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. 2017 Sep 22;107(10):871-876.
doi: 10.7196/SAMJ.2017.v107i10.12362.

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

M M Sengayi  1 , D Kielkowski, M Egger, L Dreosti, J Bohlius
Affiliations

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

M M Sengayi et al. S Afr Med J. .

Abstract

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.

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Conflict of interest statement

Competing interests

All authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Survival and retention in oncology care by calendar period
See this image and copyright information in PMC

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