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Byakwaga H, Semeere A, Laker-Oketta M, Busakhala N, Freeman E, Rotich E, Wenger M, Kadama-Makanga P, Kisuya J, Semakadde M, Mwine B, Kasozi C, Mwebesa B, Maurer T, Glidden DV, Kaloustian KW, Kambugu A, Martin J. Survival Following Diagnosis of HIV-Associated Kaposi Sarcoma Among Adults in East Africa in the "Treat-All" Era. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.26.24312536. [PMID: 39252899 PMCID: PMC11383447 DOI: 10.1101/2024.08.26.24312536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background Despite widespread access to antiretroviral therapy (ART) in the "Treat All" era, HIV-associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan Africa. Survival after KS diagnosis has historically been poor in Africa, but knowledge whether survival has changed at the population level in the contemporary era has been limited by lack of community-representative surveillance and monitoring systems. Methods We identified all adult persons living with HIV (PLWH) with a new diagnosis of KS made between 2016 and 2019 during outpatient or inpatient care at prototypical primary care-providing medical facilities in Kenya and Uganda using rapid case ascertainment. Participants were subsequently followed for vital status, including community tracking for those who became lost to follow-up. Findings Among 411 participants with newly diagnosed KS, 71% were men, median age was 34 (IQR: 30 to 41) years, and 91% had ACTG T1 tumor extent. Over a median follow-up of 7.8 (IQR: 2.4 to 17.9) months, cumulative incidence of death (95% CI) at months 6, 12 and 18 were 34% (30% to 39%), 41% (36% to 46%) and 45% (40% to 51%), respectively. Having the highest number of anatomic sites (11 to 16) harboring KS lesions (hazard ratio 2.2 (95% CI: 1.3-3.8) compared to 1 to 3 sites) and presence of oral KS lesions (hazard ratio 2.2 (95% CI: 1.4-3.3)) were independently associated with higher mortality. Lower hemoglobin and CD4 count as well as higher plasma HIV RNA were also associated with higher mortality. Interpretation Among PLWH with newly diagnosed KS in East Africa in the "Treat All" era, survival was poor and related to mucocutaneous extent of KS. The findings emphasize the need for better control of KS in Africa, including novel approaches for earlier detection, better linkage to oncologic care, and more potent therapy.
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Sabourin KR, Borok M, Mawhinney S, Matimba M, Jaji F, Fiorillo S, Chifamba DD, Muserere C, Mashiri B, Bhodheni C, Gambiza P, Mandidewa R, Mutimuri M, Gudza I, Mulvahill M, Moore CM, Kutner JS, Simões EAF, Campbell TB. Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community-based stepped-wedge cluster randomized trial. J Int AIDS Soc 2022; 25:e25998. [PMID: 36028920 PMCID: PMC9418419 DOI: 10.1002/jia2.25998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Most Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings. Methods Interventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped‐wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within‐clinic correlations. Results A total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post‐intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66–3.79], p = 0.37). New KS diagnosis rates increased 103% (95% CI: 11–273%), p = 0.02) post‐intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33–3.24], p = 0.001). Post‐intervention, non‐significant decreases in 90‐day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38–1.45], p = 0.21) and survival (aHR = 1.36 [95% CI: 0.85–2.20], p = 0.20) were estimated. Conclusions KS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90‐day return rates or survival.
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Affiliation(s)
| | - Margaret Borok
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Maxwell Matimba
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Francis Jaji
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Suzanne Fiorillo
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | | | - Patricia Gambiza
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | - Mercia Mutimuri
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Ivy Gudza
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Camille M Moore
- National Jewish Health, Denver, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
| | - Jean S Kutner
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric A F Simões
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
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Liew YCC, Tam YCS, Oh CC. Treatments for AIDS/HIV-related Kaposi sarcoma: A systematic review of the literature. Int J Dermatol 2022; 61:1311-1324. [PMID: 35775738 DOI: 10.1111/ijd.16318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment guidelines are not well established in AIDS-related Kaposi sarcoma (KS). OBJECTIVE We aim to review the evidence on efficacy of treatments for AIDS-related Kaposi sarcoma. METHODS We searched the Cochrane Library, PubMed, and Embase Database from date of database inception till July 2020. Randomized controlled trials reporting intervention consisting of any type of treatment compared to control/placebo to a different treatment modality or different combination of treatment/treatment doses with a diagnosis of AIDS-related KS are selected. MAIN OUTCOMES AND MEASURES Primary outcomes were response rates defined as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Secondary outcomes were cosmesis and adverse outcomes such as pain and erythema. RESULTS Thirteen out of 536 articles met our eligibility criteria. Three studies reported the efficacy of chemotherapy, two studies looked at different doses of radiotherapy regimes, and three studies compared different antiretroviral therapy (ART) and chemotherapy regimens. Other studies reported topical therapies such as alitretinoin gel, IM862, and bHCG injection which showed varied efficacies. LIMITATIONS Lack of standardization classification of disease activity and clinical outcomes and treatment modalities precluded meaningful comparison of studies. CONCLUSION The evidence of efficacy of any particular intervention is overall varied and there was insufficient evidence to recommend any particular intervention. We have provided an overview of treatments for KS but larger studies need to be carried out to verify the efficacy of treatment options reported in the literature.
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Affiliation(s)
| | - Yew Chong Steve Tam
- Department of Education Resource Centre, Medical Board, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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4
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Freeman EE, Semeere A, McMahon DE, Byakwaga H, Laker-Oketta M, Regan S, Wenger M, Kasozi C, Ssemakadde M, Bwana M, Kanyesigye M, Kadama-Makanga P, Rotich E, Kisuya J, Wools-Kaloustian K, Bassett IV, Busakhala N, Martin J. Beyond T Staging in the "Treat-All" Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa. J Acquir Immune Defic Syndr 2021; 87:1119-1127. [PMID: 33871409 PMCID: PMC8263487 DOI: 10.1097/qai.0000000000002699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although many patients with Kaposi sarcoma (KS) in sub-Saharan Africa are diagnosed with AIDS Clinical Trials Group (ACTG) T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detailed disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa. METHODS We performed rapid case ascertainment on people living with HIV, aged 18 years or older, newly diagnosed with KS from 2016 to 2019 at 3 clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria and detailed measurements that are not captured in the current staging systems. RESULTS We performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. The study was 68% men with median age 35 years and median CD4 count 239. Most of the patients had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO severe/symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor-associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having 2 T1 qualifying symptoms and 3% having 3 or more. CONCLUSION Most of the patients newly diagnosed with KS had advanced stage disease, even in the current antiretroviral therapy "treat-all" era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy.
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Affiliation(s)
- Esther E Freeman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aggrey Semeere
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Devon E McMahon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Helen Byakwaga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Susan Regan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Elyne Rotich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Job Kisuya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Ingrid V Bassett
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Naftali Busakhala
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, Eldoret, Kenya
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Coldiron ME, Gutierrez Zamudio AG, Manuel R, Ciglenecki I, Trellu LT, Molfino L. Authors' response to "Evaluation of Treatments for HIV-Associated Kaposi Sarcoma in Africa". Infect Agent Cancer 2021; 16:27. [PMID: 33952333 PMCID: PMC8097918 DOI: 10.1186/s13027-021-00372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/03/2022] Open
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Coldiron ME, Gutierrez Zamudio AG, Manuel R, Luciano G, Rusch B, Ciglenecki I, Telnov A, Grais RF, Trellu LT, Molfino L. Outcomes of AIDS-associated Kaposi sarcoma in Mozambique after treatment with pegylated liposomal doxorubicin. Infect Agent Cancer 2021; 16:2. [PMID: 33413521 PMCID: PMC7791748 DOI: 10.1186/s13027-020-00341-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a common HIV-associated malignancy frequently associated with poor outcomes. It is the most frequently diagnosed cancer in major cities of Mozambique. Antiretroviral therapy is the cornerstone of KS treatment, but many patients require cytotoxic chemotherapy. The traditional regimen in Mozambique includes conventional doxorubicin, bleomycin and vincristine, which is poorly tolerated. In 2016, pegylated liposomal doxorubicin was introduced at a specialized outpatient center in Maputo, Mozambique. METHODS We performed a prospective, single-arm, open-label observational study to demonstrate the feasibility, safety, and outcomes of treatment with pegylated liposomal doxorubicin (PLD) in patients with AIDS-associated Kaposi sarcoma (KS) in a low-resource setting. Chemotherapy-naïve adults with AIDS-associated KS (T1 or T0 not responding to 6 months of antiretroviral therapy) were eligible if they were willing to follow up for 2 years. Patients with Karnofsky scores < 50 or contraindications to PLD were excluded. One hundred eighty-three patients were screened and 116 participants were enrolled. Patients received PLD on three-week cycles until meeting clinical stopping criteria. Follow-up visits monitored HIV status, KS disease, side effects of chemotherapy, mental health (PHQ-9) and quality of life (SF-12). Primary outcome measures included vital status and disease status at 6, 12, and 24 months after enrollment. RESULTS At 24 months, 23 participants (20%) had died and 15 (13%) were lost to follow-up. Baseline CD4 < 100 was associated with death (HR 2.7, 95%CI [1.2-6.2], p = 0.016), as was T1S1 disease compared to T1S0 disease (HR 2.7, 95%CI [1.1-6.4], p = 0.023). Ninety-two participants achieved complete or partial remission at any point (overall response rate 80%), including 15 (13%) who achieved complete remission. PLD was well-tolerated, and the most common AEs were neutropenia and anemia. Quality of life improved rapidly after beginning PLD. DISCUSSION PLD was safe, well-tolerated and effective as first-line treatment of KS in Mozambique. High mortality was likely due to advanced immunosuppression at presentation, underscoring the importance of earlier screening and referral for KS.
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Affiliation(s)
| | | | | | | | | | | | - Alex Telnov
- Médecins Sans Frontières, Geneva, Switzerland
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Viral and Immunological Analytes are Poor Predictors of the Clinical Treatment Response in Kaposi's Sarcoma Patients. Cancers (Basel) 2020; 12:cancers12061594. [PMID: 32560243 PMCID: PMC7352224 DOI: 10.3390/cancers12061594] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/07/2020] [Accepted: 06/12/2020] [Indexed: 12/26/2022] Open
Abstract
Kaposi’s sarcoma-associated herpes virus (KSHV) is the etiologic agent for Kaposi’s sarcoma (KS). The prognostic utility of KSHV and HIV-1 (human immunodeficiency virus) viremia as well as immunological parameters in clinical management of participants with KS is unclear. The objective of this study was to investigate viral and immunological parameters as predictors of KS treatment responses in participants with KS from sub-Saharan Africa (SSA). Plasma KSHV-DNA, HIV-1 viral load, total anti-KSHV antibody, KSHV-neutralizing antibody (nAb), cytokine/chemokine levels, and T-cell differentiation subsets were quantified before and after KS treatment in 13 participants with KS and in 13 KSHV-infected asymptomatic control individuals. One-way analysis of variance and the Mann-Whitney t-test were used to assess differences between groups where p-values < 0.05 were considered significant. Subjects with patch and plaque KS lesions responded more favorably to treatment than those with nodular lesions. Pre-treatment and post-treatment levels of plasma KSHV-DNA, HIV-1 viral load, KSHV-Ab responses, cytokines, and T-cell populations did not predict the KS treatment response. Elevated KSHV-humoral and cytokine responses persisted in participants with KS despite a clinical KS response. While patch and plaque KS lesions were more common among treatment responders, none of the analyzed viral and immunological parameters distinguished responders from non-responders at baseline or after treatment.
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Freeman EE, Busakhala N, Regan S, Asirwa FC, Wenger M, Seth D, Moon KC, Semeere A, Maurer T, Wools-Kaloustian K, Bassett I, Martin J. Real-world use of chemotherapy for Kaposi's sarcoma in a large community-based HIV primary care system in Kenya. BMC Cancer 2020; 20:71. [PMID: 31996161 PMCID: PMC6990575 DOI: 10.1186/s12885-019-6506-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa. METHODS We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or "severe" disease defined by WHO KS treatment guidelines. RESULTS Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1-50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46-3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%). CONCLUSIONS A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.
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Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA.
| | | | - Susan Regan
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Fredrick Chite Asirwa
- AMPATH, Moi University, Eldoret, Kenya
- Indiana University, Indianapolis, Indiana, USA
| | | | - Divya Seth
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Khatiya Chelidze Moon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Aggrey Semeere
- University of California, San Francisco, USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Toby Maurer
- University of California, San Francisco, USA
| | | | - Ingrid Bassett
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
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Busakhala N, Kigen G, Waako P, Strother RM, Chite F, Loehrer P. Three year survival among patients with aids-related Kaposi sarcoma treated with chemotherapy and combination antiretroviral therapy at Moi teaching and referral hospital, Kenya. Infect Agent Cancer 2019; 14:24. [PMID: 31516547 PMCID: PMC6734447 DOI: 10.1186/s13027-019-0242-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background AIDS-related Kaposi sarcoma (AIDS-KS), a common malignancy in Kenya is associated with high morbidity and mortality. AIDS-KS is treated using bleomycin and vincristine (BV) plus or minus doxorubicin in most low resource settings, with response rates ranging from 24.8 to 87%. Survival in low resource settings has not been well documented. We report the three-year survival in a cohort of seventy patients referred to Moi Teaching and Referral Hospital (MTRH). Methods Study participants are part of a randomized phase IIA trial on the use of gemcitabine compared to bleomycin plus vincristine for the treatment of Kaposi sarcoma after combination antiretroviral therapy (cART) in Western Kenya. All patients were followed for three years in MTRH. Survival was determined by three monthly physical examination and analysed using Kaplan-Meier method, while possible determinants of survival such as baseline characteristics, type of chemotherapy, initial CD4 counts, age at enrolment, gender and early response to chemotherapy were analysed using univariate and multivariate Cox regression. Results Participants were aged between 19 and 70 years with 56% being male. The median CD4 count was 224 cells/μl, median duration of HIV diagnosis was 12.0 months and median duration of KS lesions after histology diagnosis before initiating chemotherapy was 4.8 weeks. At three years, 60 (85.7%) patients were alive. Six of those who died were under treatment with BV while four with gemcitabine. There was no difference in the probability of survival between the patients on either treatment arm (HR = 0.573 [95% C. I 0.143, 2.292; p = 0.4311]). Additionally, the hazard ratio (HR) for response after six weeks, age at enrolment and gender indicated that they were not significant determinants of survival. Patients with normal CD4 cell counts (> = 500/μl), had a HR of 0.401(0.05,3.23; p = 0.391), suggesting better survival. Conclusions Patients with AIDS-KS treated with combined antiretroviral drugs had excellent three-year survival regardless of whether they were treated with BV or gemcitabine as first line therapy. An initial CD4 cell count of > = 500/μl appeared to improve survival while gender, age and early response to chemotherapy were not predictors of survival after three years. Trial registration Number PACTR201510001. Electronic supplementary material The online version of this article (10.1186/s13027-019-0242-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naftali Busakhala
- 1Department of Pharmacology and Toxicology, AMPATH Haemato-oncology institute, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
| | - Gabriel Kigen
- 1Department of Pharmacology and Toxicology, AMPATH Haemato-oncology institute, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
| | - Paul Waako
- Department of Pharmacology and Therapeutics, Makerere College of Health Sciences, P. O. Box 3833, Kampala, Uganda
| | - R Matthew Strother
- 3Oncology Department, Canterbury District Health Board and Department of Medicine University of Otago, Christchurch, New Zealand
| | - Fredrick Chite
- Field Director of AMPATH Oncology and Haematology, P.O. Box 4606-30100, Eldoret, Kenya
| | - Patrick Loehrer
- 5Indiana University Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN46202 USA
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