Author
Affilliation
Abstract
BACKGROUND:
We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.
METHODS:
We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs).
RESULTS:
We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions.
CONCLUSIONS:
Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
Citation
ROHNER, E. et al. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clinical Infectious Diseases, v. 65, n. 8, p. 1316–1326, 2017.
DOI
10.1093/cid/cix480
ISSN
1058-4838
Notes
Writing group. Eliane Rohner1, Lukas Bütikofer2, Kurt Schmidlin1, Mazvita Sengayi3, Mhairi Maskew4, Janet Giddy5, Daniela Garone6, Richard D. Moore7, Gypsyamber D’Souza8, James J. Goedert9, Chad Achenbach10, M. John Gill11, Mari M. Kitahata12, Pragna Patel13, Michael J. Silverberg14, Jessica Castilho15, Catherine McGowan15, Yi-Ming Arthur Chen16, Matthew Law17, Ninon Taylor18, Vassilios Paparizos19, Fabrice Bonnet20,21, Annelies Verbon22, Gerd Fätkenheuer23, Frank A. Post24, Caroline Sabin25, Amanda Mocroft25, Vincent Le Moing26, Fernando Dronda27, Niels Obel28, Sophie Grabar29-31, Vincenzo Spagnuolo32, Andrea Antinori33, Eugenia Quiros-Roldan34, Cristina Mussini35, José M. Miro36, Laurence Meyer37,38, Barbara Hasse39, Deborah Konopnicki40, Bernardino Roca41, Diana Barger21,42, Dorthe Raben43, Gary M. Clifford44, Silvia Franceschi44, Norbert Brockmeyr45, Rana Chakraborty46, Matthias Egger1,47, Julia Bohlius1.
Affiliations.1Institute of Social and Preventive Medicine, University of Bern, Switzerland; 2CTU Bern, University of Bern, Switzerland; 3National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; 4Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 5Department of Medicine, McCord Hospital, Durban, South Africa; 6Médecins Sans Frontières Belgium; 7Johns Hopkins University, School of Medicine, Baltimore, Maryland; 8Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 9Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland; 10Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago; 11University of Calgary, Alberta, Canada; 12University of Washington, School of Medicine, Seattle, Washington; 13Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; 14Division of Research, Kaiser Permanente Northern California, Oakland, USA; 15Vanderbilt University Medical Center, Nashville, TN, USA; 16Kaohsiung Medical University, Taiwan; 17Kirby Institute, UNSW Sydney, NSW Australia; 18IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectious Diseases and Rheumathology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; 19AIDS Unit, Clinic of Venereologic and Dermatologic Diseases, Athens Medical School, “Syngros” Hospital, Athens, Greece; 20CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France; 21INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; 22Department Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands; 23Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; 24King’s College Hospital NHS Foundation Trust, London, UK; 25Research Department of Infection & Population Health, UCL, London, United Kingdom; 26Montpellier University, Montpellier, France; 27Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain; 28Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark; 29Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France; 30INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France; 31Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Cochin Hôtel-Dieu, Paris, France; 32Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; 33INMI ‘L. Spallanzani’, Rome, Italy; 34Infectious and Tropical Diseases Institute, University of Brescia, Brescia, Italy; 35Infectious Diseases Clinics, University Hospital, Modena, Italy; 36Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain; 37INSERM, U1018, Epidemiology of HIV, Reproduction, Paediatrics, CESP, University Paris-Sud, Paris, France; 38Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, Paris, France; 39Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland; 40Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium; 41Hospital General Universitario, Castellón, Spain; 42Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; 43CHIP, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark; 44International Agency for Research on Cancer, Lyon, France; 45Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Germany; 46Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, USA; 47Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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