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. 2022 Mar 21;17(1):10.
doi: 10.1186/s13027-022-00424-4.

Analyses of Kaposi Sarcoma trends among adults establishing initial outpatient HIV care in Nigeria: 2006-2017

Maxwell O Akanbi  1   2   3   4 , Lucy A Bilaver  5 , Chad Achenbach  6   7 , Lisa R Hirschhorn  6   8 , Adovich S Rivera  5 , Olugbenga A Silas  9 , Patricia A Agaba  10 , Oche Agbaji  11 , Nathan Y Shehu  11 , Solomon A Sagay  12 , Lifang Hou  5   13   14 , Robert L Murphy  6   7
Affiliations

Analyses of Kaposi Sarcoma trends among adults establishing initial outpatient HIV care in Nigeria: 2006-2017

Maxwell O Akanbi et al. Infect Agent Cancer. .

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.

Keywords: Africa; Antiretroviral therapy; Epidemiology; Human Immunodeficiency Virus; Kaposi Sarcoma.

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Conflict of interest statement

All authors declare no competing interest.

Figures

Fig. 1
Fig. 1
Conceptual model of the impact of HIV program expansion on Kaposi Sarcoma risk in patients initiating HIV care
Fig. 2
Fig. 2
Trends in Kaposi Sarcoma prevalence among adults newly enrolling for HIV care in Jos, Nigeria (2006–2017). [Pairs testing (A): 2006–2008 significantly lower than rest; 2009–2011 significantly higher than 2012–2014 but not 2015–2017 (relatively flat trend)]. HIV human immunodeficiency virus
Fig. 2
Fig. 2
Trends in Kaposi Sarcoma prevalence among adults newly enrolling for HIV care in Jos, Nigeria (2006–2017). [Pairs testing (A): 2006–2008 significantly lower than rest; 2009–2011 significantly higher than 2012–2014 but not 2015–2017 (relatively flat trend)]. HIV human immunodeficiency virus
Fig. 3
Fig. 3
Prevalence of Kaposi Sarcoma at HIV care initiation in adults at the Jos University Teaching Hospital HIV Clinic in Jos, Nigeria (2006–2017), stratified by CD4 T-cell count at HIV care initiation and sex. (Analysis adjusted for age; bars show 95% confidence intervals). HIV human immunodeficiency virus
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