January 2017- Kaposi’s sarcoma (KS) is the leading cancer in much of sub-Saharan Africa. HIV has resulted in a dramatic increase in KS throughout the region, due to high overlapping prevalence of HIV and the etiologic agent of KS, Kaposi’s sarcoma-associated herpesvirus. We sought to describe contemporary burden and characteristics of KS in the HIV+ and HIV- populations at a national teaching hospital in the capital, Lilongwe.
Kaposi’s sarcoma in Malawi: a continued problem for HIV-positive and HIV-negative individuals
Host, Kurtis, Horner, Marie-Josephe, van der Gronde, Toon, Moses, Agnes, Phiri, Sam, Dittmer, Dirk, Damania, Blossom, Gopal, Satish
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Despite a high HIV prevalence in Malawi, HIV-negative endemic Kaposi’s sarcoma represents at least 9% of contemporary Kaposi’s sarcoma burden at a national teaching hospital, with possible differences in presenting characteristics between HIV-positive and HIV-negative patients. Despite major investments and research programs in the region focused on AIDS-related Kaposi’s sarcoma, endemic Kaposi’s sarcoma has received relatively little attention. At our center, endemic Kaposi’s sarcoma appeared to occur at both younger and older ages compared with HIV-positive Kaposi’s sarcoma. Lifelong KSHV infection in sub-Saharan Africa is often acquired in childhood through salivary and breast milk transmission, although KSHV may also be acquired in adulthood. Subsequent infection with HIV during adulthood abruptly alters host immune function allowing Kaposi’s sarcoma development, accounting for high Kaposi’s sarcoma burden in the HIV-positive population between ages 20 and 49 years. In the absence of HIV, precipitating cofactors of endemic Kaposi’s sarcoma remain unclear and may be associated with volcanic soils, African natural products, and genetic predisposition.