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

Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord; Centre for Infectious Disease Epidemiology and Research

doi:10.1093/cid/ciw562

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

Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord, Centre for Infectious Disease Epidemiology and Research

Department of Clinical Medicine

14 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Clinical Infectious Diseases
Volume	63
Issue number	10
Pages (from-to)	1373-1379
Number of pages	7
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/ciw562
Publication status	Published - 15 Nov 2016

Keywords

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord, & Centre for Infectious Disease Epidemiology and Research (2016). Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies. Clinical Infectious Diseases, 63(10), 1373-1379. https://doi.org/10.1093/cid/ciw562

Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy : Collaborative Analysis of 21 European Cohort Studies. / Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord; Centre for Infectious Disease Epidemiology and Research.

In: Clinical Infectious Diseases, Vol. 63, No. 10, 15.11.2016, p. 1373-1379.

Research output: Contribution to journal › Journal article › Research › peer-review

Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord & Centre for Infectious Disease Epidemiology and Research 2016, 'Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies', Clinical Infectious Diseases, vol. 63, no. 10, pp. 1373-1379. https://doi.org/10.1093/cid/ciw562

Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord, Centre for Infectious Disease Epidemiology and Research. Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies. Clinical Infectious Diseases. 2016 Nov 15;63(10):1373-1379. doi: 10.1093/cid/ciw562

Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord ; Centre for Infectious Disease Epidemiology and Research. / Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy : Collaborative Analysis of 21 European Cohort Studies. In: Clinical Infectious Diseases. 2016 ; Vol. 63, No. 10. pp. 1373-1379.

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

abstract = "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.",

keywords = "Journal Article",

author = "Natascha Wyss and Marcel Zwahlen and Julia Bohlius and Gary Clifford and Maria Campbell and Rana Chakraborty and Fabrice Bonnet and Genevi{\`e}ve Ch{\^e}ne and Firouze Bani-Sadr and Annelies Verbon and Robert Zangerle and Vassilios Paparizos and Maria Prins and Fernando Dronda and Moing, {Vincent Le} and Andrea Antinori and Eugenia Quiros-Roldan and Cristina Mussini and Mir{\'o}, {Jose M} and Laurence Meyer and Vehreschild, {J{\"o}rg J} and Niels Obel and Amanda Mocroft and Caroline Sabin and Norbert Brockmeyer and Fran{\c c}ois Bou{\'e} and Vincenzo Spagnuolo and Barbara Hasse and {De Wit}, St{\'e}phane and Bernardino Roca and Matthias Egger and {Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord} and {Centre for Infectious Disease Epidemiology and Research}",

year = "2016",

month = nov,

day = "15",

doi = "10.1093/cid/ciw562",

language = "English",

volume = "63",

pages = "1373--1379",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

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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

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.

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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 -

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

Abstract

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