Quantifying, Explaining and Predicting Survival After Diagnosis of HIV-related Kaposi Sarcoma in East Africa

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Project Summary Among malignant complications of HIV infection in sub-Saharan Africa, one of the most common cancers in the pre-antiretroviral therapy (ART) era — Kaposi’s sarcoma (KS) — continues to be amongst the most common in the ART era. Despite a decline in mortality in the ART era, KS survival is still unacceptably poor, and many questions remain regarding mortality after KS diagnosis in the ART era. These questions span epidemiology and clinical management. With much yet to be learned, and as a direct response to the urgent need for effective strategies to improve survival of patients with HIV-related KS, the overall goal of this mentored career development proposal is to support Dr. Helen Byakwaga in acquiring the knowledge and skills to become an independent investigator in clinical and translational HIV-associated cancer research, with a focus on efforts to reduce KS mortality among HIV-infected individuals in Sub-Saharan Africa. Dr. Byakwaga has developed a research proposal linked to a career development plan, both of which are supported by a multi-faceted mentoring team that will guide her in completing the research and transitioning to an internationally competitive independent scientist. The specific aims are: Aim 1: Determine excess risk of mortality associated with KS among HIV-infected adults in East Africa; Aim 2: Identify potential biologic determinants of mortality among HIV-infected adults with a new diagnosis of KS; and Aim 3: Develop and validate a prediction model for mortality among individuals with HIV-related KS This project will determine the true magnitude of the impact of KS on mortality among HIV-infected individuals in the ART era, identify potential pathways that can be targeted to attenuate KS progression, and develop an algorithm to predict those at highest risk for death after KS diagnosis and for whom rapid interventions are most warranted. Overall, this proposal describes a comprehensive menu of research and career development activities consisting of mentoring and coursework that will help Dr. Byakwaga to achieve her research objectives and become an independent researcher.