HIV-associated Kaposi sarcoma: Advanced disease and high mortality of patients referred to a multidisciplinary clinic in South Africa, 2022–2024

Abstract

Background: Kaposi sarcoma (KS) remains the most common HIV-associated malignancy in South Africa and continues to contribute substantially to the national disease burden, despite the widespread availability of antiretroviral therapy (ART) since 2004. Objectives: To describe the clinical characteristics and outcomes of patients referred to a multidisciplinary HIV-associated KS clinic. Method: A retrospective, descriptive cohort study was conducted at a South African tertiary hospital, including patients diagnosed with HIV-associated KS between January 2022 and December 2024. Data were deidentified, pooled, and analysed using descriptive statistics and univariate analysis. Results: A total of 137 patients were included. Most were on ART at the time of KS diagnosis, with a median CD4 count of 122 cells/µL. Advanced disease was common, with 85% of patients presenting with AIDS Clinical Trial Group (ACTG) poor risk tumour stage KS, including 43% with visceral involvement. The 1-year all-cause mortality rate was 38%, with visceral KS and lower CD4 counts on presentation being significantly associated with increased risk of death. HIV viral suppression was associated with improved survival, while duration of ART prior to KS diagnosis did not significantly affect outcomes. Conclusion: These findings highlight the late stage at presentation and poor prognosis of HIV-associated KS in this cohort, underscoring the urgent need for improved retention in HIV care and earlier diagnosis of KS.