access to ART through these facilities is increasing through
the efforts of the Ministry of Health to decentralize ART in
Zimbabwe, AIDS-KS treatment is centralized at tertiary
referral centres such as the Parirenyatwa Hospital in Harare
where laboratory facilities and chemotherapy drugs are
available; patients with AIDS-KS are often diagnosed late in
the course of their illness, resulting in a high tumour burden
on presentation. In a study conducted in Harare, after 96
weeks of ART, despite suppression of plasma HIV-1 RNA
below the limits of detection only 19% of Zimbabweans had
complete or partial resolution of AIDS-KS disease and 16%
died; in addition, 34% of participants had no improvement in
their quality of life after 24 weeks of treatment, indicating
that more effective treatment of symptoms related to AIDSKS and associated co-morbidities is needed for a large
portion of AIDS-KS patients after beginning ART.30
Palliative care for AIDS-KS in Zimbabwe
Patients with AIDS-KS experience a high burden of pain and
other chronic symptoms, over a long period of time, and have
a disease course marked by cumulative exacerbations and
remissions, making palliative care highly relevant to this
population.27 The World Health Organization (WHO) has
recognized that development of palliative care for HIV/AIDS
has been relatively neglected in Africa and made
enhancement of palliative care for HIV/AIDS in Africa a
priority in 2002.28 Although much progress has been made in
enhancing access to palliative care in Zimbabwe, little is
known about the role of palliative care to improve outcomes
specifically in the treatment of patients with AIDS-KS in
resource-poor areas. (For this study, we are using the WHO
definition of palliative care: "An approach that improves the
quality of life of patients and their families facing problems
associated with life-threatening illness, through the
prevention and relief of suffering by means of early
identification and impeccable assessment and treatment of
pain and other problems, physical, psychosocial and spiritual".)
Essential elements of palliative care relevant to AIDS-KS are
the focus of palliative care on providing relief from pain and
other distressing symptoms and enhancing quality of life, and
DISEASE-SPECIFIC CANCER CONTROL
CANCER CONTROL 2014 93
Table 1: Summary of recommendations for AIDS-KS management in recent international guidelines
Source Kaposi sarcoma-related recommendations
Screening Diagnosis Staging Treatment
Integrated management of adolescent and adult illness, None None None None
chronic HIV care module (WHO 2006)
http://www.who.int/3by5/publications/documents/imai/en
Primary care guidelines for the management of persons Examine skin None None None
infected with HIV (IDSA 2009) Aberg et al., and mouth
Clin Infect Dis 2009; 49:651-81 for KS lesions
Guidelines for prevention and treatment of opportunistic None None None ART for all
infections in HIV-infected adults and adolescents KS; ART with
(NIH/CDC/IDSA, 2013) http://aidsinfo.nih.gov/guidelines chemotherapy
for visceral
and
disseminated
disease
Guidelines for the use of antiretroviral agents in None None None None
HIV-1-infected adults and adolescents (US DHHS 2013)
http://aidsinfo.nih.gov/guidelines
Consolidated guidelines on the use of antiretroviral None Criteria for None None
drugs for treating and preventing HIV infection clinical and
(WHO, 2013) http://www.who.int/hiv/pub/guidelines/ definitive
arv2013/download/en/ diagnoses
Integrated management of childhood illness, Manual None None None None
on Paediatric HIV Care and Treatment for District
Hospitals (WHO 2011)
Guidelines for the prevention and treatment of opportunistic None None None None
infections among HIV-exposed and HIV-infected
children (US DHHS, 2009)
http://aidsinfo.nih.gov/guidelines