Abstract

The HIV/AIDS epidemic has driven the rise in cases of Kaposi sarcoma (KS) among children and adolescents living with HIV in countries with high Human gammaherpesvirus 8 (HHV-8) seroprevalence, such as Tanzania, where specialized oncology programs are sparse. Consequently, descriptions of successful treatment of KS in children and adolescents by general pediatricians are important. A retrospective analysis was performed of children and adolescents diagnosed with KS and treated with chemotherapy and combination antiretroviral therapy (cART) at the Baylor College of Medicine Children’s Foundation Tanzania Center of Excellence – Mbeya between 2011 and 2017. Sixty-one patients were diagnosed with KS with a median age of 12.6 years (interquartile range (IQR) 9.4 − 15.5). Diagnosis was confirmed by histopathology in 36% (22/61). Among HIV positive patients (59/61), 78% (46/59) were on cART at KS diagnosis. Severe immunosuppression was present in 63% (35/56) of those with CD4 data and 44% (27/61) had SAM. Advanced-stage T1 disease was present in 64% (39/61), including 28% (17/61) with visceral/disseminated KS. Two-year estimated overall survival (OS) was 72% (95% Confidence Interval (CI): 58%–82%) and median follow up for survivors was 25.7 months (IQR 14.2–53.8). No patients were lost to follow up. Two-year OS was 63% (95% CI: 44%–77%) in patients with severe immune suppression and 60% (95% CI: 37%–76%) in patients with SAM. Among patients with visceral/disseminated KS, 53% (9/17) survived. This retrospective analysis demonstrated favorable outcomes in a complex cohort of children and adolescents with KS treated with chemotherapy by general pediatricians in Tanzania.

摘要

艾滋病毒/艾滋病的流行导致在人类伽马疱疹病毒高发国家感染艾滋病毒的儿童和青少年中卡波西肉瘤 (KS) 病例增加8 (HHV-8) 血清阳性率，例如坦桑尼亚，那里专门的肿瘤学项目很少。因此，普通儿科医生对儿童和青少年 KS 成功治疗的描述很重要。对 2011 年至 2017 年间在贝勒医学院儿童基金会坦桑尼亚卓越中心 – Mbeya 诊断为 KS 并接受化疗和联合抗逆转录病毒疗法 (cART) 治疗的儿童和青少年进行了回顾性分析。61 名患者被诊断为 KS中位年龄为 12.6 岁（四分位距 (IQR) 9.4 - 15.5）。36% (22/61) 的组织病理学证实了诊断。在 HIV 阳性患者 (59/61) 中，78% (46/59) 在 KS 诊断时接受 cART。63% (35/56) 有 CD4 数据的患者存在严重的免疫抑制，44% (27/61) 有 SAM。64% (39/61) 存在晚期 T1 疾病，其中 28% (17/61) 患有内脏/播散性 KS。两年估计总生存期 (OS) 为 72%（95% 置信区间 (CI)：58%–82%），幸存者的中位随访时间为 25.7 个月（IQR 14.2–53.8）。没有患者失访。严重免疫抑制患者的两年 OS 为 63%（95% CI：44%–77%），SAM 患者为 60%（95% CI：37%–76%）。内脏/播散性 KS 患者中，53% (9/17) 存活。这项回顾性分析表明，坦桑尼亚的普通儿科医生在接受化疗的 KS 儿童和青少年的复杂队列中取得了良好的结果。58%–82%)，幸存者的中位随访时间为 25.7 个月 (IQR 14.2–53.8)。没有患者失访。严重免疫抑制患者的两年 OS 为 63%（95% CI：44%–77%），SAM 患者为 60%（95% CI：37%–76%）。内脏/播散性 KS 患者中，53% (9/17) 存活。这项回顾性分析表明，坦桑尼亚的普通儿科医生在接受化疗的 KS 儿童和青少年的复杂队列中取得了良好的结果。58%–82%)，幸存者的中位随访时间为 25.7 个月 (IQR 14.2–53.8)。没有患者失访。严重免疫抑制患者的两年 OS 为 63%（95% CI：44%–77%），SAM 患者为 60%（95% CI：37%–76%）。内脏/播散性 KS 患者中，53% (9/17) 存活。这项回顾性分析表明，坦桑尼亚的普通儿科医生在接受化疗的 KS 儿童和青少年的复杂队列中取得了良好的结果。