Research

HAART in hand: The change in Kaposi’s sarcoma presentation in KwaZulu-Natal, South Africa

Levashni Naidoo, Judith S Jacobson, Alfred I Neugut, Ncoza C Dlova, Anisa Mosam

Abstract


Background. HIV/AIDS-related Kaposi’s sarcoma (HIV-KS) is a public health problem in South Africa (SA). It is AIDS defining. There have been no studies evaluating its prevalence since the national roll-out of highly active antiretroviral therapy (HAART).

Objective. To evaluate the effect of HAART on the disease profile of HIV-KS in KwaZulu-Natal Province (KZN), SA.

Methods. Charts of patients with histologically confirmed HIV-KS were reviewed at an oncology clinic in KZN. The significance of associations of HAART with age, gender, CD4 count, urban/rural residence, fungating lesions, ulceration and lymphoedema, and treatment delay, was determined by t-tests for normally distributed continuous variables and χ2 tests for categorical variables. Logistic regression models were used to analyse the association of HAART with CD4 count.

Results. Of 198 patients, 194 were documented as HIV-positive; 168 (86.6%) were on HAART at the time of their KS diagnosis. The mean CD4 count of 266 cells/μL was higher than that in previous studies at this site. The mean age at presentation was 36.6 (standard deviation 10.1) years. Females presented at a younger mean age than males (p<0.001). The mean age of females on HAART was 34.7 years and that of males 39.0 years (p=0.003). HAART-naive patients were three times more likely than those receiving HAART (15.4% v. 4.8%) to have visceral involvement (p=0.03).

Conclusions. HAART use has resulted in outcome improvement. Mean age at presentation has increased in the group as a whole and for females in particular. The trend in mean CD4 counts has shown positive growth. Females no longer shoulder a disproportionate burden of disease. 


Authors' affiliations

Levashni Naidoo, Department of Dermatology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Judith S Jacobson, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA

Alfred I Neugut, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA

Ncoza C Dlova, Department of Dermatology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Anisa Mosam, Department of Dermatology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

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Keywords

HIV; Kaposi's sarcoma; South Africa; Highly active antiretroviral therapy; HAART

Cite this article

South African Medical Journal 2016;106(6):611-616. DOI:10.7196/SAMJ.2016.v106i6.10333

Article History

Date submitted: 2015-11-10
Date published: 2016-05-11

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