Why cancer-causing ‘Kisipi’ is on the rise in Ugandan men

Kaposi sarcoma (KS), a cancer that can cause abnormal patches or lesions on the skin and inside the body, remains a major concern among Ugandan men.

Health experts are linking the burden to HIV, weakened immunity and poorer access to antiretroviral treatment among men.

The cancer is caused by Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8). The virus is found in the lesions of people with KS, although most people infected with it never develop the cancer.

In Uganda, the condition is associated with what is locally referred to in Luganda as “Kisipi”, according to Dr Alfred Jatho, the Head of Community Cancer Services at the Uganda Cancer Institute (UCI).

Jatho said recent UCI findings show that KS remains one of the common cancers affecting Ugandan men. He cited prostate, oesophageal and liver cancers among the other leading cancers in men.

“KS in Luganda falls under the group called Kisipi. This Kisipi can later on advance and cause KS,” Jatho said while disseminating findings from a recent UCI study.

Kaposi sarcoma develops in cells lining blood and lymph vessels. It often appears as abnormal lesions on the skin but can also affect the mouth, lymph nodes, lungs, liver, spleen, stomach and intestines.

The disease has a long history in Uganda. Research based on the Kampala Cancer Registry found that Kaposi sarcoma became the leading cancer among men during the HIV/AIDS epidemic. Between 2009 and 2013, it still recorded the highest annual incidence among men in Kampala, at 18 cases per 100,000 people.

Jatho said KSHV infection alone does not mean someone will develop Kaposi sarcoma. The risk increases when the immune system becomes weak.

“For most cases it is associated with people living with HIV and it is true that there is a virus which causes this disease that can be passed through sexual intercourse,” he said.

However, scientific evidence shows that KSHV is most commonly transmitted through saliva, particularly in regions such as sub-Saharan Africa where the virus is widespread. Evidence also points to other possible transmission routes in some populations.

“But if you have that virus and your immunity is okay, for most cases you are less likely to develop KS,” Jatho said.

“But if you are living with HIV, or your diet is not good, either due to old age, your risk of this cancer is much higher.”

HIV does not directly cause Kaposi sarcoma. Instead, it weakens the immune system, making it harder for the body to control infections such as HHV-8. People living with HIV consequently face a higher risk of developing KS.

Antiretroviral therapy can restore immune function and substantially reduce the risk of HIV-associated Kaposi sarcoma. It also forms an important part of treatment for people who develop the cancer.

Jatho said the disease has declined among Ugandan women partly because women living with HIV have better access to antiretroviral treatment than men.

“In women it is there also, but it has reduced because access to ARVs among women living with HIV is much better compared to men. So in men, it remains a big problem,” he said.

The World Health Organisation says untreated HIV progressively weakens the immune system and increases vulnerability to serious illnesses, including Kaposi sarcoma.

Jatho said the KS problem forms part of a wider cancer burden that is placing pressure on Uganda's health system.

According to the latest figures he presented, Uganda records about 29,000 new cancer cases annually, while about 18,000 patients die from the disease each year. About 59,000 cancer patients receive care at different health facilities annually.

He said treating a single cancer patient can cost an average of Shs300 million, with the expense ultimately falling on the government, donors or patients and their families.

Uganda faces more than 100 types of cancer, but a small number account for a large share of cases.

Among women, cervical and breast cancers account for almost half of the burden, according to the findings.

Jatho said this should guide women who cannot afford or find time for extensive cancer screening.

“This is important information because it means that if you don't have money or time to screen for all these cancer types, at least try these two because there is a high probability of developing those two as a woman,” he said.