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Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children

  • 1, 2Email author,
  • 3, 4,
  • 2,
  • 3, 4,
  • 2, 5,
  • 2, 5 and
  • 3, 4
Infectious Agents and Cancer20105 (Suppl 1) :A12

  • Published:


  • Vincristine
  • Bleomycin
  • Complete Resolution
  • Cancer Chemotherapy
  • Pediatric Cancer


Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub-Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV-associated) KS.


Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions, biopsy results, CD4 T-cell counts, and KS treatment and outcome. (Table 1)
Table 1






KS cases, n (percent)

73 (100%)

37 (50.7%)

36 (49.3%)

Age in years, median (range), n=56

10.1 (2 – 18)

9.3 (2 – 16)

11.0 (2 – 18)

CD4 T-cells/uL, median (IQR) n=36

210 (21 – 482)

165 (16 – 538)

263 (26 – 464)

Location of lesions n=42*


Skin involvement

20 (47.6%)

10 (45.5%)

10 (50.0%)

Oral cavity involvement

9 (21.4%)

4 (20.0%)

5 (22.7%)

Viscera involvement

5 (11.9%)

3 (15.0%)

2 (9.1%)

Lymph node involvement

25 (59.5%)

11 (55.0%)

14 (58.3%)

*Categories of lesion location not mutually exclusive.

Those children with lymphadenopathic KS were younger (mean difference 3.7 years; p = 0.01), and had higher CD4 T-cell counts (mean difference 242 cells/μL; p = 0.03) than those without lymph node involvement. CD4 T-cell count was not associated with KS presentations other than lymph node involvement (Figure 1).
Figure 1
Figure 1

CD4 T-cell count quartiles (boxes and whiskers) and outliers (dots) for those patients with and without KS involvement of the lymph nodes (A), skin (B), oral cavity (C), and viscera (D).

Twenty children (62.5%) of the 32 patients with outcome data available had a complete resolution of KS. Eleven patients had a partial response, and only one patient had a documented lack of response. No association was apparent between outcome and age, sex, or type of KS presentation. Thirty (93.8%) of the 32 patients with outcome data available received cancer chemotherapy (10 with vincristine, 20 with vincristine plus bleomycin). No difference was observed in outcome with respect to whether cancer chemotherapy was used, or whether one or two drugs were given. Of those patients with a known outcome, a higher proportion had a complete resolution of KS among those who received any antiretroviral therapy (ART) regimen compared to those who did not receive ART (19 of 26 vs. 1 of 6; P=0.02).


Compared to skin involvement, lymph node involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in some cases, but the observed response rate was almost certainly biased by the large number of children lost to followup, among whom we expect disproportionately poor outcomes. Prospective studies are needed to determine optimal management.



This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at

Authors’ Affiliations

Seattle Children’s Hospital, Seattle, WA, USA
University of Washington, Seattle, WA, USA
Uganda Cancer Institute, Kampala, Uganda, Africa
Makerere University College of Health Sciences, Kampala, Uganda, Africa
Fred Hutchinson Cancer Research Center, Seattle, WA, USA


© Gantt et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.