A retrospective review of treatment outcomes of HIV positive patients with Kaposi's sarcoma receiving antriretroviral therapy at Charlotte Maxeke Johannesburg academic hospital (2011-2013)

Chandoo, Fatema Aonali
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Background: South Africa in 2015 had approximately 7 million people living with Human Immunodeficiency Virus (HIV)1. This constitutes one of the highest numbers of people living with HIV in any single country. Acquired Immunodeficiency Syndrome (AIDS)-related Kaposi’s sarcoma (KS) has also been identified as one of the most common malignancies in the HIV infected population in South Africa2. The incidence of KS in South Africa initially increased substantially with the HIV epidemic3 however with the increasing availability of antiretroviral therapy (ART) the incidence of AIDS-related KS has dropped dramatically in the last few years from 1220 to 669 in females and 1491 to 978 in males from 2008 to 2014 (4, 5). Objectives: To assess the demography and response to treatment of KS patients on ART at a quaternary hospital. Design: Retrospective record review of patients’ files. Methods: Patients with a histological diagnosis of KS were recruited from the Medical Oncology clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Their demographic, laboratory and treatment information were recorded on a data sheet (see appendix A). Results: There were 109 patients in the study cohort (1st January 2011 to 31st December 2013). The majority of patients (71%) were male. Mean age of the group was 39 (range 21 – 63) years. The mean CD4 count at KS diagnosis was 212 (range 17 – 696) cells/ μL. Almost half (49%) of the cohort were ART- naïve at the time KS was diagnosed, however almost all the KS symptomatic patients (99%) were on ARTs upon Medical Oncology clinic enrolment/at the time of their inclusion in the study. Concomitant systemic infections were documented in 49% of patients at the time of initial diagnosis. The most common co-infection was tuberculosis (TB). The majority (80%) of patients received chemotherapy most of whom (66.7%) received doxorubicin, bleomycin, vincristine (ABV). The mortality at two years was 45%. The majority of deaths occurred within the first six months of the diagnosis of KS with 50% of the dead patients having concomitant TB on TB treatment together with HIV-KS. Conclusion: Mortality related to HIV-KS remains high in our setting despite widely available ARTs. The possible factors associated with high mortality in this cohort were concomitant coinfection with tuberculosis (TB), possibly ART initiation timing and immune reconstitution inflammatory syndrome (IRIS), bulk of KS disease burden with visceral involvement and probably the choice and toxicity of chemotherapy agents especially doxorubicin.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the Degree of Master of Medicine. Johannesburg, 2019.