TY - JOUR
T1 - Comparison of kaposi sarcoma risk in human immunodeficiency virus-positive adults across 5 continents
T2 - A multiregional multicohort study
AU - The AIDS-defining Cancer Project Working Group for IeDEA and COHERE in EuroCoord
AU - Rohner, Eliane
AU - Bütikofer, Lukas
AU - Schmidlin, Kurt
AU - Sengayi, Mazvita
AU - Maskew, Mhairi
AU - Giddy, Janet
AU - Garone, Daniela
AU - Moore, Richard D.
AU - D'Souza, Gypsyamber
AU - Goedert, James J.
AU - Achenbach, Chad
AU - Gill, M. John
AU - Kitahata, Mari M.
AU - Patel, Pragna
AU - Silverberg, Michael J.
AU - Castilho, Jessica
AU - McGowan, Catherine
AU - Chen, Yi Ming Arthur
AU - Law, Matthew
AU - Taylor, Ninon
AU - Paparizos, Vassilios
AU - Bonnet, Fabrice
AU - Verbon, Annelies
AU - Fätkenheuer, Gerd
AU - Post, Frank A.
AU - Sabin, Caroline
AU - Mocroft, Amanda
AU - Le Moing, Vincent
AU - Dronda, Fernando
AU - Obel, Niels
AU - Grabar, Sophie
AU - Spagnuolo, Vincenzo
AU - Antinori, Andrea
AU - Quiros-Roldan, Eugenia
AU - Mussini, Cristina
AU - Miro, José M.
AU - Meyer, Laurence
AU - Hasse, Barbara
AU - Konopnicki, Deborah
AU - Roca, Bernardino
AU - Barger, Diana
AU - Raben, Dorthe
AU - Clifford, Gary M.
AU - Franceschi, Silvia
AU - Brockmeyer, Norbert
AU - Chakraborty, Rana
AU - Egger, Matthias
AU - Bohlius, Julia
AU - Judd, Ali
AU - Mejia, Fernando
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - 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 208 140 patients from 57 countries. Over a period of 1 066 572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100 000 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.
AB - 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 208 140 patients from 57 countries. Over a period of 1 066 572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100 000 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.
KW - Antiretroviral therapy
KW - Cohort study
KW - HIV
KW - Kaposi sarcoma
UR - https://www.scopus.com/pages/publications/85032789580
U2 - 10.1093/cid/cix480
DO - 10.1093/cid/cix480
M3 - Artículo
C2 - 28531260
AN - SCOPUS:85032789580
SN - 1058-4838
VL - 65
SP - 1316
EP - 1326
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -
SDG 3 Good Health and Well-being