Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies

TY - JOUR

T1 - Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy

T2 - Collaborative Analysis of 21 European Cohort Studies

AU - Wyss, Natascha

AU - Zwahlen, Marcel

AU - Bohlius, Julia

AU - Clifford, Gary

AU - Campbell, Maria

AU - Chakraborty, Rana

AU - Bonnet, Fabrice

AU - Chêne, Geneviève

AU - Bani-Sadr, Firouze

AU - Verbon, Annelies

AU - Zangerle, Robert

AU - Paparizos, Vassilios

AU - Prins, Maria

AU - Dronda, Fernando

AU - Moing, Vincent Le

AU - Antinori, Andrea

AU - Quiros-Roldan, Eugenia

AU - Mussini, Cristina

AU - Miró, Jose M

AU - Meyer, Laurence

AU - Vehreschild, Jörg J

AU - Obel, Niels

AU - Mocroft, Amanda

AU - Sabin, Caroline

AU - Brockmeyer, Norbert

AU - Boué, François

AU - Spagnuolo, Vincenzo

AU - Hasse, Barbara

AU - De Wit, Stéphane

AU - Roca, Bernardino

AU - Egger, Matthias

AU - Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord

AU - Centre for Infectious Disease Epidemiology and Research

N1 - © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail [email protected].

PY - 2016/11/15

Y1 - 2016/11/15

N2 - Background. Kaposi sarcoma (KS) remains a frequent cancer in human immunodeficiency virus (HIV)-positive patients starting combination antiretroviral therapy (cART). We examined incidence rates and risk factors for developing KS in different periods after starting cART in patients from European observational HIV cohorts. Methods. We included HIV-positive adults starting cART after 1 January 1996. We analyzed incidence rates and risk factors for developing KS up to 90 and 180 days and 1, 2, 5, and 8 years after cART start and fitted univariable and multivariable Cox regression models. Results. We included 109 461 patients from 21 prospective clinical cohorts in Europe with 916 incident KS cases. The incidence rate per 100 000 person-years was highest 6 months after starting cART, at 953 (95% confidence interval, 866-1048), declining to 82 (68-100) after 5-8 years. In multivariable analyses adjusted for exposure group, origin, age, type of first-line regimen, and calendar year, low current CD4 cell counts increased the risk of developing KS throughout all observation periods after cART initiation. Lack of viral control was not associated with the hazard of developing KS in the first year after cART initiation, but was over time since starting cART increasingly positively associated (P <. 001 for interaction). Conclusion. In patients initiating cART, both incidence and risk factors for KS change with time since starting cART. Whereas soon after starting cART low CD4 cell count is the dominant risk factor, detectable HIV-1 RNA viral load becomes an increasingly important risk factor in patients who started cART several years earlier, independently of immunodeficiency.

AB - Background. Kaposi sarcoma (KS) remains a frequent cancer in human immunodeficiency virus (HIV)-positive patients starting combination antiretroviral therapy (cART). We examined incidence rates and risk factors for developing KS in different periods after starting cART in patients from European observational HIV cohorts. Methods. We included HIV-positive adults starting cART after 1 January 1996. We analyzed incidence rates and risk factors for developing KS up to 90 and 180 days and 1, 2, 5, and 8 years after cART start and fitted univariable and multivariable Cox regression models. Results. We included 109 461 patients from 21 prospective clinical cohorts in Europe with 916 incident KS cases. The incidence rate per 100 000 person-years was highest 6 months after starting cART, at 953 (95% confidence interval, 866-1048), declining to 82 (68-100) after 5-8 years. In multivariable analyses adjusted for exposure group, origin, age, type of first-line regimen, and calendar year, low current CD4 cell counts increased the risk of developing KS throughout all observation periods after cART initiation. Lack of viral control was not associated with the hazard of developing KS in the first year after cART initiation, but was over time since starting cART increasingly positively associated (P <. 001 for interaction). Conclusion. In patients initiating cART, both incidence and risk factors for KS change with time since starting cART. Whereas soon after starting cART low CD4 cell count is the dominant risk factor, detectable HIV-1 RNA viral load becomes an increasingly important risk factor in patients who started cART several years earlier, independently of immunodeficiency.

KW - Journal Article

U2 - 10.1093/cid/ciw562

DO - 10.1093/cid/ciw562

M3 - Journal article

C2 - 27535953

SN - 1058-4838

VL - 63

SP - 1373

EP - 1379

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 10

ER -