Kaposi's Sarcoma in HIV‐infected patients in South Africa: Multicohort study in the antiretroviral therapy era

Abstract

The incidence of Kaposi’s Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV-infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time-updated CD4 cell counts and HIV-1 RNA. 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person-years follow-up 162 patients developed KS. The incidence was 1,682/100,000 person-years (95% confidence interval [CI] 1,406–2,011) among patients not receiving ART and 138/100,000 person-years (95% CI 102–187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13–0.28). Low CD4 cell counts (time-updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9–80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to preventing KS and KS-associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV.

Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

“…We confirmed the findings of other studies that advanced KS stage [10,11,18,19] predicts mortality, while chemotherapy [8,20] increases the chance of survival in KS patients. Unlike other South African studies [16,21] , we found no gender differences in mortality. Our study showed that both chemotherapy and radiation therapy were associated with improved survival.…”

“…We found good survival rates of KS patients in routine care, treated with ART and chemotherapy (ABV or oral VP16) and/or radiotherapy for selected patients. The overall one-year survival rate of 78.5% is comparable to survival estimates from other South African studies [8,9,16] , including a clinical trial that used similar chemotherapy regimens [9] . An observational study in the U.S. estimated two-year survival rates comparable to what we found in the late ART period in South Africa (81% and 79%, respectively) [17] .…”

Association of CD4+ T-cell Count, HIV-1 RNA Viral Load, and Antiretroviral Therapy With Kaposi Sarcoma Risk Among HIV-infected Persons in the United States and Canada

“…First, over the course of HIV infection, when is CD4 most predictive of KS risk? KS risk has been observed to be inversely associated with baseline, 22-24 recent/current, 11,25-30 and nadir 31 CD4, and positively associated with time duration with CD4<200 cells/μL, 32 with inconclusive evidence that recent/current CD4 is the best predictor. 11,26 …”

Incidence Rate of Kaposi Sarcoma in HIV-Infected Patients on Antiretroviral Therapy in Southern Africa

“…Three studies conducted in Africa found KS incidence rates between 138/100,000 and 340/100,000 person-years in patients treated with ART. 5;8;9 These estimates suggest that the risk of developing KS in patients on ART is still substantial. In order to effectively plan and implement measures to reduce the KS burden in Africa, more reliable information on the KS risk in patients on ART and associated risk factors is needed.…”