Epidemiology of Kaposi's sarcoma in sub-Saharan Africa

Melitah Motlhale; Freddy Sitas; Debbie Bradshaw; Wenlong Carl Chen; Mwiza Gideon Singini; Chantal Babb de Villiers; Cathryn M Lewis; Mazvita Muchengeti; Tim Waterboer; Christopher G Mathew; Robert Newton; Elvira Singh

doi:10.1016/j.canep.2022.102167

Epidemiology of Kaposi's sarcoma in sub-Saharan Africa

Cancer Epidemiol. 2022 Jun:78:102167. doi: 10.1016/j.canep.2022.102167. Epub 2022 Apr 30.

Authors

Affiliations

¹ National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. Electronic address: melitahm@nicd.ac.za.
² Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Australia; Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia.
³ Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁴ National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
⁶ Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, United Kingdom; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom.
⁸ National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
⁹ Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁰ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom.
¹¹ MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; University of York, York, United Kingdom.

PMID: 35504064
DOI: 10.1016/j.canep.2022.102167

Abstract

Kaposi's sarcoma (KS) has become a common AIDS-defining cancer in sub-Saharan Africa. Kaposi's sarcoma-associated human herpesvirus strongly modulated by HIV-related immune suppression are the principal causes of this cancer. No other risk factors have been identified as playing a strong role. HIV prevention programs and good coverage of antiretroviral therapy (ART) in developed countries resulted in a remarkable decline in HIV-KS incidence and better KS prognosis. By contrast, in sub-Saharan Africa, population ART rollout has lagged, but clinical studies have shown positive results in reduction of KS incidence and better KS prognosis. However, the effect of ART rollout in relation to population KS incidence is unclear. We describe the incidence of KS in sub-Saharan Africa, in four time-periods, (1) before 1980 (before HIV/AIDS era); (2) 1981-2000 (early HIV/AIDS era, limited or no ART coverage); (3) 2001-2010 (early ART coverage period); and (4) 2011-2016 (fair to good ART coverage period). We used KS incidence data available from WHO-International Agency for Research on Cancer (IARC) publications and the Africa Cancer Registry Network. National HIV prevalence and ART coverage data were derived from UNAIDS/WHO. A rapid increase in KS incidence was observed throughout sub-Saharan Africa as the HIV epidemic progressed, reaching peak incidences in Period 2 (pre-ART rollout) of 50.8 in males and 20.3 per 100 000 in females (Zimbabwe, Harare). The overall unweighted average decline in KS incidence between 2000 and 2010 and 2011-2016 was 27%, but this decline was not statistically significant across the region. ART rollout coincides with a decline in KS incidence across several regions in sub-Saharan Africa. The importance of other risk factors such as reductions in HIV incidence could not be ascertained.

Keywords: Antiretroviral therapy; Human immunodeficiency virus/acquired immunodeficiency syndrome; Kaposi’s sarcoma; Kaposi’s sarcoma-associated herpesvirus; Sub-Saharan Africa.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome* / complications
Africa South of the Sahara / epidemiology
Female
HIV Infections* / epidemiology
Herpesvirus 8, Human*
Humans
Male
Sarcoma, Kaposi* / epidemiology
Sarcoma, Kaposi* / etiology
Zimbabwe

Grants and funding

MRC-RFA-SHIP 01-2015/MRC_/Medical Research Council/United Kingdom