Kaposi Disease in Hospitalization: Reflet of Accessibility to Haart in African Countries? Case of Dermatology Department of the University Hospital of Treichville (Abidjan-Rci)

Abstract

Background: Several studies have showed that the prognosis and the incidence of Kaposi disease had been improved in many countries where HAART was accessible and provided. In Cote d’Ivoire, an improvement of ART accessibility has occurred since 2006, but, few studies have been conducted for measuring potential changes in the epidemiology and the prognosis of the Kaposi disease. The dermatology department of the Teaching Hospital of Treichville, as a reference center for this disease could reflect the changes of interest. This study was first aiming at describing the clinical, therapeutic and progressive aspects of Kaposi disease in HIV-positive patients admitted to the service, then measuring the impact of the improved HAART accessibility. Material and methods: It was a retrospective, describtive and cross-sectionnal study, based on HIV-positive patients medical records from those hospitalized for Kaposi Disease from 1995 to 2010, in the dermatology department of the teaching hospital of Treichville. Results: 96 Medical records from patients were included, which frequency was 6.4 cases/year in hospitalization. The sex-ratio was 1.97 and the mean age was 40, 2 years. The skin lesions were ulcerative and budding in 36.2% of cases; mucous lesions were found in 14.2% and visceral lesions were found in 51% of cases.83 patients were under chemotherapy (86.4%) and 32 were under HAART (33.3%). 5 were not treated for Kaposi disease. The global mortality rate was 39.6%. The frequency of hospital patients decreased from 6.4 cases /year to 1.5 cases /year by 2009.The visceral lesions were frequents (51%) from 1995 to 2009 afterward they were absents. The chemotherapy was the first choice treatment. Interferon was used in 1995 and in 1996 and was abandoned because of the high cost. 20 out of 32 patients were under HAART by 2006. From 1995 to 2008, almost half the patients were dying (40.8%), but, since 2009, no death related to Kaposi disease was observed. Though the global mortality rate was 39.6%, it was almost twice higher among patients without ART (46.9%) as compared to those under HAART (25%). The improvement of the HAART accessibility which occurred in 2006, had impacted the hospitalization frequency, the disease progressive course; clinical and treatment aspects and the mortality rate of Kaposi disease after 3 years.