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

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

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

8 Citations (Scopus)

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.

Original language	English
Article number	102167
Journal	Cancer Epidemiology
Volume	78
DOIs	https://doi.org/10.1016/j.canep.2022.102167
Publication status	Published - Jun 2022

Keywords

Antiretroviral therapy
Human immunodeficiency virus/acquired immunodeficiency syndrome
Kaposi's sarcoma
Kaposi's sarcoma-associated herpesvirus
Sub-Saharan Africa

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.canep.2022.102167

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@article{aa23f01a2b2c4acea0feb2b030ee7552,

title = "Epidemiology of Kaposi's sarcoma in sub-Saharan Africa",

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",

author = "Melitah Motlhale and Freddy Sitas and Debbie Bradshaw and Chen, {Wenlong Carl} and Singini, {Mwiza Gideon} and {de Villiers}, {Chantal Babb} and Lewis, {Cathryn M.} and Mazvita Muchengeti and Tim Waterboer and Mathew, {Christopher G.} and Robert Newton and Elvira Singh",

note = "Funding Information: This study was supported by the South African Medical Research Council and the UK Medical Research Council (with funds from the UK Government{\textquoteright}s Newton Fund) ( MRC-RFA-SHIP 01-2015 ). The authors are solely responsible for the contents of this publication and do not necessarily represent views of the funders. Funding Information: This study was supported by the South African Medical Research Council and the UK Medical Research Council (with funds from the UK Government's Newton Fund) (MRC-RFA-SHIP 01-2015). The authors are solely responsible for the contents of this publication and do not necessarily represent views of the funders. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = jun,

doi = "10.1016/j.canep.2022.102167",

language = "English",

volume = "78",

journal = "Cancer Epidemiology",

issn = "1877-7821",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Epidemiology of Kaposi's sarcoma in sub-Saharan Africa

AU - Motlhale, Melitah

AU - Sitas, Freddy

AU - Bradshaw, Debbie

AU - Chen, Wenlong Carl

AU - Singini, Mwiza Gideon

AU - de Villiers, Chantal Babb

AU - Lewis, Cathryn M.

AU - Muchengeti, Mazvita

AU - Waterboer, Tim

AU - Mathew, Christopher G.

AU - Newton, Robert

AU - Singh, Elvira

N1 - Funding Information: This study was supported by the South African Medical Research Council and the UK Medical Research Council (with funds from the UK Government’s Newton Fund) ( MRC-RFA-SHIP 01-2015 ). The authors are solely responsible for the contents of this publication and do not necessarily represent views of the funders. Funding Information: This study was supported by the South African Medical Research Council and the UK Medical Research Council (with funds from the UK Government's Newton Fund) (MRC-RFA-SHIP 01-2015). The authors are solely responsible for the contents of this publication and do not necessarily represent views of the funders. Publisher Copyright: © 2022 The Authors

PY - 2022/6

Y1 - 2022/6

N2 - 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.

AB - 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.

KW - Antiretroviral therapy

KW - Human immunodeficiency virus/acquired immunodeficiency syndrome

KW - Kaposi's sarcoma

KW - Kaposi's sarcoma-associated herpesvirus

KW - Sub-Saharan Africa

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U2 - 10.1016/j.canep.2022.102167

DO - 10.1016/j.canep.2022.102167

M3 - Review article

C2 - 35504064

AN - SCOPUS:85129561881

SN - 1877-7821

VL - 78

JO - Cancer Epidemiology

JF - Cancer Epidemiology

M1 - 102167

ER -

Epidemiology of Kaposi's sarcoma in sub-Saharan Africa

Abstract

Keywords

UN SDGs

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