Background:  Kaposi’s Sarcoma (KS) is a common presenting disease among HIV-positive patients in Malawi, where access to both chemotherapy and antiretroviral therapy (ART) is limited. A subset of patients attending the outpatient HIV clinic has been treated with Vincristine (VIN) or ART or both. This study evaluates demographic and clinical characteristics of patients presenting with KS and contrasts therapeutic outcomes based on therapy received.

Methods:  Files of patients with a clinical diagnosis of KS attending the clinic between July 2000 and July 2002 were retrospectively reviewed using a chart abstraction tool including symptoms, treatments, responses and retention to care. Loss to follow-up was considered no visits in >3months. For univariate and bivariate analysis we relied on standard descriptive statistics including Pearson’s Chi Square and t-tests. For time from therapy initiation to death or censoring, we fit Kaplan Meier plots and calculated the log rank statistic. 

Results:  We evaluated 208 patients. Mean age was 35.7, 63% were male. Median CD4 count was 53 cell/mm³ (IQR:  15 to 135). At least 36% of all patients had disseminated KS at baseline, 56% had edema, 41% had bilateral leg involvement, 18% had suspected pulmonary involvement. Of the patients who had follow-up visits, 34%(n = 71) received ART only, 32% (n = 66) received VIN, 27% (n = 27) received both, 6% (n = 12) received neither. Of patients receiving VIN and/or ART, 77% had at least a partial response to chemotherapy. We were unable to detect a statistically significant difference based on receiving VIN vs both (p = 0.21). Those treated with ART or both remained in care longer than those receiving VIN alone (p <0.0001). No difference in duration of care was observed between both and ART groups (p = 0.139) and loss to follow up rates were similar in these groups. Documented mortality was 8.6% but loss to follow-up was 64% over the 2 year period and prior research indicates this is largely mortality. Notably, among patients starting ART but not chemotherapy (n = 26), 4 patients had marked worsening of KS lesions within 1 month thus requiring VIN initiation.

Conclusions:  Advanced KS is a common presentation of HIV patients in Malawi with adverse outcomes. Patients receiving ART and both remained in care significantly longer than patient receiving VIN. Possible immune reconstitution syndromes were observed requiring prompt initiation of chemotherapy or concomitant ART/chemotherapy.

Keywords: Kaposi Sarcoma; Antiretrovirals; Chemotherapy