Abstract
Background: Kaposi sarcoma (KS) remains a significant manifestation of advanced HIV disease, despite progress in antiretroviral therapy (ART). In the United States, the burden of KS disproportionately affects Black men and those from socioeconomically disadvantaged backgrounds. However, the neighborhood-level characteristics among patients diagnosed with KS have not been well characterized. This study explores demographic, clinical, and neighborhood-level characteristics among patients diagnosed with KS, with particular focus on the Area Deprivation Index (ADI) as an exploratory measure of structural disadvantage.
Methods: A retrospective observational study was conducted using the TriNetX database and local EMR to identify Maryland residents with confirmed KS. Records were reviewed across available years, with KS diagnoses spanning the 1990s through 2023.
Results: Forty-five patients were included, predominantly Black (71%), male (93%), gay or bisexual men (55%), and living with HIV (82%). Of people living with HIV (PLWH), 44% were diagnosed with KS within one year of their HIV diagnosis. Only 5 of 36 PLWH had CD4 count >200 cells/mm³ and HIV RNA < 200 copies/mL, consistent with well-controlled HIV at KS diagnosis. The median state ADI decile was 8 (IQR, 6–9), while the median national ADI rank was 49 (IQR, 33–70). Exploratory analyses demonstrated weak, non-significant correlations between state ADI and symptom burden (ρ=0.14, p=0.37) and national ADI and symptom burden (ρ=0.11, p=0.47). KS in this cohort occurred most commonly among people living with poorly controlled HIV and in historically disadvantaged populations.
Conclusion: Our findings emphasize the importance of timely HIV diagnosis, ongoing KS monitoring in both virally suppressed and unsuppressed individuals, and improved access to care for historically marginalized populations, particularly MSM and those in socioeconomically disadvantaged areas. Further research is needed to clarify the underlying mechanisms and explore how interventions targeting socioeconomic factors can improve outcomes.
Keywords
Kaposi Sarcoma (KS), People living with HIV (PLWH), Antiretroviral Therapy (ART), Social Determinants of Health (SDOH), Area Deprivation Index (ADI)