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AIDS-related Kaposi’s sarcoma: outcomes after initiation of highly active antiretroviral therapy under routine conditions in Zimbabwe

Background

Additional information on the outcomes of patients with AIDS-related Kaposi’s sarcoma (AIDS-KS) on highly active antiretroviral therapy (HAART) in resource-limited settings is needed. This study evaluated outcomes in AIDS-KS patients after initiation of HAART in Zimbabwe.

Methods

A retrospective cohort of 124 patients from the Parirenyatwa Hospital Kaposi’s Sarcoma and Opportunistic Infections (OI) Clinics was studied. 31 patients with AIDS-KS were matched 1:3 to 93 non-KS AIDS patients based on date of initiation of HAART, gender, and age. The primary endpoint was loss to care, defined as failure to attend clinic or refill prescriptions for 3 months or longer. Secondary endpoints were weight gain at 6 months, change in CD4+ count within 1 year, and final CD4+ count within 1 year of initiating HAART. Eligibility criteria included a minimum of 6 months of followup in the OI Clinic and less than 2 months of previous HAART prior to beginning therapy through the OI Clinic. A two-step model-selection strategy using KS status, gender, age, WHO performance status, OI disease burden, medical aid, employment, education, pre-treatment cotrimoxazole use, pre-treatment weight, and pre-treatment CD4+ count was used to identify factors associated with loss to care. On the initial univariate analysis, KS status, medical aid, and pre-treatment cotrimoxazole use had a p<0.15 and were included in the final multivariate analysis.

Results

AIDS-KS and non-KS patients did not differ significantly in baseline characteristics except for pre-treatment CD4+ count (196 vs. 92 cells/mm3, p=0.005). On the multivariate analysis, KS status (p=0.016, HR: 4.11, CI: 1.31-12.92) and having medical aid were significant predictors of loss to care (p=0.048, HR: 3.84, CI: 1.02-14.44). At a median followup of 632 days, 37.5% of AIDS-KS patients were lost to care compared to 16.1% of non-KS patients. AIDS-KS patients had significantly worse weight gain than non-KS patients (+0.78% vs. +4.18%, p=0.023). Change in CD4+ count (p=0.149) and final CD4+ count (p=0.729) were not significantly different between study groups. Amongst AIDS-KS patients, retained patients (n=20) had significantly higher pre-treatment CD4+ counts than patients lost to care (n=11) (232 vs. 122 cells/mm3, p=0.048).

Conclusions

After initiating HAART, AIDS-KS patients experienced greater loss to care and poorer weight gain than matched non-KS patients, suggesting that, under routine conditions in Zimbabwe, AIDS-KS patients have worse intermediate- and long-term clinical outcomes than non-KS AIDS patients. AIDS-KS patients retained in care had higher pre-treatment CD4+ counts than patients lost to care, indicating that early intervention with HAART may improve outcomes in AIDS-KS patients.

Acknowledgements

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.

Author information

Correspondence to Bradley Nelson.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Weight Gain
  • Opportunistic Infection
  • Routine Condition
  • Poor Weight Gain
  • Final Multivariate Analysis