Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda.
The incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and res...
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doaj-fa0eb075a3ec44d2a072d8986f71ba912020-11-25T00:23:26ZengPublic Library of Science (PLoS)PLoS ONE1932-62032010-11-01511e1393610.1371/journal.pone.0013936Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda.Warren PhippsFred SsewankamboHuong NguyenMisty SaracinoAnna WaldLawrence CoreyJackson OremAndrew KambuguCorey CasperThe incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda.HIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to "improvement", as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm(3); IQR 11-156 cells/mm(3)) than men (124 cells/mm(3); IQR 22-254 cells/mm(3)) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis.The clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.http://europepmc.org/articles/PMC2980479?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Warren Phipps Fred Ssewankambo Huong Nguyen Misty Saracino Anna Wald Lawrence Corey Jackson Orem Andrew Kambugu Corey Casper |
spellingShingle |
Warren Phipps Fred Ssewankambo Huong Nguyen Misty Saracino Anna Wald Lawrence Corey Jackson Orem Andrew Kambugu Corey Casper Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. PLoS ONE |
author_facet |
Warren Phipps Fred Ssewankambo Huong Nguyen Misty Saracino Anna Wald Lawrence Corey Jackson Orem Andrew Kambugu Corey Casper |
author_sort |
Warren Phipps |
title |
Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. |
title_short |
Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. |
title_full |
Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. |
title_fullStr |
Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. |
title_full_unstemmed |
Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. |
title_sort |
gender differences in clinical presentation and outcomes of epidemic kaposi sarcoma in uganda. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2010-11-01 |
description |
The incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda.HIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to "improvement", as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm(3); IQR 11-156 cells/mm(3)) than men (124 cells/mm(3); IQR 22-254 cells/mm(3)) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis.The clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest. |
url |
http://europepmc.org/articles/PMC2980479?pdf=render |
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