title: Treatment outcomes of AIDS-associated Kaposi's sarcoma under a routine antiretroviral therapy program in Lilongwe, Malawi: bleomycin/vincristine compared to vincristine monotherapy.
abstract: OBJECTIVE
  Despite Kaposi's sarcoma (KS) being the most prevalent AIDS-associated cancer in resource limited settings, optimal treatment options remain unknown. We assessed whether bleomycin/vincristine compared to vincristine monotherapy was associated with improved treatment outcomes for AIDS-associated KS among patients initiating combination antiretroviral therapy (cART) in Malawi.
  
  
  METHODS
  All patients initiating cART and chemotherapy for AIDS-related KS were identified from an electronic data system from the HIV Lighthouse Clinic from 2002 to 2011. Treatment responses were compared between patients receiving vincristine monotherapy and vincristine/bleomycin. Binomial regression models were implemented to assess probability of tumor improvement for patients receiving vincristine/bleomycin compared to vincristine monotherapy after a complete cycle of chemotherapy (9-10 months). A chi-squared test was used to compare changes in CD4 count after six months of chemotherapy.
  
  
  RESULTS
  Of 449 patients with AIDS-associated KS on chemotherapy, 94% received vincristine monotherapy and 6% received bleomycin/vincristine. Distribution of treatment outcomes was different: 29% of patients on vincristine experienced tumor improvement compared to 53% of patients on bleomycin/vincristine. Patients receiving bleomycin/vincristine were 2.25 (95% CI: 1.47, 3.44) times as likely to experience tumor improvement as to those on vincristine monotherapy. This value changed little after adjustment for age and baseline CD4 count: 2.46 (95% CI: 1.57, 3.86). Change in CD4 count was similar for patients receiving vincristine monotherapy and bleomycin/vincristine (p = 0.6).
  
  
  CONCLUSIONS
  Bleomycin/vincristine for the treatment of AIDS-associated KS was associated with better tumor response compared to vincristine monotherapy without impairing CD4 count recovery. Replication in larger datasets and randomized controlled trials is necessary.
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Albert A
authors.initials: AA
authors.lastname: Mwafongo
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi; University of North Carolina- Chapel Hill, North Carolina, United States of America.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Wingston
authors.initials: W
authors.lastname: Ng'ambi
authors.affiliation: University of North Carolina- Chapel Hill, North Carolina, United States of America.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Werner
authors.affiliation: University of North Carolina- Chapel Hill, North Carolina, United States of America.
authors.forename: William M
authors.initials: WM
authors.lastname: Garneau
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Joe
authors.initials: J
authors.lastname: Gumulira
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi; University of North Carolina- Chapel Hill, North Carolina, United States of America.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000188:drug therapy*; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D001761:Bleomycin; D014750:Vincristine