Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study

Eliane Rohner; Lukas Bütikofer; Kurt Schmidlin; Mazvita Sengayi; Mhairi Maskew; Janet Giddy; Daniela Garone; Richard D. Moore; Gypsyamber D'Souza; James J. Goedert; Chad Achenbach; M. John Gill; Mari M. Kitahata; Pragna Patel; Michael J. Silverberg; Jessica Castilho; Catherine McGowan; Yi Ming Arthur Chen; Matthew Law; Ninon Taylor; Vassilios Paparizos; Fabrice Bonnet; Annelies Verbon; Gerd Fätkenheuer; Frank A. Post; Caroline Sabin; Amanda Mocrof; Vincent Le Moing; Fernando Dronda; Niels Obel; Sophie Grabar; Vincenzo Spagnuolo; Andrea Antinori; Eugenia Quiros-Roldan; Cristina Mussini; José M. Miro; Laurence Meyer; Barbara Hasse; Deborah Konopnicki; Bernardino Roca; Diana Barger; Dorthe Raben; Gary M. Cliford; Silvia Franceschi; Norbert Brockmeyer; Rana Chakraborty; Matthias Egger; Julia Bohlius

doi:10.1093/cid/cix480

Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study

Eliane Rohner, Lukas Bütikofer, Kurt Schmidlin, Mazvita Sengayi, Mhairi Maskew, Janet Giddy, Daniela Garone, Richard D. Moore, Gypsyamber D'Souza, James J. Goedert, Chad Achenbach, M. John Gill, Mari M. Kitahata, Pragna Patel, Michael J. Silverberg, Jessica Castilho, Catherine McGowan, Yi Ming Arthur Chen, Matthew Law, Ninon TaylorVassilios Paparizos, Fabrice Bonnet, Annelies Verbon, Gerd Fätkenheuer, Frank A. Post, Caroline Sabin, Amanda Mocrof, Vincent Le Moing, Fernando Dronda, Niels Obel, Sophie Grabar, Vincenzo Spagnuolo, Andrea Antinori, Eugenia Quiros-Roldan, Cristina Mussini, José M. Miro, Laurence Meyer, Barbara Hasse, Deborah Konopnicki, Bernardino Roca, Diana Barger, Dorthe Raben, Gary M. Cliford, Silvia Franceschi, Norbert Brockmeyer, Rana Chakraborty, Matthias Egger, Julia Bohlius^*

^*Corresponding author for this work

Department of Clinical Medicine

14 Citations (Scopus)

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
Journal	Clinical Infectious Diseases
Volume	65
Issue number	8
Pages (from-to)	1316-1326
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/cix480
Publication status	Published - 2017

Keywords

Antiretroviral therapy
Cohort study
HIV
Kaposi sarcoma

UN SDGs

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

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Rohner, E., Bütikofer, L., Schmidlin, K., Sengayi, M., Maskew, M., Giddy, J., Garone, D., Moore, R. D., D'Souza, G., Goedert, J. J., Achenbach, C., Gill, M. J., Kitahata, M. M., Patel, P., Silverberg, M. J., Castilho, J., McGowan, C., Chen, Y. M. A., Law, M., ... Bohlius, J. (2017). Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study. Clinical Infectious Diseases, 65(8), 1316-1326. https://doi.org/10.1093/cid/cix480

Rohner, E, Bütikofer, L, Schmidlin, K, Sengayi, M, Maskew, M, Giddy, J, Garone, D, Moore, RD, D'Souza, G, Goedert, JJ, Achenbach, C, Gill, MJ, Kitahata, MM, Patel, P, Silverberg, MJ, Castilho, J, McGowan, C, Chen, YMA, Law, M, Taylor, N, Paparizos, V, Bonnet, F, Verbon, A, Fätkenheuer, G, Post, FA, Sabin, C, Mocrof, A, Le Moing, V, Dronda, F, Obel, N, Grabar, S, Spagnuolo, V, Antinori, A, Quiros-Roldan, E, Mussini, C, Miro, JM, Meyer, L, Hasse, B, Konopnicki, D, Roca, B, Barger, D, Raben, D, Cliford, GM, Franceschi, S, Brockmeyer, N, Chakraborty, R, Egger, M & Bohlius, J 2017, 'Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study', Clinical Infectious Diseases, vol. 65, no. 8, pp. 1316-1326. https://doi.org/10.1093/cid/cix480

@article{bb3ee3eb9638423ca032a34f62d2f395,

title = "Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study",

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.",

keywords = "Antiretroviral therapy, Cohort study, HIV, Kaposi sarcoma",

author = "Eliane Rohner and Lukas B{\"u}tikofer and Kurt Schmidlin and Mazvita Sengayi and Mhairi Maskew and Janet Giddy and Daniela Garone and Moore, {Richard D.} and Gypsyamber D'Souza and Goedert, {James J.} and Chad Achenbach and Gill, {M. John} and Kitahata, {Mari M.} and Pragna Patel and Silverberg, {Michael J.} and Jessica Castilho and Catherine McGowan and Chen, {Yi Ming Arthur} and Matthew Law and Ninon Taylor and Vassilios Paparizos and Fabrice Bonnet and Annelies Verbon and Gerd F{\"a}tkenheuer and Post, {Frank A.} and Caroline Sabin and Amanda Mocrof and {Le Moing}, Vincent and Fernando Dronda and Niels Obel and Sophie Grabar and Vincenzo Spagnuolo and Andrea Antinori and Eugenia Quiros-Roldan and Cristina Mussini and Miro, {Jos{\'e} M.} and Laurence Meyer and Barbara Hasse and Deborah Konopnicki and Bernardino Roca and Diana Barger and Dorthe Raben and Cliford, {Gary M.} and Silvia Franceschi and Norbert Brockmeyer and Rana Chakraborty and Matthias Egger and Julia Bohlius",

year = "2017",

doi = "10.1093/cid/cix480",

language = "English",

volume = "65",

pages = "1316--1326",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "8",

}

TY - JOUR

T1 - Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents

T2 - A multiregional multicohort study

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 - Mocrof, 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 - Cliford, Gary M.

AU - Franceschi, Silvia

AU - Brockmeyer, Norbert

AU - Chakraborty, Rana

AU - Egger, Matthias

AU - Bohlius, Julia

PY - 2017

Y1 - 2017

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

U2 - 10.1093/cid/cix480

DO - 10.1093/cid/cix480

M3 - Journal article

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 -

Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study

Abstract

Keywords

UN SDGs

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