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 - Clifford, Gary
AU - Campbell, Maria
AU - Chakraborty, Rana
AU - Bonnet, Fabrice
AU - Chene, Geneviève
AU - Bani-Sadr, Firouze
AU - Verbon, Annelies
AU - Zangerle, Robert
AU - Paparizos, Vassilios
AU - Prins, Maria
AU - Dronda, Fernando
AU - Le Moing, Vincent
AU - Antinori, Andrea
AU - Quiros-Roldan, Eugenia
AU - Mussini, Cristina
AU - Miro, Jose M.
AU - Meyer, Laurence
AU - Vehreschild, Janne
AU - Obel, Niels
AU - Mocroft, Amanda
AU - Brockmeyer, Norbert
AU - Boue, François
AU - Sabin, Caroline
AU - Spagnuolo, Vincenzo
AU - Hasse, Barbara
AU - De Wit, Stéphane
AU - Roca, Bernardino
AU - Egger, Matthias
AU - Bohlius, Julia
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 - adults
KW - antiretroviral therapy
KW - HIV
KW - Kaposi sarcoma
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=84994452820&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994452820&partnerID=8YFLogxK
U2 - 10.1093/cid/ciw562
DO - 10.1093/cid/ciw562
M3 - Article
AN - SCOPUS:84994452820
VL - 63
SP - 1373
EP - 1379
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 10
ER -