Publication:

Kaposi’s sarcoma in North-East India: an under recognized burden

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.