Mortality disparities among patients with HIV-associated Kaposi's sarcoma in the southern United States

Objective: To describe risk factors for mortality in HIV-associated Kaposi's sarcoma in an urban population in Dallas, Texas. Design: Retrospective electronic medical record review of patients with HIV-associated Kaposi's sarcoma. Methods: Electronic medical records were reviewed from 1 January 2009 to 31 December 2018 for patients with a diagnosis of HIV and Kaposi's sarcoma by ICD-9 or ICD-10 codes. Demographics, HIV history, Kaposi's sarcoma history, treatment, and mortality data were collected. Mortality data was supplemented by an inquiry from the National Death Index (NDI). Survival analyses were performed using Cox proportional hazards analysis to determine independent predictors of mortality. Results: Black patients had higher mortality than white or Hispanic patients (hazard ratio 2.07, 95% confidence interval 1.12-3.82), even after adjusting for covariates. This mortality difference correlates with higher rates of advanced Kaposi's sarcoma disease and KS-IRIS in black patients compared with other groups and is not explained by differences in CD4(+) cell count, HIV viral load, engagement in care, or ART adherence at the time of cancer diagnosis. Conclusion: Despite nationwide trends showing decreased incidence and decreased mortality in Kaposi's sarcoma in the ART era, a high number of Kaposi's sarcoma cases and disparities in Kaposi's sarcoma outcomes persist in certain populations in the United States.