Abstract
Background: The incidence of Human Immunodeficiency Virus (HIV)-associated Kaposi Sarcoma (KS) in the pre-antiretroviral therapy (ART) population remains high in several countries in sub-Saharan Africa. We examined trends of KS prevalence in adults, establishing initial outpatient HIV care from 2006 to 2017 in Nigeria. Methods: We analyzed data of 16,431 adults (age ≥ 18 years) enrolled for HIV care from January 1, 2006, to December 31, 2017, in a large clinic in Jos, Nigeria. KS at enrollment was defined as KS recorded in the electronic health record within 30 days of clinic enrollment. Time trends were compared among four periods: 2006–2008, 2009–2011, 2012–2014, and 2015–2017 using logistic regression models. Annual trends were analyzed using join point regression and restricted splines. Results: The study population had a mean age 35.1 (standard deviation, SD 9.5) years, and were 65.7% female (n = 10,788). The mean CD4 cell count was 220 (95% CI 117–223). The overall KS prevalence at entry was 0.59% (95% CI 0.48–0.72). Compared to 2006–2008, KS prevalence was significantly higher in 2009–2011 (adjusted odds ratio 5.07 (95% CI 3.12–8.24), p < 0.001), but remained unchanged in subsequent periods. Male sex and low CD4 T-cell count independently increased odds for KS. Conclusions: Despite ART expansion, KS at enrollment showed no significant decline. The low CD4 cell count, across all periods, indicates delay in enrollment for HIV care, which increases KS risk. Interventions aimed at early HIV diagnosis and linkage to ART is critical to KS risk reduction in this population.
Original language | English (US) |
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Article number | 10 |
Journal | Infectious Agents and Cancer |
Volume | 17 |
Issue number | 1 |
DOIs | |
State | Published - Dec 2022 |
Funding
Despite these limitations, our study highlights the ongoing burden of KS among patients newly enrolling in HIV care in the contemporary ART era in Nigeria. The period covered by our study made it feasible to evaluate changes in KS prevalence during the expansion of Nigeria’s HIV program. Though routinely collected clinical data was utilized, the HIV clinic had rigorous protocols to maintain a high-quality database, which is routinely used for research. In addition, the study population typifies the hospital-based HIV treatment program where the majority of patients with HIV in the country received care [, ]. Finally, recent funding support from the US National Institute of Health has also supported the validation of cancer cases within the database, which improved the accuracy of our findings. We analyzed data of PLWH who enrolled for initial HIV outpatient care at one of the largest stand-alone HIV treatment facilities in Nigeria. The clinic commenced patient enrollment in 2002, and by December 2017, had provided care to over 30,000 persons with HIV. HIV care and treatment were supported by funding from the Government of Nigeria, the Bill and Melinda Gates Foundation, and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) fund [, ]. Follow-up visits were scheduled monthly or every other month. During patient visits, data on AIDS-defining events, including KS, was routinely obtained.
Keywords
- Africa
- Antiretroviral therapy
- Epidemiology
- Human Immunodeficiency Virus
- Kaposi Sarcoma
ASJC Scopus subject areas
- Infectious Diseases
- Oncology
- Cancer Research
- Epidemiology
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Analyses of Kaposi Sarcoma trends among adults establishing initial outpatient HIV care in Nigeria: 2006–2017
Akanbi, M. O. (Creator), Bilaver, L. A. (Creator), Achenbach, C. (Creator), Hirschhorn, L. R. (Creator), Rivera, A. S. (Creator), Silas, O. A. (Creator), Agaba, P. A. (Creator), Agbaji, O. (Creator), Shehu, N. Y. (Creator), Sagay, S. A. (Creator), Hou, L. (Creator) & Murphy, R. L. (Creator), figshare, 2022
DOI: 10.6084/m9.figshare.c.5908156, https://springernature.figshare.com/collections/Analyses_of_Kaposi_Sarcoma_trends_among_adults_establishing_initial_outpatient_HIV_care_in_Nigeria_2006_2017/5908156
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