Outcome of drug management of patients with aids-related Kaposi's Sarcoma in a referral hospital
Kaposi's sarcoma (KS) is the most common malignant complication in patients suffering from human immune deficiency virus (HIV) infection. It was recognized in 1994, that the tumour was caused by infection with a human gamma herpes virus -8(HHV -8). HIV seropositive patients have a 73,000 fold greater chance of developing KS than HIV seronegative individuals. The tumour in HIV seropostive patients is more aggressive compared to HIV seronegative patients .The tumour involves the lymphoreticular system, often with visceral dissemination, poor prognosis and shortened survival, where as in non HIV setting ,the tumour is indolent and slow growing and patients live over 10 years even without treatment. Management of AIDS-related KS is palliative and is aimed at controlling the progression of the disease, improving the patients quality of life and reducing disease relapse. However there is no standard management protocol available for the management of AIDS related KS .Therefore ,there was need to conduct this research to assess the outcome of drug management of patients with AIDS- related KS at Kenyatta National Hospital in order to compare the clinical outcome of the cytotoxic drug schedules and identify a suitable cost effective protocol among the drugs used at the hospital for the management of patients with AIDS -related KS. The study was conducted between September and December of 2005 at the Hospital's Haematology and Radiotherapy Clinics and the Medical wards. Approval of the study was granted by the ethics and research committee at Kenyatta National Hospital before the investigations were commenced. Patients were enrolled into the study on the basis of the inclusion criteria and after undergoing a comprehensive consenting process. During the study period a total of 95 patients with KS were on management at K.N .H. Out of these 74 patients were enrolled in the study .The sex distribution of the study population was 57% males and 43% females. Age ranged between 13 years to 55 years. The median age was 35.5 years and the mean age was 36.5 years. The following were the drugs/therapies used for the management of the patients ; Vincristine(Vin) , Bleomycin(B) , Doxorubicin( A) , Actinomycin -0 (ACT-D) and Radiotherapy(RT). The pattern of protocol distribution among the patients was as follows; VinlB,44, Vin.lB/A. 2, Vin.lA. 3, Vin.3, RT. 12,Vin.lRT. I, Vin.lA.lActinimycin- D.(ACT.D) 2. Seven (7) patients were not on any specific treatment for KS . The outcome of management wa~ as follows; 54 patients were lost to follow up,29 males and 25 females, 15 patients survived,10 males and five (5) females and five(5) patients died, three(3 )males and two (2 )females. The relationship between outcome and therapy administered was as follows: Vin.lB. 35 were lost to follow up, two (2) died and seven(7) survived, Vin.lB.lA. the only two(2) patients were lost to follow up, Vin.lA all the three (3)were lost to follow up, Vin. One (l ) was lost to follow up and two (2) survived ,RT. six(6) were lost to follow up, two(2) died and four(4)survived,Vin.lRT the only one (1) patient was lost to follow ,Vin.lA.lACT-D,one(l) died and the other one(l) was lost to follow up. Those patients not on KS treatment five (5) were lost to follow up and two(2) survived. Test for association showed that there was no significant association between drug schedule(p=O.347) and the outcome. However comparing the cost and adverse effect profile of the therapeutic regimens , Vincristine was the cheapest and most tolerated by the patients Therefore Vincristine only regimen is suitable for the management of patients with AIDS- related KS in Kenyatta National Hospital.