Comparison of Kaposi disease outlines in patients with and without HIV infection in two tertiary care hospitals in Bucharest, Romania

Background

Kaposi disease (KD) displays polymorphic manifestations, ranging from minimal cutaneous involvement to extensive visceral disease. Its clinical outline is different in HIV-positive patients compared to the classical non-HIV-related form that is diagnosed more often in elderly patients without other significant immune impairment.

Methods

A retrospective study on KD was performed in two academic centers, tertiary-care hospitals with national addressability in Romania. Two groups were comparatively studied: HIV-infected patients diagnosed in the National Institute for Infectious Diseases “Prof.Dr. Matei Balş” (HIV-positive group), and non-HIV patients diagnosed in the first Clinic of Dermatology, Colentina Clinical Hospital (HIV-negative group). The statistical analysis was performed using IBM SPSS Statistics v.22 (Chicago, USA).

Results

A total number of 71 cases, 30 in the HIV-positive group and 41 in the HIV-negative group were identified. The non-HIV patients were benign European form and immunosuppressed other than HIV, respectively. There was a male predominance, with a male-to-female ratio in HIV-positive and HIV-negative patients of 2:1 and 4.1:1 respectively. The mean age at KD diagnosis was 41.6±15.0 years in HIV-positive and 70.2±11.8 years in HIV-negative patients.

The mean number of comorbidities was 3 in the HIV-positive group compared to 1 in HIV-negative, p=0.011). In the HIV-positive group, 17 patients (56.7%) were classified Mitsuyasu stage 1, 6 (20%) stage 2, 2 (6.7%) stage 3 and 5 (16.7%) stage 4. In the HIV-negative group, all 41 patients were Mitsuyasu stage 1.

In the HIV-positive group all patients received antiretroviral therapy and only 6 (20%) received other types of targeted therapy for KD: topical (5, 16.7%), systemic (5, 16.7% – interferon, etc.), chemotherapy (2, 6.7%), local radiotherapy (2, 6.7%). In the HIV-negative group, all patients received specific treatment, such as: topical (24, 58.5%), systemic (14, 34.1% – dapsone, pentoxifylline), chemotherapy (2, 4.9%), local radiotherapy (7, 17.1%), electrocauterization (15, 36.6%), surgical excision (4, 9.8%).

Loss for follow-up appeared to be less frequent in the HIV-positive group (7 patients, 35%) than in the HIV-negative group (35 patients, 85.4%) but occurred faster in the HIV-positive group, after a mean interval of 8.6±3.4 vs. 15.9±37.3 months in HIV-negative group. Overall survival was 60% (HIV-positive) and 100% (HIV-negative).

Conclusion

This work has identified two different outlines of KD, an aggressive progression with high mortality in HIV-positive patients, and a gradual progression, with virtually no short-term mortality, in elderly patients. In the HIV-positive group, very few patients received other types of treatment for KD, apart from antiretroviral therapy.