Research

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

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

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.

 


Authors' affiliations

M M Sengayi, National 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 Africa

D Kielkowski, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa

M Egger, Institute 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 Africa

L Dreosti, Department of Medical Oncology, Steve Biko Academic Hospital and School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

J Bohlius, Institute of Social and Preventive Medicine, University of Bern, Switzerland

Full Text

PDF (165KB)

Keywords

Kaposi’s sarcoma; Survival; South Africa

Cite this article

South African Medical Journal 2017;107(10):871-876. DOI:10.7196/SAMJ.2017.v107i10.12362

Article History

Date submitted: 2017-09-22
Date published: 2017-09-22

Article Views

Abstract views: 611
Full text views: 469

Comments on this article

*Read our policy for posting comments here