title: Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, United States of America. wtphipps@fhcrc.org
authors.forename: Warren
authors.initials: W
authors.lastname: Phipps
authors.forename: Fred
authors.initials: F
authors.lastname: Ssewankambo
authors.forename: Huong
authors.initials: H
authors.lastname: Nguyen
authors.forename: Misty
authors.initials: M
authors.lastname: Saracino
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Jackson
authors.initials: J
authors.lastname: Orem
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012514:Sarcoma, Kaposi / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012737:Sex Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents