Kaposi’s sarcoma in North-East India: an under recognized burden
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20261097Keywords:
Kaposi sarcoma, Northeast India, Nagaland, Human herpesvirus 8Abstract
Background: Kaposi’s sarcoma (KS) is a rare AIDS-defining malignancy strongly associated with human herpesvirus 8 (HHV-8). Although KS is considered uncommon in India owing to its low HHV-8 seroprevalence, regions with high HIV prevalence, such as Northeast India, may exhibit a higher burden of KS. This study investigated the clinical characteristics and outcomes of KS cases in Nagaland, a region with a high HIV prevalence.
Methods: This retrospective observational study analyzed the demographics, clinical characteristics, and treatment outcomes of 16 KS cases diagnosed between 2011 and 2024 in Nagaland.
Results: The mean age of the patients was 45 years (±13.57) mean (±SD), and the male-to-female ratio was 1.7:1. Mucocutaneous lesions were the predominant presentation, while four patients exhibited pulmonary involvement. The median CD4 count at diagnosis was notably low at 54 cells/mm3 (IQR 47-262.5)). Six patients had coexisting opportunistic infections, such as tuberculosis, and two patients had Pneumocystis carinii pneumonia. Four patients improved with antiretroviral treatment (ART) alone, while four received liposomal doxorubicin along with ART, showing varying outcomes. Three patients died, likely due to systemic involvement and comorbidities. One patient was HIV-naïve, suggesting classic KS.
Conclusions: This study provides initial evidence that may challenge the previously held notion of KS rarity in India by documenting a notable burden in Nagaland, India. Increased vigilance is warranted in areas with high HIV prevalence, and further research is needed to understand the epidemiology and optimize treatment strategies in this region.
References
Chang Y, Cesarman E, Pessin MS, Lee F, Culpepper J, Knowles DM, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science. 1994;266:1865-9.
Ablashi D, Yadav M, Chandana AK, Chatlynne L, Manns A, Gill P, et al. Seroprevalence of human herpesvirus-8 (HHV-8) in countries of Southeast Asia compared to the USA, the Caribbean and Africa. Br J Cancer. 1999;81(5):893-7.
Das P, Chattopadhyay NR, Chatterjee K, Choudhuri T. Kaposi's sarcoma-associated herpesvirus related malignancy in India, a rare but emerging member to be considered. Virusdisease. 2020;31(3):209-19.
Bhatia R, Shubhdarshini S, Yadav S, Ramam M, Agarwal S. Disseminated Kaposi’s Sarcoma in a human immunodeficiency virus-infected homosexual Indian man. Indian J Dermatol Venereol Leprol. 2017;83:78-83.
Reddy HK, Raju BP, Methre V, Samagani A. Kaposi's sarcoma: An interesting case report in a human immunodeficiency virus-positive heterosexual male. Indian J Sex Transm Dis AIDS. 2022;43(2):179-81.
Prabhakaran N, Gupta D, Chandrashekhar L, Thappa DM, Rajesh NG. Disseminated Kaposi's sarcoma as a presenting sign of HIV in an Indian male: A case report with dermoscopic findings. Indian J Sex Transm Dis AIDS. 2020;41(1):102-5.
Munawwar A, Gupta S, Sharma SK, Singh S. Seroprevalence and determinants of Kaposi sarcoma-associated human herpesvirus 8 in Indian HIV-infected males. AIDS Res Human Retroviruses. 2014;30(12):1192-6.
Nnoruka EN, Anisuiba B, Chukwuka JC. Correlation of mucocutaneous manifestations of HIV/AIDS infection with CD4 counts and disease progression. Int J Dermatol. 2007;46(s2):14-8.
Goff CB, Dasanu CA. Changing therapeutic landscape in advanced Kaposi’s sarcoma: current state and future directions. J Oncol Pharm Pract. 2023;29(4):917-26.
Paksoy N, Khanmammadov N, Doğan İ, Ferhatoğlu F, Ahmed MA, Karaman S, et al. Weekly paclitaxel treatment in the first-line therapy of classic Kaposi sarcoma: A real-life study. Medicine (Baltimore). 2023;102(5):e32866.
Mosam A, Shaik F, Esterhuizen T, Uldrick TS, Aboobaker J, Scadden DT, et al. A Randomized Controlled Trial of Highly Active Antiretroviral Therapy Versus Highly Active Antiretroviral Therapy and Chemotherapy in Therapy-Naive Patients With HIV-Associated Kaposi Sarcoma in South Africa. JAIDS J Acquired Immune Deficiency Syndromes. 2012;60(2):150-7.
Gbabe OF, Dedicoat M, Okwundu CI, Freeman EE. Treatment of severe or progressive Kaposi’s sarcoma in HIV-infected adults. Cochrane Database Syst Rev. 2014;2014(9).
Lupia R, Wabuyia PB, Otiato P, Fang CT, Tsai FJ. Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case-control study in Kenya. J Microbiol Immunol Infect. 2017;50(6):781-8.
Arbune M, Padurariu-Covit MD, Rebegea LF, Lupasteanu G, Arbune AA, Stefanescu V, et al. AIDS Related Kaposi's Sarcoma: A 20-Year Experience in a Clinic from the Southeast of Romania. J Clin Med. 2021;10(22):5346.
Darung I, Shah N, Ghosh A, Kamgo L, Kavishwar V. Classic Kaposi sarcoma in Eastern India. Indian J Dermatol Venereol Leprol. 2023;89(2):334.
Kongbam L, Thokchom N, Salam E. Classic Kaposi Sarcoma from Northeast India: A case report. IP Indian J Clin Exp Dermatol. 2020;6(3):291-3.
Sachithanandham J, Kannangai R, Abraham AM, Fletcher GJ, Abraham OC, Daniel D, et al. Human herpes virus-8 infections among subjects with human immunodeficiency virus infection and normal healthy individuals in India. Intervirology. 2013;56(4):253-7.
Downloads
Published
How to Cite
Issue
Section
