Kaposi’s Sarcoma Trends in the Era of Highly Active Antiretroviral Therapy in Zambia.

  • Lubinda Mukololo
  • Lorenda Temwani Phiri
  • Memory Chisha
  • Florence Mwaba
  • Rabecca Tembo University of Zambia
  • Mildred Zulu
Keywords: AIDS, Highly active antiretroviral therapy, Antiretroviral therapy, Kaposi’s sarcoma-associated herpesvirus, Human Herpes virus 8, Zambia national cancer registry.

Abstract

Background: AIDS-related Kaposi’s sarcoma (KS) is a multi-centric angiogenic neoplastic proliferation which is predominantly seen in individuals with HIV-1 infection and men who have sex with men. Although the incidences of aggressive KS have reduced following the introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV-infection, the effect of HAART rollout in relation to population KS incidence in Zambia still remains unclear as cases of the malignancy have continued to be reported. Objectives: In this study, we set out to investigate the trends of KS in the era of HAART in Zambia. Study Design: We conducted a retrospective cross-sectional study. Methodology: 320 cases of HIV-infected individuals on HAART that developed KS between 2008 and 2017 were reviewed. Data was retrieved from the Zambia National Cancer Registry (ZNCR). Results: Of the records reviewed, we observed a sharp increase in KS cases from 5.6% in 2008 to 21.2% in 2014; from 2015 to 2017, there was a general decline in KS cases countrywide in both sexes from 13.1% to 9.4%. KS was more prevalent in Lusaka Province while Western Province had the least number of cases. For each province, there were more males affected by KS than females. We further observed that 19.1% of the cases reviewed developed KS while on HAART while 80.9% developed KS before commencement of HAART. The age group with the highest number of KS cases was 21-40 years while the age group ≥ 80 had the least number of cases. Conclusion: Our data has shown that although there is a general decline in KS cases across the 10 provinces of Zambia in recent years, more efforts are still required to mitigate the AIDS-related KS incidence and improve KS prognosis. There is need to encourage efforts aimed at HIV-infection prevention, wide coverage of HAART across the country, and KS awareness and screening.

References

1. Lihachev, A. et al. Differentiation of seborrheic keratosis from basal cell carcinoma, nevi and melanoma by RGB autofluorescence imaging. Biomed Opt Express 9, (2018).
2. Karabajakian, A., Ray-Coquard, I. & Blay, J.-Y. Molecular Mechanisms of Kaposi Sarcoma Development. Cancers (Basel) 2022, 1869 (2022).
3. Gonçalves, P. H., Uldrick, T. S. & Yarchoan, R. HIV-associated Kaposi sarcoma and related diseases. AIDS vol. 31 Preprint at https://doi.org/10.1097/QAD.0000000000001567 (2017).
4. Giffin, L. & Damania, B. KSHV: Pathways to tumorigenesis and persistent infection. in Advances in Virus Research vol. 88 (2014).
5. Liu, Z. et al. The world-wide incidence of Kaposi’s sarcoma in the HIV/AIDS era. HIV Med 19, (2018).
6. Facciolà, A. et al. Kaposi’s sarcoma in HIV-infected patients in the era of new antiretrovirals. Eur Rev Med Pharmacol Sci 21, (2017).
7. Fardet, L. et al. Treatment with taxanes of refractory or life-threatening Kaposi sarcoma not associated with human immunodeficiency virus infection. Cancer 106, (2006).
8. Mariggiò, G., Koch, S. & Schulz, T. F. Kaposi sarcoma herpesvirus pathogenesis. Philosophical Transactions of the Royal Society B: Biological Sciences vol. 372 Preprint at https://doi.org/10.1098/rstb.2016.0275 (2017).
9. Vincenzi, B. et al. Classic Kaposi Sarcoma: To treat or not to treat? BMC Res Notes 8, (2015).
10. Lanternier, F. et al. Kaposi’s sarcoma in HIV-negative men having sex with men.
11. Friedman-Kien, A. E. & Saltzman, B. R. Clinical manifestations of classical, endemic African, and epidemic AIDS-associated Kaposi’s sarcoma. J Am Acad Dermatol 22, (1990).
12. Ziegler, J. L. Endemic Kaposi’s sarcoma in Africa and local volcanic soils. The Lancet 342, (1993).
13. Cesarman, E., Chang, Y., Moore, P. S., Said, J. W. & Knowles, D. M. Kaposi’s Sarcoma–Associated Herpesvirus-Like DNA Sequences in AIDS-Related Body-Cavity–Based Lymphomas. New England Journal of Medicine 332, (1995).
14. Lebbé, C., Legendre, C. & Francès, C. Kaposi sarcoma in transplantation. Transplant Rev 22, (2008).
15. la Ferla, L. et al. Kaposi’ s sarcoma in HIV-positive patients: The state of art in the HAART-era. Eur Rev Med Pharmacol Sci 17, (2013).
16. Ferlay, J. et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136, (2015).
17. Levine, A. M. & Tulpule, A. Clinical aspects and management of AIDS-related Kaposi’s sarcoma. www.ejconline.com.
18. Sparano, J. A. Clinical aspects and management of AIDS-related Kaposi’s sarcoma. Eur J Cancer 37, (2001).
19. Bohlius, J. et al. Kaposi’s Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era. Int J Cancer 135, 2644–2652 (2014).
20. Motlhale, M. et al. Epidemiology of Kaposi’s sarcoma in sub-Saharan Africa. Cancer Epidemiology vol. 78 Preprint at https://doi.org/10.1016/j.canep.2022.102167 (2022).
21. Stebbing, J., Portsmouth, S. & Gazzard, B. How does HAART lead to the resolution of Kaposi’s sarcoma? Journal of Antimicrobial Chemotherapy 51, (2003).
22. Gantt, S. et al. Reduced human herpesvirus-8 oropharyngeal shedding associated with protease inhibitor-based antiretroviral therapy. Journal of Clinical Virology 60, (2014).
23. Ngalamika, O., Minhas, V. & Wood, C. Kaposi’s sarcoma at the University Teaching Hospital, Lusaka, Zambia in the antiretroviral therapy era. International Journal of Cancer vol. 136 Preprint at https://doi.org/10.1002/ijc.29184 (2015).
24. Kalubula, M., Shen, H. & Makasa, M. Epidemiology of kaposi’s sarcoma in Zambia, 2007-2014. Malawi Medical Journal 32, (2020).
25. Zyaambo, C. et al. Distribution of cancers in Zambia: evidence from the Zambia National Cancer Registry (1990-2009). J Public Health Epidemiol 5, (2013).
26. Tembo, R. et al. Detection of human herpes virus 8 in Kaposi’s sarcoma tissues at the University Teaching Hospital, Lusaka, Zambia. Pan African Medical Journal 27, (2017).
27. Maskew, M. et al. Treatment Response and Mortality among Patients Starting Antiretroviral Therapy with and without Kaposi Sarcoma: A Cohort Study. PLoS One 8, (2013).
28. Chaabna, K. et al. Kaposi sarcoma trends in Uganda and Zimbabwe: A sustained decline in incidence? Int J Cancer 133, (2013).
29. Chalya, P. L. et al. Kaposi’s sarcoma: A 10-year experience with 248 patients at a single tertiary care hospital in Tanzania Cancer. BMC Res Notes 8, (2015).
30. Kagu, M. B., Nggada, H. A., Garandawa, H. I., Askira, B. H. & Durosinmi, M. A. AIDS-associated Kaposi’s sarcoma in Northeastern Nigeria. Singapore Med J 47, (2006).
31. Shmakova, A., Germini, D. & Vassetzky, Y. HIV-1, HAART and cancer: A complex relationship. International Journal of Cancer vol. 146 Preprint at https://doi.org/10.1002/ijc.32730 (2020).
32. Mandong, B. M., Chirdan, L. B., Anyebe, A. O. & Mannaseh, A. N. Histopathological Study of Kaposi’s Sarcoma in Jos: A 16-Year Review. Ann Afr Med 3, (2004).
33. Forae, G. D. & Obaseki, D. E. Trends and histopathological patterns of Kaposi Sarcoma at the university of Benin teaching hospital, Benin city, Nigeria. Oman Med J 33, (2018).
34. Phipps, W. et al. Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. PLoS One 5, (2010).
35. Chaabna, K. et al. Cancer incidence and all-cause mortality in HIV-positive patients in Northeastern Algeria before and during the era of highly active antiretroviral therapy. J Cancer Res Ther 12, (2016).
Published
2023-06-01
How to Cite
1.
Mukololo L, Phiri L, Chisha M, Mwaba F, Tembo R, Zulu M. Kaposi’s Sarcoma Trends in the Era of Highly Active Antiretroviral Therapy in Zambia. University of Zambia Journal of Agricultural and Biomedical Sciences [Internet]. 1Jun.2023 [cited 14Jun.2024];6(3). Available from: https://journals.unza.zm/index.php/JABS/article/view/978
Section
Biomedical Sciences