kelsey B Nusbaum
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abraham M Korman
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - John Trinidad
- Department of Dermatology, Massachusetts General Hospital, , Harvard Medical School, 50 Staniford St, Boston, MA, 02114, USA.
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Li W, Wang L, Zhang Y, Liu Y, Lin Y, Li C. A SEER data-based nomogram for the prognostic analysis of survival of patients with Kaposi's sarcoma. J Cancer Res Ther 2023; 19:917-923. [PMID: 37675717 DOI: 10.4103/jcrt.jcrt_2587_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background This study developed the first comprehensive nomogram for predicting the cancer-specific survival (CSS) of patients with Kaposi's sarcoma (KS). Methods Data on the demographic and clinical characteristics of 4143 patients with KS were collected from the Surveillance, Epidemiology, and End Results (SEER) database and used for the prognostic analysis. The patients were randomly divided into two groups: training cohort (n = 2900) and validation cohort (n = 1243). Multivariate Cox regression analysis was used to identify the predictive variables for developing the first nomogram for the survival prediction of patients with KS. The new survival nomogram was further evaluated using the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision curve analysis (DCA). Results A nomogram was developed for determining the 3-, 5-, 8-, and 10-year CSS probabilities for patients with KS. The nomogram showed that tumor stage had the greatest influence on the CSS of patients with KS, followed by demographic variables (race, marital status, and age at diagnosis) and other clinical characteristics (surgery status, chemotherapy status, tumor risk classification, and radiotherapy status). The nomogram exhibited excellent performance based on the values of the C-index, AUC, NRI, and IDI as well as calibration plots. DCA further confirmed that the nomogram had good net benefits for 3-, 5-, 8-, and 10-year survival analyses. Conclusions In this study, by using data from the SEER database, we developed the first comprehensive nomogram for analyzing the survival of patients with KS. This nomogram could serve as a convenient and reliable tool for clinicians to predict CSS probabilities for individual patients with KS.
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Affiliation(s)
- Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Ling Wang
- Department of Obstetrics and Gynecology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yulong Liu
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yinsheng Lin
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
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Anthony M, Farkouh C, Abdi P. Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial Minority Communities of America. Dermatol Pract Concept 2023; 13:e2023167. [PMID: 37557146 PMCID: PMC10412004 DOI: 10.5826/dpc.1303a167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | - Parsa Abdi
- Memorial University Faculty of Medicine, St. John’s, Newfoundland, Canada
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Mangusan RF, Ekwede I, Widell A. CE: HIV-Associated Kaposi Sarcoma in the Combination Antiretroviral Therapy Era. Am J Nurs 2022; 122:32-40. [PMID: 36321823 PMCID: PMC9671845 DOI: 10.1097/01.naj.0000901848.07128.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT Kaposi sarcoma is a tumor caused by Kaposi sarcoma herpesvirus, also known as human herpesvirus 8. Its occurrence is associated with an immunocompromised state. Kaposi sarcoma that occurs among people living with HIV (PLWH) is known as epidemic Kaposi sarcoma. Despite the decline in HIV-associated complications because of the introduction of combination antiretroviral therapy two decades ago, Kaposi sarcoma continues to affect PLWH worldwide. It affects young African American men more than other age and racial groups and can result in multiorgan dysfunction, leading to short-term and chronic debilitating symptoms as well as death. While some patients with epidemic Kaposi sarcoma are managed as outpatients, others may require higher levels of care and their acuity may fluctuate throughout their life span. Therefore, nurses, regardless of their specialty, may experience caring for a patient with epidemic Kaposi sarcoma at some point in their career. Learning about this condition and the needs of patients who have it will help nurses provide effective care. Here, the authors describe Kaposi sarcoma in general as well as the epidemiology, characteristics, and management of epidemic Kaposi sarcoma. They also describe specific nursing considerations in the care of PLWH who have the disease.
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Affiliation(s)
- Ralph F Mangusan
- Ralph F. Mangusan is an NP III, clinical research directorate, Frederick National Laboratory for Cancer Research in Bethesda, MD. Irene Ekwede is a research nurse specialist, and Anaida Widell is senior research nurse specialist, both in the HIV and AIDS Malignancy Branch, National Cancer Institute in Bethesda, MD. The authors acknowledge Dr. Robert Yarchoan and Dr. Ramya Ramaswami at the HIV and AIDS Malignancy Branch for their editorial comments. Contact author: Ralph F. Mangusan, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Ragi SD, Moseley I, Ouellette S, Rao B. Epidemiology and Survival of Kaposi's Sarcoma by Race in the United States: A Surveillance, Epidemiology, and End Results Database Analysis. Clin Cosmet Investig Dermatol 2022; 15:1681-1685. [PMID: 36003526 PMCID: PMC9394645 DOI: 10.2147/ccid.s380167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/13/2022] [Indexed: 11/26/2022]
Abstract
The introduction of highly active antiretroviral treatment (HAART) for acquired immunodeficiency syndrome (AIDS) has led to a significant decrease in the incidence of Kaposi’s sarcoma (KS) in recent years. However, a concomitant increase in racial disparities in KS has arisen. Here, we analyze data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for epidemiology and survival of Kaposi’s sarcoma by race. The highest incidence was observed among Black patients (incidence rate (IR), 1.189; 95% confidence interval (CI), 1.092–1.189), followed by White patients (IR, 0.486; 95% CI, 0.473–0.498). Relative survival at 1, 3, and 5 years differed significantly by race, with White patients having the highest survival rates (84.26%, 77.79%, and 74.79% at 1, 3, and 5 years respectively) and Black patients demonstrating the lowest (71.50%, 61.37%, and 57.38%), with intermediate survival rates in Asians/Pacific Islanders (AAPI) (80.62%, 71.19%, and 67.28%) and American Indians/Alaska Natives (AIAN) (80.56%, 61.45%, and 61.45%). We conclude that there are significant racial disparities in the incidence, epidemiology, and survival of KS.
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Affiliation(s)
- Sara D Ragi
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Samantha Ouellette
- Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
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Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
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Godbole S, Ghate M, Mehendale S. Understanding racial diversities in Kaposi's sarcoma. Indian J Med Res 2019; 149:319-321. [PMID: 31249194 PMCID: PMC6607822 DOI: 10.4103/ijmr.ijmr_2164_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sheela Godbole
- Epidemiology & Biostatistics, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Manisha Ghate
- Clinical Sciences, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Sanjay Mehendale
- Research Department, P.D. Hinduja National Hospital & Medical Research Center, Mumbai 400 016, Maharashtra, India
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