Brief Report: Prognostic Value of Kaposi Sarcoma Herpes Virus–Associated Clinical Symptom Scores in HIV-Associated Kaposi Sarcoma

BACKGROUND: Kaposi sarcoma herpes virus (KSHV)-associated inflammatory cytokine syndrome (KICS) is defined by clinical, laboratory, and radiographic findings and KSHV viremia. Whether the presenting clinical symptoms of KICS have prognostic value in patients with HIV-associated Kaposi sarcoma (HIV-KS) initiating therapy is unknown. SETTING: Two prospective clinical trials were conducted among participants with mild-to-moderate (A5264/AMC067) and advanced (A5263/AMC066) HIV-KS in low-income and middle-income countries. All participants received antiretroviral therapy, and chemotherapy was given according to the randomly assigned treatment arm. METHODS: We developed a Kaposi sarcoma clinical symptom score (KSCS score), derived from the previously described KICS definition to determine whether the score could inform prognosis. The score ranging from 0 to 3 was based on increasing severity of clinical manifestations. We evaluated the impact of baseline KSCS score on progression-free and overall survival using Cox proportional hazard regression. RESULTS: Of 190 participants in A5264/AMC067 and 329 in A5263/AMC066, 150 (78.9%) and 239 (72.6%) had KSCS score ≥1 and 15 (7.9%) and 95 (28.9%) had KSCS score 3, respectively. Independent of the treatment arm, participants with KSCS score 3 had a higher risk of death (A5264/AMC067: adjusted hazard ratio (aHR) = 9.17; 95% CI: 3.60 to 23.41; A5263/AMC066: aHR = 2.99; 95% CI: 1.69 to 5.28) and shorter progression-free survival (A5264/AMC067: aHR = 2.36 95% CI: 1.26 to 4.43; A5263/AMC066: aHR = 2.31; 95% CI: 1.23 to 3.60) compared with those with KSCS score ≤2. CONCLUSIONS: KSCS score symptoms are common, especially in advanced HIV-KS. KSCS score 3 is associated with higher risk of progressive KS disease or death, despite treatment with antiretrovirals and chemotherapy. This population may benefit from improved diagnostic and management options.