Outcomes of patients with Kaposi's sarcoma who start antiretroviral therapy under routine programme conditions in Malawi

Abstract

AIDS-associated Kaposi's sarcoma (KS) is the most common AIDS-related malignancy in sub-Saharan Africa, with a generally unfavourable prognosis. We report on six-month and 12-month cohort treatment outcomes of human immunodeficiency virus (HIV)-positive KS patients and HIV-positive non-KS patients treated with antiretroviral therapy (ART) in public sector facilities in Malawi. Data were collected from standardized antiretroviral (ARV) patient master cards and ARV patient registers. Between July and September 2005, 7905 patients started ART-488 (6%) with a diagnosis of KS and 7417 with a non-KS diagnosis. Between January and March 2005, 4580 patients started ART-326 (7%) with a diagnosis of KS and 4254 with a non-KS diagnosis. At six-months and 12-months, significantly fewer KS patients were alive and significantly more had died or defaulted compared to non-KS patients. HIV-positive KS patients on ART in Malawi have worse outcomes than other patients on ART. Methods designed to improve these outcomes must be found.

Kaposi’s sarcoma: a 10-year experience with 248 patients at a single tertiary care hospital in Tanzania

“…In addition, the angiogenic nature of Kaposi’s sarcoma makes it particularly suitable for therapies based on targeted agents such as metalloproteinase inhibitors, angiogenesis inhibitors and tyrosine kinase inhibitors [53]. In low income countries, the choice of therapeutic agents is limited to the combination of VAB or even more toxic drugs such as thalidomide because liposomal anthracyclines are not available or affordable [54]. In the present study, our patients were treated with a combination of vincristine, doxorubicin and bleomycin, similar to reports from other low income countries [54].…”

“…In low income countries, the choice of therapeutic agents is limited to the combination of VAB or even more toxic drugs such as thalidomide because liposomal anthracyclines are not available or affordable [54]. In the present study, our patients were treated with a combination of vincristine, doxorubicin and bleomycin, similar to reports from other low income countries [54]. The internationally recommended chemotherapeutic agents such as Paclitaxel, Liposomal doxorubicin and immune modulators (alpha interferon) were not used in this study due to high cost and unavailability.…”

Risk factors for mortality in AIDS-associated Kaposi sarcoma in a primary care antiretroviral treatment program in Malawi

“…10 In sub-Saharan Africa, despite the intro- duction of HAART, AIDS-KS remains associated with higher mortality. 2 Contributing factors likely include late diagnosis of KS disease, late access to HAART, and poor availability of chemotherapy. Earlier HIV diagnosis and HAART initiation, and improved retention in care, especially for patients with AIDS-KS, are needed.…”

“…The majority of cases are found in sub-Saharan Africa, where the disease is associated with increased mortality. 1,2 However, there is a dearth of published information on risk factors associated with mortality among AIDS-KS patients.…”

“…5 Unfortunately HAART is still not widely available in the developing world where AIDS-KS mortality remains high. 2 Moreover, in many settings KS is a visible and potentially stigmatising sign of AIDS that is known to the community. In this respect, KS-related mortality may undermine public health objectives by supporting the notion that, despite substantial advances, AIDS is still a death sentence.…”