Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study

dc.contributor.authorMaskew, Mhairien_ZA
dc.contributor.authorFox, Matthew Pen_ZA
dc.contributor.authorCutsem, Gilles vanen_ZA
dc.contributor.authorChu, Kathrynen_ZA
dc.contributor.authorMacPhail, Patricken_ZA
dc.contributor.authorBoulle, Andrewen_ZA
dc.contributor.authorEgger, Matthiasen_ZA
dc.contributor.authorAfrica, for IeDEA Southernen_ZA
dc.date.accessioned2015-11-16T04:09:39Z
dc.date.available2015-11-16T04:09:39Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: Improved survival among HIV-infected individuals on antiretroviral therapy (ART) has focused attention on AIDS-related cancers including Kaposi sarcoma (KS). However, the effect of KS on response to ART is not well-described in Southern Africa. We assessed the effect of KS on survival and immunologic and virologic treatment responses at 6- and 12-months after initiation of ART. METHODS: We analyzed prospectively collected data from a cohort of HIV-infected adults initiating ART in South Africa. Differences in mortality between those with and without KS at ART initiation were estimated with Cox proportional hazard models. Log-binomial models were used to assess differences in CD4 count response and HIV virologic suppression within a year of initiating treatment. RESULTS: Between January 2001-January 2008, 13,847 HIV-infected adults initiated ART at the study clinics. Those with KS at ART initiation (n = 247, 2%) were similar to those without KS (n = 13600,98%) with respect to age (35 vs. 35yrs), presenting CD4 count (74 vs. 85cells/mm 3 ) and proportion on TB treatment (37% vs. 30%). In models adjusted for sex, baseline CD4 count, age, treatment site, tuberculosis and year of ART initiation, KS patients were over three times more likely to have died at any time after ART initiation (hazard ratio[HR]: 3.62; 95% CI: 2.71-4.84) than those without KS. The increased risk was highest within the first year on ART (HR: 4.05; 95% CI: 2.95-5.55) and attenuated thereafter (HR: 2.30; 95% CI: 1.08-4.89). Those with KS also gained, on average, 29 fewer CD4 cells (95% CI: 7-52cells/mm 3 ) and were less likely to increase their CD4 count by 50 cells from baseline (RR: 1.43; 95% CI: 0.99-2.06) within the first 6-months of treatment. CONCLUSIONS: HIV-infected adults presenting with KS have increased risk of mortality even after initiation of ART with the greatest risk in the first year. Among those who survive the first year on therapy, subjects with KS demonstrated a poorer immunologic response to ART than those without KS.en_ZA
dc.identifier.apacitationMaskew, M., Fox, M. P., Cutsem, G. v., Chu, K., MacPhail, P., Boulle, A., ... Africa, f. I. S. (2013). Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study. <i>PLoS One</i>, http://hdl.handle.net/11427/15003en_ZA
dc.identifier.chicagocitationMaskew, Mhairi, Matthew P Fox, Gilles van Cutsem, Kathryn Chu, Patrick MacPhail, Andrew Boulle, Matthias Egger, and for IeDEA Southern Africa "Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15003en_ZA
dc.identifier.citationMaskew, M., Fox, M. P., van Cutsem, G., Chu, K., Macphail, P., Boulle, A., ... & Africa, F. I. (2012). Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study. PloS one, 8(6), e64392-e64392. doi:10.1371/journal.pone.0064392en_ZA
dc.identifier.ris TY - Journal Article AU - Maskew, Mhairi AU - Fox, Matthew P AU - Cutsem, Gilles van AU - Chu, Kathryn AU - MacPhail, Patrick AU - Boulle, Andrew AU - Egger, Matthias AU - Africa, for IeDEA Southern AB - BACKGROUND: Improved survival among HIV-infected individuals on antiretroviral therapy (ART) has focused attention on AIDS-related cancers including Kaposi sarcoma (KS). However, the effect of KS on response to ART is not well-described in Southern Africa. We assessed the effect of KS on survival and immunologic and virologic treatment responses at 6- and 12-months after initiation of ART. METHODS: We analyzed prospectively collected data from a cohort of HIV-infected adults initiating ART in South Africa. Differences in mortality between those with and without KS at ART initiation were estimated with Cox proportional hazard models. Log-binomial models were used to assess differences in CD4 count response and HIV virologic suppression within a year of initiating treatment. RESULTS: Between January 2001-January 2008, 13,847 HIV-infected adults initiated ART at the study clinics. Those with KS at ART initiation (n = 247, 2%) were similar to those without KS (n = 13600,98%) with respect to age (35 vs. 35yrs), presenting CD4 count (74 vs. 85cells/mm 3 ) and proportion on TB treatment (37% vs. 30%). In models adjusted for sex, baseline CD4 count, age, treatment site, tuberculosis and year of ART initiation, KS patients were over three times more likely to have died at any time after ART initiation (hazard ratio[HR]: 3.62; 95% CI: 2.71-4.84) than those without KS. The increased risk was highest within the first year on ART (HR: 4.05; 95% CI: 2.95-5.55) and attenuated thereafter (HR: 2.30; 95% CI: 1.08-4.89). Those with KS also gained, on average, 29 fewer CD4 cells (95% CI: 7-52cells/mm 3 ) and were less likely to increase their CD4 count by 50 cells from baseline (RR: 1.43; 95% CI: 0.99-2.06) within the first 6-months of treatment. CONCLUSIONS: HIV-infected adults presenting with KS have increased risk of mortality even after initiation of ART with the greatest risk in the first year. Among those who survive the first year on therapy, subjects with KS demonstrated a poorer immunologic response to ART than those without KS. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0064392 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study TI - Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study UR - http://hdl.handle.net/11427/15003 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15003
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0064392
dc.identifier.vancouvercitationMaskew M, Fox MP, Cutsem Gv, Chu K, MacPhail P, Boulle A, et al. Treatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort study. PLoS One. 2013; http://hdl.handle.net/11427/15003.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Maskew et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherKaposi sarcomaen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherCancer treatmenten_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherEpidemiologyen_ZA
dc.titleTreatment response and mortality among patients starting antiretroviral therapy with and without Kaposi sarcoma: a cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Maskew_Treatment_Response_2013.pdf
Size:
352.6 KB
Format:
Adobe Portable Document Format
Description:
Collections