Clinical Outcomes of HIV-infected Patients with Kaposi's Sarcoma Disease Receiving ART in Rural Uganda
Fred Asiimwe*1, D Moore1,2, D Moore1,2, R Nakityo1, W Were1, J Mermin1, and F Kaharuza1
1Global AIDS Prgm, CDC, Uganda, Entebbe and 2BC Ctr for Excellence in HIV/AIDS, Vancouver, Canada
Background: Kaposi’s sarcoma (KS) is the most common
AIDS-related malignancy and is associated with increased mortality. Clinical
outcomes for patients with AIDS-related KS in resource-limited settings where
non-nucleoside reverse transcriptase inhibitor (NNRTI) -based ART is predominantly used, have not been previously described.
Methods: We evaluated HIV-infected patients aged ≥18 years, who initiated
ART in the Home-Based AIDS Care Project in Tororo, Uganda, from May 2003 to December
2005 and were diagnosed with KS at baseline or in follow-up. The primary ART
regimen used was lamivudine, stavudine,
and nevirapine. KS was diagnosed based on clinical
judgement, augmented where feasible by biopsies, chest X-rays, and ultrasonography.
We compared subjects who had KS at baseline with those who developed KS in
follow-up. Logistic regression was used to examine independent risk factors for
having KS at baseline or in follow-up and Cox proportional hazards modeling was used to examine associations between baseline
variables and risk factors for death among KS patients.
Results: Of 1125 study subjects, 16 were diagnosed
with KS at baseline and 17 during 1983 person-years of follow-up. A total of 12
subjects received any chemotherapy for their KS (3 baseline cases; 9 follow-up
cases). For incident KS, the median time from initiating ART to KS diagnosis
was 115 days (IQR 60 to 300), resulting in an incidence of 0.86/100
person-years. Prevalent KS subjects differed from incident KS subjects in sex
distribution (31.3% female vs 64.7%, p = 0.02) and baseline log viral load
(5.3 vs 5.9, p
= 0.02); but did not differ with respect to baseline CD4 cell count, body mass
index, or crude mortality. KS was associated with being male (adjusted odds
ratio, AOR, 2.47, 95%CI 1.23 to 5.01) and baseline CD4 cell count <50 (AOR
3.05, 95%CI 0.96 to 9.67). A total of 23 subjects (69.7%) experienced
regression of their KS lesions and 10 (30.3%) subjects died with persistent KS.
Within the KS group, mortality was associated with visceral KS (adjusted hazard
ratio, AHR, 21.5, 95%CI 2.71 to 171.0), but not with baseline CD4 cell count or
viral load and use of chemotherapy.
KS diagnosis at baseline or in follow-up
during NNRTI-based ART was associated with 30% mortality. However, KS regression
rates appear to be similar to those reported using protease inhibitor based–ART.