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 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.
Original language | English |
---|---|
Pages (from-to) | 1316-1326 |
Number of pages | 11 |
Journal | Clinical Infectious Diseases |
Volume | 65 |
Issue number | 8 |
DOIs | |
Publication status | Published - 1 Oct 2017 |
Keywords
- Antiretroviral therapy
- Cohort study
- HIV
- Kaposi sarcoma
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In: Clinical Infectious Diseases, Vol. 65, No. 8, 01.10.2017, p. 1316-1326.
Research output: Contribution to journal › Article › Academic › peer-review
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 - Reiss, Peter
AU - Prins, Maria
AU - Van Der Valk, Marc
AU - Avihingsanon, A.
N1 - Funding Information: Healthcare, BMS, and MSD. G. F. received support from Janssen, BMS, MSD, and Gilead. J. C. is employed by the Vanderbilt University Medical Center, and received support from the NIH. M. J. G. is ad hoc member of HIV National Advisory Boards of Merck, Gilead, and ViiV. J. M. M. received support from Abbvie, BMS, Merck, Novartis, ViiV Healthcare, Genentech, Medtronic, and Pfizer. L. M. received funding from ANRS and FP7 through MRC. M. L. received support from Gilead Sciences, Boehringer Ingelheim, Merck, Sharp & Dohme, Bristol Myers Squibb, Janssen-Cilag, and ViiV Healthcare and DSMB sitting fees from Sirtex Pty Ltd. M. M. received support from the USAID. M. S. received funding from Pfizer and Merck. N. T. has been an advisory board member for GSK, Gilead, and MSD, and received travel support from Gilead and GSK. R. C. received funding from Gilead, the NICHD, and the NIAID. R. M. received payments for the development of educational presentations from Medscape. V. S. received payments for the development of educational presentations from ViiV Healthcare and Gilead Sciences. Y.-M. A. C. received support from the Kaohsiung Medical University and the Ministry of Science and Technology. All other authors report no potential conflicts. The authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Funding Information: The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007–2013; EuroCoord grant 260694). A list of the funders of the participating cohorts can be found at www.COHERE.org. JMM received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain during 2017-19. This study was also made possible by the generous support of the American people through the United States Agency for International Development (INROADS USAID-674-A-12-00029) and by the Swiss National Science Foundation (grant Ambizione-PROSPER PZ00P3_160407 to J. B.). Funding Information: Potential conflicts of interest. A. M. received honoraria, lecture fees, consultancy fees, and travel support from Gilead, BMS, BI, Pfizer, Merck, GSK and Wragge LLC. A. A. received support from Gilead Sciences, Bristol Myers Squibb, Janssen Cilag, Merck, ViiV Healthcare, and Abbvie. C. S. received support from MRC, Gilead Sciences, ViiV Healthcare, and Janssen-Cilag. C. A. is an ABIVAX DSMB member. C. M. received support from BMS, MSD, ViiV, Gilead, and Abbvie. D. B. received funding from Sidaction. F. B. received support from Gilead, Janssen, ViiV Funding Information: Financial support. Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, and the National Cancer Institute of the US National Institutes of Health (grants U01AI069924 [Southern Africa], U01AI069907 [Asia-Pacific], U01AI069923 [Caribbean, Central and South America], U01-AI069918 [North America], and U01A1096186 [IeDEA Network Coordinating Center at Vanderbilt]). The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) was also supported by the National Institutes of Health (grants F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01CA165937, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794,U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176), the US Centers for Disease Control and Prevention (contracts CDC-200-2006-18797 and CDC-200-2015-63931), the Agency for Healthcare Research and Quality (contract 90047713), the Health Resources and Services Administration (contract 90051652), the Canadian Institutes of Health Research (grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118), the Ontario Ministry of Health and Long Term Care, and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, National Institute for Mental Health, and National Institute on Drug Abuse. The TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD) are initiatives of TREAT Asia, a program of amfAR, the Foundation for AIDS Research; AHOD is also funded by unconditional grants from Merck Sharp & Dohme, Gilead Sciences, Bristol-Myers Squibb (BMS), Boehringer Ingelheim, Janssen-Cilag, ViiV Healthcare. The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, University of New South Wales Australia. The COHERE study group has received unrestricted funding from ANRS, France; HIV Monitoring Foundation, the Netherlands; and the Augustinus Foundation, Denmark. 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 - http://www.scopus.com/inward/record.url?scp=85032789580&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/cix480
DO - https://doi.org/10.1093/cid/cix480
M3 - Article
C2 - 28531260
SN - 1058-4838
VL - 65
SP - 1316
EP - 1326
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -