| 摘要: | Background: Despite the success of highly active antiretroviral therapy (HAART) in reducing the incidence of Kaposi sarcoma, HIV-infected individuals continue to be diagnosed with Kaposi sarcoma (KS). Strict adherence to antiretroviral therapy (ART) is key to sustained HIV suppression, improved overall health and survival. This study aimed to evaluate the association between HAART medication adherence and development of Kaposi’s sarcoma in HIV-AIDS patients.
Methods: We conducted a nested-case-control study in Kenya on 33 HIV-positive Kaposis Sarcoma cases and 132 HIV-positive non-Kaposis sarcoma controls from Maseno hospital in Kenya. Patients were matched (in the ratio 1:4) from the Maseno electronic Medical Record System on the basis of age, gender, and date of KS diagnosis. Cases were adults Kaposis Sarcoma patients who were initiated on highly active antiretroviral therapy between January 1, 2005 and October 2013. Controls were HIV-positive non - Kaposis sarcoma between the same period. Participators’ Age at enrollment, Age at ART start, gender, education level, occupation, latest CD4 count, WHO clinical stage (stage 1, 2, 3 and 4), distance to clinic, ART perfect adherence, lost to follow up status and number of regular sexual partners in lifetime (self-disclosure) was all collected for the analysis. Wilcoxon rank-sum test was performed to compare socio-economic and clinical status including age, gender, Occupation, Distance to facility, Number of regular sexual partners and WHO stage between the cases and the controls. Conditional logistic regression for paired data was used to assess the effect of the variables including adherence, Education level, CD4 count ART perfect adherence and Number of regular sexual partners on development of Kaposis sarcoma. Multivariate analysis was performed by fitting a stratified Cox model on matched pairs to adjust for potential imbalance in the baseline and clinical characteristics for both cases and controls.
Results: Of the 33 cases and 132 controls included in the analysis, 51.5 % were female. Median age was 35 years (IQR = 30 - 49.5); median baseline CD4 cell count among the cases was 160 /ml (IQR = 55 – 291 while the controls had a slightly higher CD4 cell count of 353 (277-455).However 7 patients (21.21%) in the KS group had CD4 count more than 300/ml. A good proportion of patients were found not to be adherent to HAART medication. Overall participants who reported perfect adherence was 63.6 %.The controls had a marginally higher value; 75.0 % (n=99) than the cases 18.2 %( n=6).Loss to follow-up (LTFU) was slightly higher 39.4 %( n= 13) than among the controls 34% (n = 45). Imperfect ART adherence (H.R = 20.988, 95% CI = 4.192-105.069) were associated with Kaposis Sarcoma development. Low CD4 cell count of less than 350 /ml was also associated with development of Kaposi sarcoma (H.R 7.114 % CI = (1.398- 36.190).
Conclusions: In this setting, low baseline CD4 count, and imperfect adherence to HAART are associated with Kaposis sarcoma development. |
