Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children

Abstract

Background: Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub-Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV-associated) KS.

Methods: Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute in Kampala, Uganda from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions at presentation, biopsy results, CD4 T-cell count and percentage, and KS treatment and outcome.

Results: Seventy-three children with epidemic KS were identified, 37 males and 36 females. The median age was 10.1 years (range 2-18). KS presented with lymph node (LN) involvement in 60% of cases. The median absolute and percentage CD4 T-cells at presentation were 210 cells/microl and 7.4%, respectively. Those children with lymphadenopathic KS were younger (mean difference 3.7 years; P = 0.01) and had higher CD4 T-cell counts (mean difference 242 cells/microl; P = 0.03) than those without LN involvement. Of 32 patients for whom outcome data were available, a complete response to chemotherapy and/or antiretroviral therapy was documented in 20 (62.5%) patients.

Conclusions: In comparison to cutaneous involvement, LN involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This clinical presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in the majority of cases, but prospective studies are needed to determine optimal management.

Figure 1

Higher CD4 T-cell counts are associated with KS involvement of lymph nodes, but not other presentations, among HIV-infected children. Box plots display the CD4 T-cell count quartiles (minimum, 25^th, 50^th, and 75^th percentile, and maximum) and outliers (dots) for those patients with and without KS lesions in a given location. CD4 T-cell values are shown for patients with and without KS involvement of the lymph nodes (panel A), skin (panel B), oral cavity (panel C), and viscera (panel D).