AIDS-associated Kaposi's sarcoma is more aggressive in women: A study of 54 patients

Objective: To describe the epidemiologic and clinical features of AIDS-asso ciated Kaposi's sarcoma (KS) in women compared with men. Methods: In a retrospective study, within the Italian Cooperative Group on AIDS and Tumors (GICAT), we compared selected characteristics of 54 women a nd 108 men with AIDS-associated KS, matched by date of KS diagnosis and ref erral hospital. The chi(2) test was used to test differences among proporti ons; the Kaplan-Meier method to estimate the survival time, and the Cox pro portional hazard model was used to assess the role of gender: age, and CD4 cell count on death's risk. Results: KS occurred at an earlier age (p = .001), was associated with a mo re severe immunodeficiency (p = .03), more advanced stages of HN disease (p = .05), and had more aggressive presentation and course in women than in m en. At KS diagnosis, women had a significantly increased proportion of visc eral disease (p = .009), in particular pulmonary involvement (p = .002) and atypical sites of involvement (p = .008). The number of deaths due to KS w as significantly higher (p = .01) in female patients. Both the higher propo rtion of visceral disease and of KS-related deaths observed in women did no t change after adjusting for CD4 cell count and age. Women showed a decreas ed overall survival compared with men (8.9 and 14.4 months, respectively; p = .07), and the CD4 cell count at diagnosis significantly influenced survi val. Conclusions: This study suggests that KS is more aggressive and life threat ening in female than in male patients. This peculiar clinical behavior may reflect an inherently more aggressive biology of KS in women, possibly medi ated by the level of immunodeficiency.