AIDS-associated Kaposi sarcoma: outcomes after initiation of antiretroviral therapy at a university-affiliated hospital in urban Zimbabwe

Bradley C Nelson; Margaret Z Borok; Tafadzwa O Mhlanga; Azure T Makadzange; Thomas B Campbell

doi:10.1016/j.ijid.2013.04.011

AIDS-associated Kaposi sarcoma: outcomes after initiation of antiretroviral therapy at a university-affiliated hospital in urban Zimbabwe

Int J Infect Dis. 2013 Oct;17(10):e902-6. doi: 10.1016/j.ijid.2013.04.011. Epub 2013 Jul 1.

Authors

Bradley C Nelson¹, Margaret Z Borok, Tafadzwa O Mhlanga, Azure T Makadzange, Thomas B Campbell

Affiliation

¹ Department of Medicine, Division of Cardiovascular Disease, University of California San Diego Health System, 9444 Medical Center Dr, La Jolla, CA 92107, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, Colorado, USA. Electronic address: [email protected].

PMID: 23809198
DOI: 10.1016/j.ijid.2013.04.011

Abstract

Objective: To retrospectively investigate the outcomes of patients with AIDS-associated Kaposi sarcoma (AIDS-KS) after initiation of antiretroviral therapy (ART), under routine practice conditions, at a university-affiliated hospital in urban Zimbabwe.

Background: While studies from developed nations have demonstrated excellent outcomes for AIDS-KS patients treated with ART, few studies have examined the outcomes of African AIDS-KS patients after starting therapy.

Methods: A retrospective cohort of 124 AIDS patients initiating ART under routine practice conditions was studied. Thirty-one patients with AIDS-KS were matched 1:3 to 93 AIDS patients without KS (non-KS). The primary outcome was loss-to-care after initiation of therapy. Multivariate analysis was performed to identify significant predictors of loss-to-care. The percent change in weight at 6 months after starting ART was a secondary outcome. A sub-group analysis evaluated differences in pre-treatment variables between AIDS-KS patients retained-in-care compared to those lost-to-care.

Results: AIDS-KS patients had significantly greater 2-year proportional loss-to-care than matched non-KS AIDS patients (26.4% vs. 9.5%; p = 0.01) after initiation of ART. In multivariate analysis, the presence of KS (p = 0.02) was the only significant predictor of loss-to-care. AIDS-KS patients had significantly less weight gain after starting ART than non-KS AIDS patients (+3.4% vs. +6.4%; p = 0.03). AIDS-KS patients retained-in-care had significantly higher pre-treatment CD4+ lymphocyte counts than AIDS-KS patients lost-to-care (223 vs. 110 cells/mm(3); p = 0.04).

Conclusions: In this retrospective study, AIDS-KS patients experienced significantly worse outcomes than matched non-KS AIDS patients after initiation of ART. AIDS-KS patients with higher pre-treatment CD4+ lymphocyte counts were more likely to be retained in care.

Keywords: AIDS; Antiretroviral therapy; HIV; Kaposi sarcoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome / complications
Acquired Immunodeficiency Syndrome / drug therapy*
Acquired Immunodeficiency Syndrome / mortality
Adult
Anti-HIV Agents / administration & dosage*
Coinfection / drug therapy*
Coinfection / mortality
Coinfection / virology
Drug Therapy, Combination
Female
HIV-1
Herpesvirus 8, Human
Hospitals, University
Humans
Kaplan-Meier Estimate
Lamivudine / administration & dosage
Male
Multivariate Analysis
Nevirapine / administration & dosage
Proportional Hazards Models
Retrospective Studies
Sarcoma, Kaposi / drug therapy*
Sarcoma, Kaposi / etiology
Sarcoma, Kaposi / mortality
Stavudine / administration & dosage
Treatment Outcome
Urban Population
Zimbabwe

Substances

Anti-HIV Agents
Lamivudine
Nevirapine
Stavudine