Abstract
BackgroundImproved survival among HIV-infected individuals on antiretroviral therapy (ART) has focused attention on AIDS-related cancers including Kaposi sarcoma (KS). However, the effect of KS on response to ART is not well-described in Southern Africa. We assessed the effect of KS on survival and immunologic and virologic treatment responses at 6- and 12-months after initiation of ART.MethodsWe analyzed prospectively collected data from a cohort of HIV-infected adults initiating ART in South Africa. Differences in mortality between those with and without KS at ART initiation were estimated with Cox proportional hazard models. Log-binomial models were used to assess differences in CD4 count response and HIV virologic suppression within a year of initiating treatment.ResultsBetween January 2001–January 2008, 13,847 HIV-infected adults initiated ART at the study clinics. Those with KS at ART initiation (n = 247, 2%) were similar to those without KS (n = 13600,98%) with respect to age (35 vs. 35yrs), presenting CD4 count (74 vs. 85cells/mm3) and proportion on TB treatment (37% vs. 30%). In models adjusted for sex, baseline CD4 count, age, treatment site, tuberculosis and year of ART initiation, KS patients were over three times more likely to have died at any time after ART initiation (hazard ratio[HR]: 3.62; 95% CI: 2.71–4.84) than those without KS. The increased risk was highest within the first year on ART (HR: 4.05; 95% CI: 2.95–5.55) and attenuated thereafter (HR: 2.30; 95% CI: 1.08–4.89). Those with KS also gained, on average, 29 fewer CD4 cells (95% CI: 7–52cells/mm3) and were less likely to increase their CD4 count by 50 cells from baseline (RR: 1.43; 95% CI: 0.99–2.06) within the first 6-months of treatment.ConclusionsHIV-infected adults presenting with KS have increased risk of mortality even after initiation of ART with the greatest risk in the first year. Among those who survive the first year on therapy, subjects with KS demonstrated a poorer immunologic response to ART than those without KS.
Highlights
Immunosuppression and co-infections with certain oncogenic viruses appears to increase the risk of some cancers in HIVinfected patients [1]
Ethics for Medical Research and the Declaration of Helsinki. As this was a retrospective analysis of routine clinical service records, no additional data collection or procedures were undertaken from or on patients, all patient information was entered into the database using coded identification numbers, and no information that could reveal patient identity was available in the analytic datasets
The median presenting CD4 count was somewhat lower in Kaposi sarcoma (KS) patients (74 vs. 85 cells/mm3) but those with KS were about twice as likely to have a CD4 count in the 200–350 cells/ mm3 category (12.3% vs. 7.2%)
Summary
Immunosuppression and co-infections with certain oncogenic viruses appears to increase the risk of some cancers in HIVinfected patients [1]. There has been a sharp increase in the incidence of KS since the advent of the HIV pandemic, and KS is a significant contributor to morbidity and mortality in subSaharan Africa [3,4,5]. Today KS is one of the most common cancers in Africa and is the most common tumour in HIV-infected individuals [4,6]. In South Africa, the incidence of KS rose dramatically as the HIV epidemic escalated (increasing threefold between 1988 and 1996) [7]. Improved survival among HIV-infected individuals on antiretroviral therapy (ART) has focused attention on AIDS-related cancers including Kaposi sarcoma (KS). The effect of KS on response to ART is not well-described in Southern Africa. We assessed the effect of KS on survival and immunologic and virologic treatment responses at 6- and 12months after initiation of ART
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