Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study.

Rohner, Eliane; Bütikofer, Lukas; Schmidlin, Kurt; Sengayi, Mazvita; Maskew, Mhairi; Giddy, Janet; Garone, Daniela; Moore, Richard D.; D’Souza, Gypsyamber; Goedert, James J.; Achenbach, Chad; Gill, M. John; Kitahata, Mari M.; Patel, Pragna; Silverberg, Michael J.; Castilho, Jessica; McGowan, Catherine; Chen, Yi-Ming Arthur; Law, Matthew; Taylor, Ninon; ... (2017). Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clinical infectious diseases, 65(8), pp. 1316-1326. Oxford University Press 10.1093/cid/cix480

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Rohner, Eliane; Bütikofer, Lukas; Schmidlin, Kurt; Egger, Matthias and Bohlius, Julia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1058-4838

Publisher:

Oxford University Press

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

19 Oct 2017 16:43

Last Modified:

23 Oct 2017 16:30

Publisher DOI:

10.1093/cid/cix480

PubMed ID:

28531260

Uncontrolled Keywords:

HIV Kaposi sarcoma antiretroviral therapy cohort study

BORIS DOI:

10.7892/boris.106458

URI:

https://boris.unibe.ch/id/eprint/106458

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