Clinicoepidemiologic Profile of Oral Kaposi Sarcoma in People Living With HIV : A Systematic Review and Meta‐Analysis

Background To characterize the clinicoepidemiologic profile of HIV‐associated oral Kaposi sarcoma (OKS) and quantitatively synthesize its frequency, anatomical distribution, and temporal patterns across antiretroviral therapy (ART) eras. Methods Six databases and gray literature were searched. Eligible observational, descriptive, and quasi‐experimental studies were appraised using JBI tools. Random‐effects meta‐analyses of patient‐based proportions and treatment‐era subgroup were performed when compatible study‐level denominators were available (PROSPERO: CRD420251105061). Results Forty‐eight studies comprising 1661 individuals were included, and 31 contributed to at least one meta‐analysis. Pooled proportions were 0.85 (95% CI: 0.76–0.91) for palatal involvement and 0.44 (95% CI: 0.23–0.68) for OKS as a sentinel presentation of HIV. Pooled prevalence of OKS among people living with HIV was 0.06 (95% CI: 0.02–0.12). Compared with the pre‐combination ART era, the combination ART era showed lower palatal (0.72 vs. 0.89; p = 0.0034) and gingival involvement (0.07 vs. 0.30; p = 0.0003), but more sentinel presentations (0.72 vs. 0.32; p = 0.0195). Methodological quality was moderate, with substantial heterogeneity. Conclusions Pooled evidence confirms strong palatal predilection of HIV‐associated OKS. Temporal subgroup findings suggest changes in oral distribution across ART eras while reinforcing its persistent role as a sentinel manifestation of HIV infection and persistent clinical relevance despite ART.