Vaccine and Infectious Disease Division

Gender differences in Kaposi sarcoma outcomes

Kaposi sarcoma (KS), a cancer caused by human herpesvirus 8, is the most common HIV-related malignancy.  Prior to the HIV epidemic, KS was a rare and almost exclusively male disease, but recently the incidence in women has increased dramatically, particularly in sub-Saharan Africa.  The reasons for this gender difference are unknown, although hormonal factors may play a role.  Due to the dearth of historic female cases, very little information is available on the etiology and pathology of KS in women.

To identify gender-related differences in KS presentation and outcomes, VIDD research associate Dr. Warren Phipps, along with VIDD member Dr. Anna Wald, Center President and Director Dr. Larry Corey, VIDD associate member Dr. Corey Casper and colleagues performed a retrospective study of 197 HIV-positive KS patients who attended two clinics in Kampala, Uganda from 2004-2006.  They studied the patient records to identify clinical features of KS, such as the location and type of lesions at the first visit, cancer stage, and other related factors such as CD4 T cell count and age.  Slightly more than half of the patients were women.  They found that women were significantly more likely to have lesions on their face and hard palate, and less likely to have lesions on their lower extremities.  Women had significantly lower CD4 counts, indicating that their immune systems were likely more compromised before the onset of KS.  Women were also less likely to show clinical improvement than men.  The causes of these gender differences remain to be determined, and prospective studies in women are needed to identify additional factors that might influence outcomes, such as access to health care, and to study the efficacy of specific treatment regimens for KS in women, since they might respond differently to existing treatments than men.

Phipps W, Ssewankambo F, Nguyen H, Saracino M, Wald A, Corey L, Orem J, Kambugu A, Casper C.  Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. PLoS One. 2010 Nov 12;5(11):e13936.