Background
Kaposi sarcoma (KS) is caused by human herpes 8 virus (HHV8); immunosuppression and inflammatory cytokines play a major role in its pathogenesis. We aimed to describe the clinical differences and outcomes of patients with disseminated KS, with and without pulmonary involvement.
Methods
We conducted a single-center retrospective cohort study from 2018 to 2024, including people with HIV and biopsy-confirmed KS, that were classified as disseminated KS by at least two of the following criteria: pulmonary, lymph-node, or gastrointestinal involvement, lymphedema, or ≥30 skin lesions. We excluded cases with lymphoma, KS inflammatory cytokine syndrome, those with less than 30 days of follow-up, or insufficient studies to diagnose or rule out pulmonary KS (pKS). We identified pKS with any of the following methods: pulmonary biopsy, direct visualization via bronchoscopy, or pulmonary lesions with negative Gallium-67 uptake. We described differences in clinical presentation and initial laboratory studies between the two groups. We created Kaplan-Meier curves to compare all-cause mortality between individuals with KS and pKS at 1 year following KS diagnosis. We performed multivariate Cox proportional hazards models to identify factors associated with 1-year mortality.
Results
A total of 320 individuals with KS were identified; after applying exclusion criteria, 223 were included in the final analysis. Individuals with pKS had lower median hemoglobin (10.6 vs 11.7, p=0.023) and albumin levels (3.3 vs 3.6, p=0.037), as well as lower median CD4 counts (57 vs 86, p=0.036), and presented with KS-immune reconstitution inflammatory syndrome (KS-IRIS) more frequently (34.3% vs 53.8%, p=0.006). People with pKS had lower survival rates after 1 year of follow-up (74.24% vs 89.16%, p = 0.014). Having higher serum creatinine (aHR 2.39, 95%CI 1.82-3.98), having lower serum albumin (aHR 0.26, 95%CI 0.17-0.40) and having pulmonary KS (aHR 2.21, 95%CI 1.12-4.36) were independently associated with 1-year mortality.
Conclusions
Pulmonary KS was associated with more severe immunosuppression, lower hemoglobin and albumin levels, and a higher frequency of KS-IRIS. Having pKS, hypoalbuminemia, and elevated creatinine independently predicted 1-year mortality in KS. These findings underscore the importance of early recognition of pKS and the need for tailored management strategies to enhance survival outcomes in this population.
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