Author: Mark Mascolini
27 July 2010
Lack of antiretroviral therapy (ART) and cancer chemotherapy raised the risk of death from Kaposi sarcoma (KS) in patients seen at public health clinics in South Africa.
HIV-associated KS became rare in high-income countries with the arrival of combination ART and improvements in KS chemotherapy. But KS remains the most common AIDS cancer in Africa and an important cause of death.
To understand factors related to death with KS, researchers in South Africa retrospectively studied 6292 HIV-positive people cared for at three public primary care clinics between May 2001 and January 2007. Of 6292 people, 215 (3.4%) had KS, with lesions usually affecting the mouth (65%) and legs (56%). One quarter of people with KS had not received combination ART.
Mortality and loss-to-follow-up rates were 25 and 8 per 100 person-years in people who received ART compared with 70 and 119 per 100 person-years in people who did not. Three factors independently raised the risk of death at the following adjusted hazard ratios (AHR):
• Advanced T-stage cancer: AHR 5.3, P < 0.001
• Advanced S-stage cancer: AHR 5.1, P = 0.008
• Absence of chemotherapy: AHR 2.4, P = 0.012
The investigators suggest that factors contributing to high mortality in HIV KS patients in South Africa “likely included late diagnosis of HIV disease, late accessibility to combination ART, and sub-optimal treatment of advanced Kaposi's sarcoma.”
The researchers believe their findings “confirm the importance of early access to both combination ART and chemotherapy for patients with AIDS-associated Kaposi's sarcoma.”
Source: Kathryn M Chu , Gcina Mahlangeni, Sarah Swannet , Nathan P Ford, Andrew Boulle, Gilles Van Cutsem. AIDS-associated Kaposi sarcoma is associated with advanced disease and high mortality in a primary care HIV program in South Africa. Journal of the International AIDS Society. 2010; 13: 23.
Complete article provided by JIAS, an open-access journal