title: Burden, characteristics, management and outcomes of HIV-infected patients with Kaposi's sarcoma in Zomba, Malawi.
abstract: METHODS
  Antiretroviral treatment (ART) clinic at Zomba Central Hospital, Malawi.
  
  
  METHODS
  Retrospective analysis of records (2004-2011) of human immunodeficiency virus (HIV) infected patients with Kaposi's sarcoma (KS).
  
  
  OBJECTIVE
  To determine the number and characteristics of HIV-infected adult patients with KS on ART and vincristine (VCR) therapy and their treatment outcomes.
  
  
  RESULTS
  A total of 545 HIV-infected patients with KS (58% male, median age 33 years) were included in the study. The baseline median CD4 count was 180 cells/µl (interquartile range 111-287). Cumulative outcomes were as follows: 168 (31%) were still alive, 133 (24%) had died, 172 (32%) were lost to follow-up and 71 (13%) had transferred out; 229 had received at least one course of VCR, 171 had received less than one full course and 145 had not received VCR. The survival probability for 229 patients who received at least one course of VCR was 65% at 1 year, 42% at 2 years and 13% by 6 years. Patients who started VCR therapy before or concurrently with ART had a higher risk of death and generally a higher risk of death and loss to follow-up than those who started VCR after ART.
  
  
  CONCLUSIONS
  Poor outcomes were noted in HIV-infected patients with KS in a programme setting in Malawi. Other treatment interventions, including combination and/or second-line chemotherapy and earlier ART initiation, are needed to reduce morbidity and mortality.
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Mwinjiwa
authors.affiliation: Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières-Brussels, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières-Brussels, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK ; International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Dignitas International, Zomba, Malawi ; Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: K D
authors.initials: KD
authors.lastname: Bezanson
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: T
authors.initials: T
authors.lastname: Beyene
authors.affiliation: School of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Thompson
authors.affiliation: Ministry of Health, Zomba Central Hospital, Zomba, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Joshua
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Akello
authors.affiliation: Dignitas International, Zomba, Malawi ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: van Lettow
keywords: HIV/AIDS; Kaposi’s sarcoma; Malawi; operational research; treatment outcomes; vincristine