10.5826/dpc.1303a167
text/xml
2160-9381
3160
en
Parsa  Abdi
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial Minority Communities of America
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Commentary
2023-07-31
2023-01-18
2023-07-31
2023-08-24
e2023167
Dermatol Pract Concept
Parsa  Abdi
2023/07/31
10.5826/dpc.1303a167
e2023167
Memorial University Faculty of Medicine, St. Johns, Newfoundland, Canada
2160-9381
en
e2023167
Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J Health Psychol. 2016;21(7):1311-1321. DOI: 10.1177/1359105314551950. PMID: 25293970. PMCID: PMC4388759.
Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial Minority Communities of America
https://dpcj.org/index.php/dpc/article/download/3160/2247
     Kaposi's Sarcoma, a Gateway to Understanding
       Healthcare Disparities Present in the Racial
           Minority Communities of America
                             Michelle Anthony1, Christopher Farkouh2, Parsa Abdi3


1 University of Arizona College of Medicine, Tucson, AZ, USA
2 Rush Medical College, Chicago, IL, USA
3 Memorial University Faculty of Medicine, St. John’s, Newfoundland, Canada



Citation: Anthony MR, Farkouh C, Abdi P. Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial
Minority Communities of America. Dermatol Pract Concept. 2023;13(3):e2023167. DOI: https://doi.org/10.5826/dpc.1303a167
Accepted: January 30, 2023; Published: July 2023
Copyright: ©2023 Anthony et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Michelle Anthony 2069 East Cedar Place, Chandler, AZ 85249 Phone: 4803530913 E-mail: michelleanthony@
arizona.edu



Kaposi sarcoma (KS) is a spindle cell malignancy derived                 of KS by race and geographic location from 2000 to 2013.
from endothelium cells and is caused by human herpesvirus-8              Their finds suggest KS significantly decreased in White males
(HHV-8) [1]. Clinically, it often presents as a patch that               but increased in Black males, especially from the US south-
progresses into purple to reddish-brown nodules. KS is                   ern states (Figure 1). Compared to other races, Black males
commonly subdivided into four known variants, namely,                    in the south developed KS six times more frequently and
AIDS-associated, classic, African, and iatrogenic [2]. KS has            were more likely to pass away (Figure 1). The increased rates
increased incidence in individuals with human immunode-                  of KS in southern states may be due to decreased HIV testing
ficiency virus (HIV) due to immune dysfunction allowing                  and treatment prevalent in these states [6,7]. Furthermore,
for the proliferation of oncogenic HHV-8 [3]. In the United              HAART compliance and use are lower in Black males, lead-
States, highly active antiretroviral treatment (HAART) for               ing to an increased risk of HHV-8 activation and subsequent
HIV has decreased the incidence of KS by improving im-                   KS [7]. Higher rates of poverty and lower education rates
mune function. Still, the current trends of KS in America il-            adversely affect access to healthcare needed to prevent and
lustrate the racial disparity prevalent in the U.S. healthcare           treat HIV. In 2016, Black Americans comprised 54% of HIV
system [4].                                                              diagnoses in southern individuals, of which 59% were men
    Hsieh et al. evaluated racial/ethnic differences in soft             who had sex with men [8].
tissue sarcoma trends and incidence. They found that from                     HIV is a stigmatized illness, especially in racial and mi-
1995–2008 there was a higher incidence of KS in Black and                nority communities, and decreased acceptance of homo-
Hispanic males compared to White males [5]. Similarly,                   sexuality in the south can hinder homosexual males from
Royse et al. analyzed the Surveillance, Epidemiology, and                obtaining needed health care. In addition, stigma adversely
End Results (SEER) database to determine the incidence                   reduces social support, resulting in increased psychological




Commentary | Dermatol Pract Concept. 2023;13(3):e2023167                                                                              1
Figure 1. Kaposi sarcoma incidence in the US by race, 2000–2013. Copyright © 2017 Royse et al [6].



distress and decreased efforts to prevent transmission                        doi:10.4103/ijmr.IJMR_2164_18. PMID: 31249194. PMCID:
through harm reduction [9].                                                   PMC6607822.
                                                                         4.   Kumar V, Soni P, Garg M, Hashmi AT, Chandra AB. Racial dis-
    The studies indicate an increasing need to tackle racial
                                                                              parities in incidence & survival of Kaposi's sarcoma in the United
disparities in accessing diagnostic tools, physicians, and treat-
                                                                              States. Indian J Med Res. 2019;149(3):354-363. DOI:10.4103
ment for HIV to prevent unnecessary comorbidities like KS.                    /ijmr.IJMR_1436_17. PMID: 31249200. PMCID: PMC6607828.
Working with federal agencies to address socioeconomic                   5.   Hsieh MC, Wu XC, Andrews PA, Chen VW. Racial and Ethnic Dis-
factors like decreased education and increased incarceration                  parities in the Incidence and Trends of Soft Tissue Sarcoma Among
rates that exacerbated HIV-related disparities is essential.                  Adolescents and Young Adults in the United States, 1995-2008.
                                                                              J Adolesc Young Adult Oncol. 2013;2(3):89-94. doi:10.1089/
To improve HIV testing in racial communities, it is crucial
                                                                              jayao.2012.0031. PMID: 24066270. PMCID: PMC3778995.
to implement clinical and non-clinical settings that promote
                                                                         6.   Royse KE, El Chaer F, Amirian ES, Hartman C, Krown SE, et al.
feasible accessibility to HIV testing. Many Black American                    (2017) Disparities in Kaposi sarcoma incidence and survival in
men distrust the medical system, which can lead to decreased                  the United States: 2000-2013. PLoS One. 2017;12(8):e0182750.
access and adherence to HAART [10]. This needs to be ad-                      DOI: 10.1371/journal.pone.0182750. PMID: 28829790.
dressed by training culturally competent physicians focused                   PMCID: PMC5567503.
                                                                         7.   Ragi SD, Moseley I, Ouellette S, Rao B. Epidemiology and Sur-
on providing a therapeutic patient-provider relationship.
                                                                              vival of Kaposi's Sarcoma by Race in the United States: A Sur-
Further studies need to be performed to understand health-
                                                                              veillance, Epidemiology, and End Results Database Analysis. Clin
care disparities and effective methods to address the trans-                  Cosmet Investig Dermatol. 2022;15:1681-1685. DOI:10.2147
mission of HIV and the comorbid development of KS in                          /CCID.S380167. PMID: 36003526. PMCID: PMC9394645.
racial minority communities [9].                                         8.   Nunn A, Jeffries WL 4th, Foster P, et al. Reducing the African
                                                                              American HIV Disease Burden in the Deep South: Address-
                                                                              ing the Role of Faith and Spirituality. AIDS Behav. 2019;23
References                                                                    (Suppl 3):319-330. DOI:10.1007/s10461-019-02631-4. PMID:
                                                                              31444712. PMCID: PMC6800644.
 1. Lebbe C, Garbe C, Stratigos AJ, et al. Diagnosis and treatment of    9.   Kenya S, Okoro I, Wallace K, Carrasquillo O, Prado G. Strat-
    Kaposi's sarcoma: European consensus-based interdisciplinary              egies to Improve HIV Testing in African Americans. J As-
    guideline (EDF/EADO/EORTC). Eur J Cancer. 2019;114:117-                   soc Nurses AIDS Care. 2015;26(4):357-367. DOI:10.1016/j
    127. DOI:10.1016/j.ejca.2018.12.036. PMID: 31096150.                      .jana.2015.04.001. PMID: 26066691. PMCID: PMC4489406.
 2. Radu O, Pantanowitz L. Kaposi sarcoma. Arch Pathol Lab              10.   Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical
    Med. 2013;137(2):289-294. DOI:10.5858/arpa.2012-0101-RS.                  mistrust is related to lower longitudinal medication adherence
    PMID: 23368874.                                                           among African-American males with HIV. J Health Psychol.
 3. Godbole S, Ghate M, Mehendale S. Understanding racial diversi-            2016;21(7):1311-1321. DOI: 10.1177/1359105314551950.
    ties in Kaposi's sarcoma. Indian J Med Res. 2019;149(3):319-321.          PMID: 25293970. PMCID: PMC4388759.




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