Incidence of Kaposi Sarcoma and Associated Mortality in HIV-infected Adults, Fresno, California, 1998-2012
Background: The incidence of Kaposi sarcoma (KS) decreased dramatically after the introduction of highly active antiretroviral therapy (HAART) in 1996. This study determined the ongoing incidence of and mortality from KS in HIV-infected adults between 1998-2012 in Fresno County, California. The role of virologic control and immune reconstitution in patient outcome was also investigated.
Methods: Incident cases of KS were identified from the state Electronic HIV/AIDS Reporting System (EHARS), the California Cancer Registry, and the hospital records of the main HIV treatment center in Fresno.
Results: From 1998–2012, the average incidence rate of KS was 0.51 cases per 100,000 person-years. Of the 66 cases of KS there were 20 deaths, with 85% of the mortality occurring in the first 12 months post KS diagnosis. In patients achieving HIV RNA <400 copies/mL on HAART, but with a <50 cells/mm3 increase in CD4 count there was no improvement in mortality compared with patients who did not achieve virologic control. For KS patients on successful HAART with virologic control (HIV VL <400 copies/mL) with a >50 cells/mm3 increase in CD4 count, the 12-month mortality was 6%; for those with a <50 cells/mm3 increase in CD4, the 12-month mortality was 50%.
Conclusion: The incidence of KS has remained stable since 1998 with an overall 12-month mortality of 30%. Immunologic reconstitution appears to be required for an improvement in outcome.
P. Mills, None
S. Paul, None