Background:  Kaposi’s sarcoma (KS) is the most common AIDS-related malignancy and is associated with increased mortality. Clinical outcomes for patients with AIDS-related KS in resource-limited settings where non-nucleoside reverse transcriptase inhibitor (NNRTI) -based ART is predominantly used, have not been previously described.

Methods:  We evaluated HIV-infected patients aged ≥18 years, who initiated ART in the Home-Based AIDS Care Project in Tororo, Uganda, from May 2003 to December 2005 and were diagnosed with KS at baseline or in follow-up. The primary ART regimen used was lamivudine, stavudine, and nevirapine. KS was diagnosed based on clinical judgement, augmented where feasible by biopsies, chest X-rays, and ultrasonography. We compared subjects who had KS at baseline with those who developed KS in follow-up. Logistic regression was used to examine independent risk factors for having KS at baseline or in follow-up and Cox proportional hazards modeling was used to examine associations between baseline variables and risk factors for death among KS patients.

Results:  Of 1125 study subjects, 16 were diagnosed with KS at baseline and 17 during 1983 person-years of follow-up. A total of 12 subjects received any chemotherapy for their KS (3 baseline cases; 9 follow-up cases). For incident KS, the median time from initiating ART to KS diagnosis was 115 days (IQR 60 to 300), resulting in an incidence of 0.86/100 person-years. Prevalent KS subjects differed from incident KS subjects in sex distribution (31.3% female vs 64.7%, p = 0.02) and baseline log viral load (5.3 vs 5.9, p = 0.02); but did not differ with respect to baseline CD4 cell count, body mass index, or crude mortality. KS was associated with being male (adjusted odds ratio, AOR, 2.47, 95%CI 1.23 to 5.01) and baseline CD4 cell count <50 (AOR 3.05, 95%CI 0.96 to 9.67). A total of 23 subjects (69.7%) experienced regression of their KS lesions and 10 (30.3%) subjects died with persistent KS. Within the KS group, mortality was associated with visceral KS (adjusted hazard ratio, AHR, 21.5, 95%CI 2.71 to 171.0), but not with baseline CD4 cell count or viral load and use of chemotherapy.

Conclusions:  KS diagnosis at baseline or in follow-up during NNRTI-based ART was associated with 30% mortality. However, KS regression rates appear to be similar to those reported using protease inhibitor based–ART.