and the second most common in women. For those under 15
years of age, KS remains in the top five cancers for both girls
(9.5% of all female paediatric cancers in 2010) and boys (12%
of all male paediatric cancers in 2010).
Treatment outcomes of AIDS-KS in Zimbabwe
In the pre-ART era, five year survival from KS in Zimbabwe
was 4% compared to 15% five year survival in the United
States.15 The disparity between AIDS-KS treatment outcomes
has persisted despite the wider availability of ART in Africa. In
recent studies conducted in Europe and North America the
rate of partial or complete response to ART with
chemotherapy has ranged from 30% to 80%.16-21 After 96
weeks of ART, despite suppression of plasma HIV-1 RNA
below the limits of detection and significant increases in CD4+
lymphocytes, only 19% of Zimbabweans had complete or
partial resolution of AIDS-KS clinical disease and 16% had
died.
22 The most common cause of death was infection
(bacterial sepsis, pneumonia and cryptococcal meningitis), and
all deaths during the first 24 weeks after the initiation of ART
were attributed to infectious complications. Infections also
caused significant morbidity during ART and 66% required
treatment for one or more new or recurrent infections. The
use of adjunctive chemotherapy was associated with a 4.8-
fold increase in the odds of survival compared to ART alone.
Importantly, 34% of participants had no improvement in the
KS quality of life module score after 24 weeks of treatment,
indicating that more effective treatment of symptoms related
to AIDS-KS and associated co-morbidities is needed for a large
portion of AIDS-KS patients after beginning ART.23 Compared
to African AIDS patients without KS, African AIDS-KS patients
have worse clinical outcomes
24-25
, so the discrepancies
between AIDS-KS outcomes in Africa and developed
countries are not solely attributable to difficulties in the use of
ART in African settings. Rather, it is likely that treatment of
AIDS-KS in African settings poses unique challenges and
alternative, innovative approaches are needed to improve
AIDS-KS treatment outcomes in Africa.
Current approach to delivery of care to people with
AIDS-KS in Zimbabwe
The Parirenyatwa Hospital KS Clinic located in Harare, the
capital city of Zimbabwe, serves as a KS referral centre for
the northern two-thirds of Zimbabwe and provides care for
approximately 1,100 to 1,200 AIDS-KS patients annually.
However, Zimbabwe is predominantly a rural country and
over 80% of the population lives in small towns, villages and
rural areas. Medical care in these areas is provided through a
system of health centres and district hospitals which are
staffed by generalist medical officers and nurses. Although
DISEASE-SPECIFIC CANCER CONTROL
92 CANCER CONTROL 2014
SIKO KS Standardized Examination (KS-SE) Checklist
Complete for all patients at initial (intake) visit and every year thereafter
**If patient has KS, place completed form in patient folder**
**If patient does not have KS, place completed form in SIKO filing cabinet**
Clinic Name: Date:
Patient Name: OI Clinic No.:
A. EXAMINATION: KS ORAL DISEASE NO KS SEEN
ASK: Do you have any lesions in your mouth? Yes No
Do you have pain or difficulty in swallowing? Yes No
B. EXAMINATION: KS SKIN DISEASE NO KS SEEN
ASK: Have you noticed any disease on your skin? Yes No
LOOK: Normal
Flat KS
Lesions
Raised KS
Lesions
Lips
Inner lip
Inside cheek
Hard and Soft Palate
Tongue
Floor of Mouth
gums
LOOK:
Patch /
Macule
Plaque /
Elevated
Nodule
No Skin Disease
Scanty (<5)
Mild (5 - <20)
Moderate (20-50)
Severe (50+)
None
Some
Pitting
Severe
or Non
Pitting
Leg edema
Other sites (e.g. face,
arms, genitals):
Specify: __________
C. EXAMINATION: LYMPHNODES (GLANDS) NO GLANDS FELT
SK: Have you noticed any lumps/glands on your body? Yes No
D. EXAMINATION: CHEST NORMAL
E. EXAMINATION: ABDOMEN NORMAL
ASK None
Duration (< month
or > month)
Severity (mild or
severe)
Nausea
Vomiting
Abdomen pain
Rectal bleeding
FEEL No Yes If
yes,
size
(cm):
Hepatomegaly (RUQ)
Splenomegaly (LUQ)
Ascites
CXR:
None Normal Hilar LN Pulmonary Infiltrate Pleural/Pericardial
Comments:
FEEL: None Yes, few (1 or 2)
Yes, many (3 or
more)
Sub-mental (chin) /
Sub-mandibular (jaw)
Cervical (neck)
Supraclavicular
Axillary (armpit)
Epitrochlear (elbow)
Groin/Femoral
EXAMINE None
Location
(e.g. right / left &
anterior / posterior)
Generalized
Dullness
Crackles
Wheezes
ASK ABOUT None
Duration Less than
a month
Duration more than
a month
Cough
Difficult breathing
Chest pain
Figure 1: The SIKO Kaposi sarcoma standardized examination checklist