Pattern of distribution of AIDS-related Kaposi’s sarcoma lesions in HIV patients in a referral hospital in Kenya

Background: Kaposi’s sarcoma (KS) is an angioproliferative malignancy caused by infection with human herpes virus -8 (HHV-8). The tumour has four subtypes including Classic KS, African- endemic, Iatrogenic and Acquired immunodeficiency syndrome (AIDS)-related KS. AIDS- related KS is the most common malignancy in patients with human immunodeficiency virus (HIV) infection and has variable clinical presentation with diverse distribution of lesions. Objective: To assess the pattern of distribution of KS lesions in patients with AIDS-related KS at Kenyatta National Hospital. Methods: We carried out a descriptive study on patients with HIV infection with histological diagnosis of KS. The study commenced upon approval by KNH-University of Nairobi Ethics and Research Committee. Following consent, clinical and demographic data was obtained from participants through verbal interviews and from medical records using a data capture form. Follow up was until 10 weeks. Management of patients was at the discretion of the attending clinician. Data was analyzed by a statistician using Instat Biostatistics program. Results Seventy-four participants aged between 13 to 55 years were enrolled into the study. Males were 42 (56.7%) and females 32 (43.2%). Mean age was 36.8 years. The distribution of KS lesions was variable. We demonstrate high predilection of lesions for skin and lymph nodes at 62.6%. Other sites were involved were the oral cavity 14.9%. Twenty-eight (38%) of the participants had multifocal lesions with a male predominance in skin and viscera with male to female ratio of skin 1.8:1 and viscera 7:1 respectively. Conclusion: We demonstrate reduced male: female ratio and multifocal distribution of AIDS-related KS lesions with predominance in skin and lymph nodes and male predominance in visceral lesions. Future studies should aim to determine what favours increase in, KS in women and visceral lesions in males among patients with HIV infection. Keywords: Kaposi’s Sarcoma, human immunodeficiency virus (HIV), Acquired Immunodeficiency Syndrome (AIDS

Abandonment of treatment and loss to follow up: a potential cause of treatment failure in patients with AIDS-related Kaposi’s sarcoma

Background: Management of patients with cancer is complex, multi-disciplinary, longitudinal and costly. Abandonment of treatment by patients and loss to follow up is a common scenario, especially in resource poor countries and severely compromises health outcomes. Objective: To assess the commitment to drug treatment protocol of patients with Acquired Immunodeficiency Syndrome (AIDS)-Related Kaposi’s Sarcoma at Kenyatta National Hospital, Kenya, over a 10 week period . Methods: The study design was prospective, observational, cross-sectional period prevalence study on patients infected with human immunodeficiency virus (HIV) with Kaposi’s sarcoma. Patients with histological diagnosis of Kaposi’s sarcoma were sequentially enrolled into the study as they attended either the Haematology or Radiotherapy clinic or during their admission in the wards. The choice of the treatment protocol was left at the discretion of the attending physician. A pretested data collection form was used to collect demographic and clinical information about the patients, including treatments prescribed and completion of follow up. Results: A total of 74 patients were enrolled into the study, 42 (56.8%) males and 32 (43.2%) females. The age ranged between 13 years to 55 years. Their treatment protocols included: Vincristine only, Vincristine plus Bleomycin, Vincristine plus Bleomycin plus Doxorubicin, Radiotherapy plus Vincristine and Radiotherapy only. Few of the patients were not assigned any antitumor treatment. Antiemetic and other conventional medicines were also prescribed when necessary. Fifty four (73%) of the patients abandoned treatment, five (6.8%) died, 15(20.3%) continued to attend clinic over the 10 week period.  There was no significant association between sex and outcome (p=0.661). Discussion: The results of this study demonstrate that abandonment of treatment is a major problem among patients on treatment for cancer in Kenyatta National Hospital in Kenya. Abandonment of treatment heavily contributes to poor clinical outcome hence complicating the burden of cancer in the country. It is therefore important to develop and establish follow-up systems to improve adherence to treatment for the cancer patients at Kenyatta National Hospital. Key words: Abandonment of treatment, Loss to follow up, AIDS-Related Kaposi’s Sarcom

How can natural products serve as a viable source of lead compounds for the development of new/novel anti-malarials?

Malaria continues to be an enormous global health challenge, with millions of new infections and deaths reported annually. This is partly due to the development of resistance by the malaria parasite to the majority of established anti-malarial drugs, a situation that continues to hamper attempts at controlling the disease. This has spurred intensive drug discovery endeavours geared towards identifying novel, highly active anti-malarial drugs, and the identification of quality leads from natural sources would greatly augment these efforts. The current reality is that other than compounds that have their foundation in historic natural products, there are no other compounds in drug discovery as part of lead optimization projects and preclinical development or further that have originated from a natural product start-point in recent years. This paper briefly presents both classical as well as some more modern, but underutilized, approaches that have been applied outside the field of malaria, and which could be considered in enhancing the potential of natural products to provide or inspire the development of anti-malarial lead compounds

Quality of Antimalarial Drugs Analysed in the National Quality Control Laboratory during the Period 2002–2005

During the period 2002–2005, the National Quality Control Laboratory analysed 229 samples of antimalarial drugs. In 2002, 42% of these products failed to comply with compendial specifications, with the sulfadoxine/ sulfamethoxypyrazine and pyrimethamine combination products forming 39% of the total failures. The respective percentages were 46% and 84% for 2003 and 36% and 72% for 2004. By May 2005, the only failures reported were of sulfadoxine/sulfamethoxypyrazine and pyrimethamine combination products. Until recently, sulfadoxine/sulfamethoxypyrazine and pyrimethamine combination products were the first-line malaria treatment regimen in Kenya. These analytical results raise concerns that the reported therapeutic failures associated with the use of these products could possibly be due to the administration of sub-standard sulfadoxine/sulfamethoxypyrazine and pyrimethamine combination products to patients. The same could be true of artemisinin based combinations which are the current first-line treatment regimen if the observed trend continues Keywords: Antimalarials, dissolution, assay, quality control testsEast and Central African Journal of Pharmaceutical Sciences Vol. 10 (3) 2007: pp. 59-6