Prevalence and factors of HIV associated Oral Kaposi Sarcoma at Wits Oral Health Centre, Johannesburg

Abstract

Introduction: HIV associated Oral Kaposi Sarcoma (OKS) is a neoplasm predominantly occurring in immunocompromised patients. Therefore, it is often observed in an HIV positive and AIDS population (Moore & Chang, 2003). KS is caused by the Kaposi Sarcoma Herpes Virus (KSHV) or Human Herpes Virus-8 (HHV8) (Naidoo et al, 2016). The risk of acquiring KS increases in the presence of HIV infection and immunosuppression (Kamulegeya & Kalyanyama, 2008). HIV-KS can occur at any stage of HIV infection but has been more prevalent at the stage of AIDS or severe immune impairment (Khammissa et al., 2012). Both HHV8 infection and HIV/AIDS are highly prevalent in Africa (Kamulegaya and Kalyanyama, 2008). There is a lack of current evidence documenting the relationship between HIV/AIDS and OKS since the implementation of ART, therefore this study intends to augment the existing literature. This study aimed to determine the prevalence and factors of HIV associated OKS, on histopathologically diagnosed patients attending the WITS Oral Health Centre, Johannesburg, between 2008 and 2018. This period predates and postdates the roll out of ART in the South African public health sector in 2012 and speaks to the relationship between ART and the occurrence of HIV associated OKS. Materials and Method: This is a cross-sectional study using records from the Wits Oral Health Centre (WOHC) and National Health Laboratory Service (NHLS). The study period is 10 years from January 2008 to December 2018. Prevalence of OKS was calculated based on patients with a positive histopathological diagnosis of OKS within the study period from the NHLS database. Ethical Considerations: Permission was requested from the Academic Affairs and Research Management System (AARMS) National Health Laboratory Service (NHLS) and WOHC to access patient files. Records of patients with a positive OKS histopathological diagnosis were noted. They were allocated a study number and patient number on a data sheet. The corresponding patients’ files were accessed from WOHC to attain further information (as per the data sheet). Patient confidentiality was be maintained as no names were recorded and files were allocated a number for cross-referencing between NHLS and WOHC data. Ethics clearance was attained from the Wits Human Research Ethics Committee to carry out this study. Results: The prevalence of OKS that was found in this population (137679 patients seen at WOHC) was 0.017432%(n=24). There were more females that presented with OKS than males. The mean age of presentation was 39.11 years of age (SD 12.459). There was a significant relationship between high viral loads and a low CD4 count. The palate was the site most frequently biopsied in diagnosed OKS cases. Conclusion: The prevalence of OKS over the study period was very low. The mean age of OKS presentation was 39.21 years of age. More females presented with HIV associated OKS than males and the palate was the site, from which most biopsy samples were taken in OKS diagnoses. There is a significant relationship between high viral loads and low CD4 cell counts. This study is suggestive that a possible reason for the low number of OKS cases could be administration of ART by state institutions in South Africa, this can be further investigated to establish the effect of ART on OKS.