Evaluation of the AIDS clinical trials group staging criteria for Kaposi Sarcoma in a resource limited setting
© Okuku et al; licensee BioMed Central Ltd. 2012
Published: 19 April 2012
Kaposi sarcoma (KS) is commonly staged using by the AIDS Clinical Trials Group (ACTG) criteria. The three variables of the ACTG are dichotomized as good risk (0) and poor risk (1). Good risk immune status (I0) is defined as CD4 T-cell count ≥200cells/µl, and poor risk (I1) as CD4 < 200cells/µl. Although validated in the US and Europe, no evaluation has been done in resource-limited settings during the HAART era. We sought to determine whether the ACTG staging criteria is predictive of overall survival among Ugandan patients with HIV-associated KS.
Data were abstracted from medical records of adult patients with HIV-associated KS seen at the Uganda Cancer Institute (UCI) from 2000-2006. The primary outcome was 2-year overall survival. Vital status at 2 years was determined from the medical chart, or by contacting the patient or next of kin using the phone contact provided in the chart or ART clinic. Survival was modeled using Kaplan-Meier methods. Factors associated with survival were evaluated using Cox proportional hazards.
Factors associated with death before 2 years from KS diagnosis
T1 VS T0
I1 VS I0
S1 VS S0
Nodular KS morphotype
On HAART at diagnosis
Receipt of chemotherapy
ACTG criteria Tumor extent (T) and Systemic symptoms (S) were associated with survival; Immune status (I) was not. Factors associated with decreased survival included: baseline CD4 counts <100, age, trunk edema, while receipt of HAART and chemotherapy were associated with increased survival. Studies are needed to validate ACTG staging criteria in sub-Saharan Africa and to identify additional prognostic factors.
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