Survival of patients with Kaposi's sarcoma in the South African antiretroviral treatment era: A retrospective cohort study.

Sengayi, M M; Kielkowski, D; Egger, M; Dreosti, L; Bohlius, J (2017). Survival of patients with Kaposi's sarcoma in the South African antiretroviral treatment era: A retrospective cohort study. SAMJ. South African medical journal, 107(10), pp. 871-876. Medical Association of South Africa 10.7196/SAMJ.2017.v107i10.12362

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Egger, Matthias and Bohlius, Julia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0256-9574

Publisher:

Medical Association of South Africa

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

26 Oct 2017 09:42

Last Modified:

02 Nov 2017 10:12

Publisher DOI:

10.7196/SAMJ.2017.v107i10.12362

PubMed ID:

29022531

BORIS DOI:

10.7892/boris.106467

URI:

https://boris.unibe.ch/id/eprint/106467

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