Assessing the outcomes of HIV-infected persons receiving treatment for Kaposi sarcoma in Conakry-Guinea

BMC Cancer

Research Article

Mohamed M. Soumah¹  Mohamed Cisse¹  Abdourahimi Diallo²  Cavin E. Bekolo²  Joseph-Desire Yuma²  Letizia Di Stefano²  Ousseni W. Tiemtore³  Carol Metcalf³ 

[1] Department of Dermatology and STD, Donka National Hospital, Conakry, Guinea;Médecins Sans Frontières – Belgium (MSF-B), Conakry, Guinea;Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa;

关键词: HIV;    Kaposi sarcoma;    Antiretroviral therapy;    Chemotherapy;    Guinea;   

DOI  :  10.1186/s12885-017-3771-x

 received in 2016-09-19, accepted in 2017-11-13,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMédecins Sans Frontières is supporting comprehensive HIV care and treatment for Kaposi Sarcoma (KS) in Guinea, where antiretroviral coverage is low and access to KS treatment is very limited. We aimed to evaluate treatment response and survival outcomes of epidemic KS in this setting.MethodsRetrospective survival analysis of routinely collected clinical data of HIV-infected patients with clinically diagnosed KS, receiving ART and chemotherapy consisting of a combination of bleomycin and vincristine at the Donka National Hospital in Conakry between 2012 and 2015.ResultsA total of 225 patients were enrolled for KS treatment within the three-year period. Late presentation with stage T1 disease was common (82.7%). At the end of a median of 8 cycles of chemotherapy (IQR: 2–12), complete remission was observed in 65 (28.9%), partial remission in 53 (23.6%), stable disease in 15 (6.7%) and unknown response for all 92 (40.9%) patients who dropped out of care. The chances of achieving complete remission doubled after each additional cycle of chemotherapy (aOR = 2.09 95% CI: 1.44–3.01) but were reduced by about two-thirds for each additional month delay between treatment and onset of KS (aOR = 0.31, 95% CI: 0.11–0.86). Treatment response was seriously compromised in patients with woody skin oedema (aOR = 0.05, 95% CI: 0.01–0.38) and those with prior chemotherapy (aOR = 0.21, 95% CI: 0.05–0.80). The median survival time was 7.6 months (95% CI: 5.9–9.8). Attrition from care was reduced by 22% for every additional cycle of chemotherapy administered (aH0R = 0.78, 95% CI: 0.71–0.84) and was lower in those with complete remission compared with those with partial or no response (aHR = 0.05, 95% CI: 0.007–0.43).ConclusionThere has been an increased access to KS treatment. The overall response rate is 52.4%, which is considered a satisfactory result. Poor outcomes were common and were largely due to late presentation and defaulting on treatment. Efforts towards early HIV/KS diagnosis and adherence to a full round of chemotherapy are needed for optimising outcomes. Newer drugs may be required for patients previously exposed to chemotherapy.

【 授权许可】

CC BY   
© The Author(s). 2017