Impact of antiretroviral therapy on the incidence of Kaposi's sarcoma in resource-rich and resource-limited settings.

Abstract

Given the recent availability of antiretroviral therapy (ART) in resource-limited settings and the significant burden exacted by Kaposi's sarcoma in these areas, we reviewed data regarding the impact of ART on Kaposi's sarcoma incidence. We summarized the sizeable literature in resource-rich settings as well as emerging data from resource-limited regions. Importantly, we delineated ways impact can be defined, including individual patient-level effectiveness; population-level effectiveness; change in population-level incidence; and residual risk of Kaposi's sarcoma. In resource-rich settings, there are now ample data demonstrating beneficial individual patient-level and population-level effects of ART on Kaposi's sarcoma incidence. There is, however, considerable variability between studies and important methodologic shortcomings. Data from resource-limited settings are much more limited; although they preliminarily indicate individual patient-level effectiveness, they do not yet provide insight on population-level effects. ART has had a substantial impact on Kaposi's sarcoma incidence in resource-rich settings, but more attention is needed on validly quantifying this effect in order to determine whether additional interventions are needed. Emerging data from resource-limited regions also suggest beneficial impact of ART on Kaposi's sarcoma incidence, but - given the scope of Kaposi's sarcoma in these settings - more data are needed to understand the breadth and magnitude of the effect.