Beyond T Staging in the "Treat-All" Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa.
Beyond T Staging in the "Treat-All" Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa.
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DOI：
10.1097/qai.0000000000002699
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发表时间：
2021-08-15
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影响因子：
--
通讯作者：
Martin J
中科院分区：
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作者：
Freeman EE;Semeere A;McMahon DE;Byakwaga H;Laker-Oketta M;Regan S;Wenger M;Kasozi C;Ssemakadde M;Bwana M;Kanyesigye M;Kadama-Makanga P;Rotich E;Kisuya J;Wools-Kaloustian K;Bassett IV;Busakhala N;Martin J
尽管撒哈拉以南非洲的许多卡波西肉瘤（KS）患者被诊断为ACTG T1疾病，但T1分期不足以捕获晚期KS的临床异质性。使用一个代表性的社区为基础的样本，我们详细的疾病诊断的严重程度，告知KS分期和治疗在撒哈拉以南非洲。我们对2016-2019年在肯尼亚和乌干达的三个诊所地点新诊断为KS的≥18岁艾滋病毒感染者进行了快速病例确定，以确定尽可能接近诊断的疾病阶段。我们使用ACTG和WHO分期标准报告KS严重程度，以及当前分期系统中未捕获的详细测量值。我们在1个月内对389例疑似KS的成人患者中的241例新诊断为KS的成人进行了快速病例确定。患者68%为男性，中位年龄35岁，中位CD 4计数239。大多数人患有晚期疾病，其中82%符合ACTG T1标准，64%符合WHO重度/症状KS标准。最常见的ACTG T1限定因子为水肿（79%）、肿瘤相关溃疡（24%）、广泛口腔KS（9%）、肺KS（7%）和胃肠道KS（4%）。在T1 KS中有显著的异质性，25%的患者有两个T1合格症状，3%的患者有三个或更多。大多数新诊断为KS的患者都有晚期疾病，即使在当前的ART“治疗所有”时代。我们观察到在晚期患者中存在很大的临床异质性，这导致了是否所有晚期KS患者都需要相同的治疗策略的问题。
Although many patients with Kaposi’s sarcoma (KS) in sub-Saharan Africa are diagnosed with ACTG T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detail disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa. We performed rapid case ascertainment on people living with HIV ≥18 years newly diagnosed with KS from 2016–2019 at three clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria, as well as detailed measurements not captured in current staging systems. We performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. Patients were 68% male, median age 35 years and median CD4 count 239. The majority had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO Severe/Symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having two T1 qualifying symptoms and 3% having three or more. The majority of patients newly diagnosed with KS had advanced stage disease, even in the current ART “Treat All” era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy.