Abstract
BackgroundKaposi’s sarcoma (KS) is a common HIV-associated malignancy associated with disability, pain and poor outcomes. The cornerstone of its treatment is antiretroviral therapy, but advanced disease necessitates the addition of chemotherapy. In high-income settings, this often consists of liposomal anthracyclines, but in Mozambique, the first line includes conventional doxorubicin, bleomycin and vincristine, which is poorly-tolerated. Médecins Sans Frontières supports the Ministry of Health (MOH) in a specialized HIV and KS treatment center at the Centro de Referencia de Alto Maé in Maputo.MethodsWe performed a retrospective analysis of data collected on patients enrolled at the CRAM between 2010 and 2015, extracting routinely-collected clinical information from patient care databases. KS treatment followed national guidelines, and KS staging followed AIDS Clinical Trials Group and MOH criteria. Baseline description of the cohort and patient outcomes was performed. Risk factors for negative outcomes (death or loss to follow-up) were explored using Cox regression.ResultsBetween 2010 and 2015, 1573 patients were enrolled, and 1210 began chemotherapy. A majority were young adult males. At enrollment, CD4 was < 200 cells/μl in 45% of patients. Among patients receiving chemotherapy, 78% received combination doxorubicin-bleomycin-vincristine. Among patients receiving chemotherapy, 43% were lost to follow-up and 8% were known to have died. In multivariate regression, the only risk factors identified with poor outcomes were CD4 < 100 cells/μl at enrollment (Risk ratio 1.5, 95%CI 1.1–2.1, p = 0.02 and having S1 disease (RR 1.7, 95%CI 1.2–2.3, p = 0.001).DiscussionWe describe a large cohort of patients receiving care for HIV-associated KS in a specialized clinic in an urban setting. Outcomes were nonetheless unsatisfactory. Efforts should be made to decrease late referrals and entry into care and to increase access to more effective and better-tolerated treatments like liposomal doxorubicin.
Highlights
Kaposi’s sarcoma (KS) is the most frequent cancer among persons living with Human immunodeficiency virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) in highresource settings [1] and is a major cause of mortality in sub-Saharan Africa [2]
We describe a large cohort of HIV-infected KS patients and their clinical outcomes
These patients are broadly similar to many other cohorts described, in both rural and urban areas, and in primary care and referrallevel centers in southern Africa [7, 27, 28] It is important to point out that only half of our patients had CD4 available at baseline, likely because most presented with Stage IV HIV disease, which did not warrant immediate CD4 measurement according to guidelines during most of the follow-up period
Summary
Kaposi’s sarcoma (KS) is the most frequent cancer among persons living with HIV/AIDS in highresource settings [1] and is a major cause of mortality in sub-Saharan Africa [2]. While its classic presentation in non-immunosuppressed individuals is often indolent, current experience in sub-Saharan Africa suggests that KS can be aggressive and lead to poor outcomes [7]. The fact that KS lesions are often visible and quite painful often leads to both physical and psychological disability [8], and the outcomes of some clinical trials have been based on quality of life [9]. Kaposi’s sarcoma (KS) is a common HIV-associated malignancy associated with disability, pain and poor outcomes. Médecins Sans Frontières supports the Ministry of Health (MOH) in a specialized HIV and KS treatment center at the Centro de Referencia de Alto Maé in Maputo
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