Abstract:
BACKGROUND : When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive
Kaposi’s sarcoma (KS) patients shifted from symptomatic palliation to potential cure.
OBJECTIVE : To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve
Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA.
METHODS : We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004
and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify
changes over time and prognostic factors.
RESULTS : Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The
median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 -
403) cells/μL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and
209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73)
in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and
poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality. CONCLUSIONS : Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual
patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop.
