Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study
Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi’s sarcoma (KS) patients shifted from symptomatic palliation to potential cure. Objective. To evaluate survival and changes over time in AIDS-KS patients trea...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2017-10-01
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| Series: | South African Medical Journal |
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| Online Access: | http://www.samj.org.za/index.php/samj/article/view/12077 |
| _version_ | 1811153658254983168 |
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| author | M M Sengayi D Kielkowski M Egger L Dreosti J Bohlius |
| author_facet | M M Sengayi D Kielkowski M Egger L Dreosti J Bohlius |
| author_sort | M M Sengayi |
| collection | DOAJ |
| description | Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi’s sarcoma (KS) patients shifted from symptomatic palliation to potential cure.
Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA.
Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors.
Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality.
Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop. |
| first_indexed | 2024-03-08T17:30:02Z |
| format | Article |
| id | doaj.art-bb1f54efe0a0438daa39b758ba0a4132 |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T17:30:02Z |
| publishDate | 2017-10-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-bb1f54efe0a0438daa39b758ba0a41322024-01-02T16:38:59ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352017-10-011071087187610.7196/SAMJ.2017.v107i10.12362Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort studyM M Sengayi0D Kielkowski1M Egger2L Dreosti3J Bohlius4National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNational Cancer Registry, National Health Laboratory Service, Johannesburg, South AfricaInstitute of Social and Preventive Medicine, University of Bern, Switzerland; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaDepartment of Medical Oncology, Steve Biko Academic Hospital and School of Medicine, Faculty of Health Sciences, University of Pretoria, South AfricaDepartment of Medical Oncology, Steve Biko Academic Hospital and School of Medicine, Faculty of Health Sciences, University of Pretoria, South AfricaBackground. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi’s sarcoma (KS) patients shifted from symptomatic palliation to potential cure. Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors. Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality. Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop.http://www.samj.org.za/index.php/samj/article/view/12077Kaposi’s sarcomaSurvival |
| spellingShingle | M M Sengayi D Kielkowski M Egger L Dreosti J Bohlius Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study South African Medical Journal Kaposi’s sarcoma Survival |
| title | Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study |
| title_full | Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study |
| title_fullStr | Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study |
| title_full_unstemmed | Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study |
| title_short | Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study |
| title_sort | survival of patients with kaposi s sarcoma in the south african antiretroviral treatment era a retrospective cohort study |
| topic | Kaposi’s sarcoma Survival |
| url | http://www.samj.org.za/index.php/samj/article/view/12077 |
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