Fatores de risco associados à mortalidade por Sarcoma de Kaposi em pacientes com AIDS no Ceará

Abstract

This study investigated factors associated with mortality from Kaposi's sarcoma (KS) in people living with HIV/AIDS (PLWHA) in Ceará, Brazil, between 2012 and 2022. A retrospective cohort was conducted at the Hospital São José de Doenças Infecciosas, with data collection on sociodemographic, clinical, laboratory, staging, and treatment characteristics. Survival was estimated using Kaplan-Meier curves, and factors associated with mortality were analyzed by logistic regression. A total of 123 patients were included, with an incidence of 12.4 KS cases per 1,000 PLWHA, predominantly among men (96.7%) with a median age of 34 years. In 35% of cases, sexual orientation was reported as men who have sex with men (MSM) or bisexual. Most patients (67.5%) were diagnosed with KS within six months of HIV diagnosis. Advanced staging (T1S1) was most common (58.5%), with frequent involvement of skin, mucosae, and the gastrointestinal tract. Among those who underwent endoscopy, 75% had gastrointestinal lesions, mainly in the stomach. Radiographic findings such as pulmonary infiltrates and pleural effusion were present in two-thirds of the evaluated cases. Opportunistic coinfections were frequent. Overall mortality was 35.8%. Mortality was significantly associated with a Karnofsky score ≤ 70, presence of edema, anemia, thrombocytopenia, and hypoalbuminemia. Chemotherapy was a protective factor, reducing the risk of death by 98% among patients with T1 staging. Antiretroviral therapy (ART) alone was insufficient to reverse poor outcomes in advanced disease. Estimated overall survival was 68.7% at 12 months and 59.8% at five years. Limited access to chemotherapy contributed to high mortality, highlighting inequalities in clinical management. The findings suggest that late diagnosis and restricted access to chemotherapy are major contributors to KS-related mortality in Ceará. Strategies aimed at early diagnosis, appropriate staging, and integrated management between infectious diseases and oncology are essential to improve survival and quality of life. This study underscores the need for public policies that promote equitable access to cancer care and address regional disparities in the health care of PLWHA.