AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa
Background AIDS‐associated Kaposi's sarcoma is an important, life‐threatening opportunistic infection among people living with HIV/AIDS in resource‐limited settings. In western countries, the introduction of combination antiretroviral therapy (cART) and new chemotherapeutic agents has resulted...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2010-01-01
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| Series: | Journal of the International AIDS Society |
| Online Access: | https://doi.org/10.1186/1758-2652-13-23 |
| _version_ | 1797894823832715264 |
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| author | Kathryn M Chu Gcina Mahlangeni Sarah Swannet Nathan P Ford Andrew Boulle Gilles Van Cutsem |
| author_facet | Kathryn M Chu Gcina Mahlangeni Sarah Swannet Nathan P Ford Andrew Boulle Gilles Van Cutsem |
| author_sort | Kathryn M Chu |
| collection | DOAJ |
| description | Background AIDS‐associated Kaposi's sarcoma is an important, life‐threatening opportunistic infection among people living with HIV/AIDS in resource‐limited settings. In western countries, the introduction of combination antiretroviral therapy (cART) and new chemotherapeutic agents has resulted in decreased incidence and improved prognosis of AIDS‐associated Kaposi's sarcoma. In African cohorts, however, mortality remains high. In this study, we describe disease characteristics and risk factors for mortality in a public sector HIV programme in South Africa. Methods We analysed data from an observational cohort study of HIV‐infected adults with AIDS‐associated Kaposi's sarcoma, enrolled between May 2001 and January 2007 in three primary care clinics. Paper records from primary care and tertiary hospital oncology clinics were reviewed to determine the site of Kaposi's sarcoma lesions, immune reconstitution inflammatory syndrome stage, and treatment. Baseline characteristics, cART use and survival outcomes were extracted from an electronic database maintained for routine monitoring and evaluation. Cox regression was used to model associations with mortality. Results Of 6292 patients, 215 (3.4%) had AIDS‐associated Kaposi's sarcoma. Lesions were most commonly oral (65%) and on the lower extremities (56%). One quarter of patients did not receive cART. The mortality and lost‐to‐follow‐up rates were, respectively, 25 (95% CI 19‐32) and eight (95% CI 5‐13) per 100 person years for patients who received cART, and 70 (95% CI 42‐117) and 119 (80‐176) per 100 person years for patients who did not receive cART. Advanced T stage (adjusted HR, AHR = 5.3, p < 0.001), advanced S stage (AHR = 5.1, p = 0.008), and absence of chemotherapy (AHR = 2.4, p = 0.012) were associated with mortality. Patients with AIDS‐associated Kaposi's sarcoma presented with advanced disease and high rates of mortality and loss to follow up. Risk factors for mortality included advanced Kaposi's sarcoma disease and lack of chemotherapy use. Contributing factors to the high mortality for patients with AIDS‐associated Kaposi's sarcoma likely included late diagnosis of HIV disease, late accessibility to cART, and sub‐optimal treatment of advanced Kaposi's sarcoma. Conclusions These findings confirm the importance of early access to both cART and chemotherapy for patients with AIDS‐associated Kaposi's sarcoma. Early diagnosis and improved treatment protocols in resource‐poor settings are essential. |
| first_indexed | 2024-04-10T07:15:30Z |
| format | Article |
| id | doaj.art-c1672fbf8e4e4c53a6c62211dc54177c |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-04-10T07:15:30Z |
| publishDate | 2010-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-c1672fbf8e4e4c53a6c62211dc54177c2023-02-25T12:30:34ZengWileyJournal of the International AIDS Society1758-26522010-01-01131232310.1186/1758-2652-13-23AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South AfricaKathryn M Chu0Gcina Mahlangeni1Sarah Swannet2Nathan P Ford3Andrew Boulle4Gilles Van Cutsem5Médecins Sans Frontières, Braamfontein, Johannesburg, South AfricaMédecins Sans Frontières, Khayelitsha, Cape Town, South AfricaMédecins Sans Frontières, Khayelitsha, Cape Town, South AfricaMédecins Sans Frontières, Braamfontein, Johannesburg, South AfricaInfectious Disease Epidemiology Unit, School of Public Health and Family Medicine University of Cape Town, Observatory, Cape Town, South AfricaMédecins Sans Frontières, Khayelitsha, Cape Town, South AfricaBackground AIDS‐associated Kaposi's sarcoma is an important, life‐threatening opportunistic infection among people living with HIV/AIDS in resource‐limited settings. In western countries, the introduction of combination antiretroviral therapy (cART) and new chemotherapeutic agents has resulted in decreased incidence and improved prognosis of AIDS‐associated Kaposi's sarcoma. In African cohorts, however, mortality remains high. In this study, we describe disease characteristics and risk factors for mortality in a public sector HIV programme in South Africa. Methods We analysed data from an observational cohort study of HIV‐infected adults with AIDS‐associated Kaposi's sarcoma, enrolled between May 2001 and January 2007 in three primary care clinics. Paper records from primary care and tertiary hospital oncology clinics were reviewed to determine the site of Kaposi's sarcoma lesions, immune reconstitution inflammatory syndrome stage, and treatment. Baseline characteristics, cART use and survival outcomes were extracted from an electronic database maintained for routine monitoring and evaluation. Cox regression was used to model associations with mortality. Results Of 6292 patients, 215 (3.4%) had AIDS‐associated Kaposi's sarcoma. Lesions were most commonly oral (65%) and on the lower extremities (56%). One quarter of patients did not receive cART. The mortality and lost‐to‐follow‐up rates were, respectively, 25 (95% CI 19‐32) and eight (95% CI 5‐13) per 100 person years for patients who received cART, and 70 (95% CI 42‐117) and 119 (80‐176) per 100 person years for patients who did not receive cART. Advanced T stage (adjusted HR, AHR = 5.3, p < 0.001), advanced S stage (AHR = 5.1, p = 0.008), and absence of chemotherapy (AHR = 2.4, p = 0.012) were associated with mortality. Patients with AIDS‐associated Kaposi's sarcoma presented with advanced disease and high rates of mortality and loss to follow up. Risk factors for mortality included advanced Kaposi's sarcoma disease and lack of chemotherapy use. Contributing factors to the high mortality for patients with AIDS‐associated Kaposi's sarcoma likely included late diagnosis of HIV disease, late accessibility to cART, and sub‐optimal treatment of advanced Kaposi's sarcoma. Conclusions These findings confirm the importance of early access to both cART and chemotherapy for patients with AIDS‐associated Kaposi's sarcoma. Early diagnosis and improved treatment protocols in resource‐poor settings are essential.https://doi.org/10.1186/1758-2652-13-23 |
| spellingShingle | Kathryn M Chu Gcina Mahlangeni Sarah Swannet Nathan P Ford Andrew Boulle Gilles Van Cutsem AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa Journal of the International AIDS Society |
| title | AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa |
| title_full | AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa |
| title_fullStr | AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa |
| title_full_unstemmed | AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa |
| title_short | AIDS‐associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa |
| title_sort | aids associated kaposi s sarcoma is linked to advanced disease and high mortality in a primary care hiv programme in south africa |
| url | https://doi.org/10.1186/1758-2652-13-23 |
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