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

Preview	Text Rohner_ClinInfectDis_2017.pdf - Published Version Available under License Publisher holds Copyright. Download (4MB) | Preview
Preview	Text Rohner_ClinInfectDis_2017_postprint.pdf - Accepted Version Available under License Publisher holds Copyright. Download (1MB) | Preview

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.

Interest & Impact

Downloads

161 since deposited on 19 Oct 2017
24 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item