Kaposi Sarcoma: Global Disease Burden, Treatment Disparities, and Barriers to Care

Kaposi sarcoma (KS) is an angioproliferative malignancy caused by Kaposi sarcoma-associated herpesvirus (KSHV/HHV-8).Immunodeficiency due to HIV infection is a major risk factor, and KS remains one of the most common HIV-associated malignancies globally.KS burden of disease is disproportionately concentrated in sub-Saharan Africa (SSA), which accounts for over 70% of incident KS cases worldwide, driven by high HHV-8 seroprevalence and a persistent regional HIV burden.The age-standardized incidence rate is generally higher in males than in females; the highest male rates have been reported in Mozambique and Zambia, whereas the lowest are seen in South Asia, particularly India and Sri Lanka.In high-income countries, widespread access to antiretroviral therapy (ART) has markedly reduced KS incidence and improved outcomes, transforming HIV-associated KS into a more manageable condition.In many low-and middle-income countries (LMICs) in SSA, patients frequently present with advanced disease, severe immunosuppression, and uncontrolled viremia.Contemporary data from East Africa suggest that one-year mortality for HIV-associated KS remains above 40%.Treatment of advanced HIV-associated KS is based on ART combined with systemic chemotherapy, most commonly pegylated liposomal doxorubicin or paclitaxel.In LMICs, access to preferred agents is limited by cost, supply constraints, inadequate access to timely histopathologic diagnosis, infusion infrastructure, and trained personnel.Where liposomal anthracyclines are unavailable, paclitaxel has emerged as a binaytara.org/journal| Mani et al.International Journal of Cancer Care and Delivery 2026;6789101112131415161718191 practical and effective alternative.Persistent barriers include delayed diagnosis, incomplete ART coverage and retention, stigma, and vulnerability to disruptions in international HIV funding and public health expenditures.Preventing HIV infection, promoting earlier diagnosis, expanding ART access, strengthening cancer care infrastructure, and improving chemotherapy availability are critical to improving outcomes.Emerging approaches, including telemedicine, digital decision support, and novel point-of-care diagnostic tools, may help extend expertise but will complement rather than replace sustained investment in health systems and workforce development.binaytara.org/