Kaposi's sarcoma at the University Teaching Hospital, Lusaka, Zambia in the antiretroviral therapy era.

Dear Editor With great interest, we read the recent publication " Kaposi's sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era " by Bohlius et al. 1 We congratulate the authors for their contribution to this field. In this study the authors observed a decrease in incidence of Kaposi's sarcoma (KS) in patients treated with anti-retroviral therapy (ART) when compared to patients who are not on ART. These results are encouraging because of the ongoing HIV epidemic in sub-Saharan Africa where KS is still one of the most prevalent cancers. Also, it is a relevant topic to study in South Africa; a country that has a high prevalence of both HIV and Kaposi's sarcoma-associated herpesvirus (KSHV) infections. This study is of interest to us because we have investigated the incidence and prevalence of KSHV infection in Zambia for more than a decade. Zambia, also a part of Southern Africa, has approximately 13% HIV prevalence in the adult population. It also has a high incidence of both epidemic and endemic forms of KS. The University teaching hospital (UTH) in Lusaka, Zambia is the national referral hospital. It has a well-established Dermatology and Venereology Division where suspected KS patients are referred and present themselves for diagnosis and treatment. UTH receives these patients from the highly populated Lusaka city and other cities and provinces throughout Zambia. Therefore, UTH records more KS cases than other health care centers in Zambia. Indeed, we have routinely been diagnosing KS even after ART became widely available in Zambia. Between 2008 and 2013 we recorded at least 726 pathologist confirmed KS cases. Of these, 460 (63.4%) cases were diagnosed in HIV infected patients (epidemic KS) and 266 (36.6%) cases in HIV negative patients (endemic KS). We agree with the results reported by Bohlius et al about KS incidence being higher in men. In our dataset, we too observed that both endemic and epidemic KS cases were diagnosed more frequently in men as compared to women The male:female ratio for epidemic KS 1.8 and for endemic cases was 1.7. (Table 1). We also want to take this opportunity to highlight that while ART may reduce the incidence of epidemic KS in HIV infected patients, the prevalence and incidence of endemic KS will likely remain high and remain under-reported in the current literature. Countries like Zambia that are a part of the " KS belt …