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

Natascha Wyss, Marcel Zwahlen, Gary Clifford, Maria Campbell, Rana Chakraborty, Fabrice Bonnet, Geneviève Chene, Firouze Bani-Sadr, Annelies Verbon, Robert Zangerle, Vassilios Paparizos, Maria Prins, Fernando Dronda, Vincent Le Moing, Andrea Antinori, Eugenia Quiros-Roldan, Cristina Mussini, Jose M. Miro, Laurence Meyer, Janne VehreschildNiels Obel, Amanda Mocroft, Norbert Brockmeyer, François Boue, Caroline Sabin, Vincenzo Spagnuolo, Barbara Hasse, Stéphane De Wit, Bernardino Roca, Matthias Egger, Julia Bohlius

Research output: Contribution to journalArticle

11 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 languageEnglish
Pages (from-to)1373-1379
Number of pages7
JournalClinical Infectious Diseases
Volume63
Issue number10
DOIs
Publication statusPublished - Nov 15 2016

Fingerprint

Kaposi's Sarcoma
Cohort Studies
Incidence
Therapeutics
HIV
CD4 Lymphocyte Count
Viral Load
Proportional Hazards Models
HIV-1
Age Groups
Observation
RNA
Confidence Intervals

Keywords

  • adults
  • antiretroviral therapy
  • HIV
  • Kaposi sarcoma
  • risk factors

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Changing Incidence and Risk Factors for Kaposi Sarcoma by Time since Starting Antiretroviral Therapy : Collaborative Analysis of 21 European Cohort Studies. / Wyss, Natascha; Zwahlen, Marcel; Clifford, Gary; Campbell, Maria; Chakraborty, Rana; Bonnet, Fabrice; Chene, Geneviève; Bani-Sadr, Firouze; Verbon, Annelies; Zangerle, Robert; Paparizos, Vassilios; Prins, Maria; Dronda, Fernando; Le Moing, Vincent; Antinori, Andrea; Quiros-Roldan, Eugenia; Mussini, Cristina; Miro, Jose M.; Meyer, Laurence; Vehreschild, Janne; Obel, Niels; Mocroft, Amanda; Brockmeyer, Norbert; Boue, François; Sabin, Caroline; Spagnuolo, Vincenzo; Hasse, Barbara; De Wit, Stéphane; Roca, Bernardino; Egger, Matthias; Bohlius, Julia.

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

Research output: Contribution to journalArticle

Wyss, N, Zwahlen, M, Clifford, G, Campbell, M, Chakraborty, R, Bonnet, F, Chene, G, Bani-Sadr, F, Verbon, A, Zangerle, R, Paparizos, V, Prins, M, Dronda, F, Le Moing, V, Antinori, A, Quiros-Roldan, E, Mussini, C, Miro, JM, Meyer, L, Vehreschild, J, Obel, N, Mocroft, A, Brockmeyer, N, Boue, F, Sabin, C, Spagnuolo, V, Hasse, B, De Wit, S, Roca, B, Egger, M & Bohlius, J 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
Wyss, Natascha ; Zwahlen, Marcel ; Clifford, Gary ; Campbell, Maria ; Chakraborty, Rana ; Bonnet, Fabrice ; Chene, Geneviève ; Bani-Sadr, Firouze ; Verbon, Annelies ; Zangerle, Robert ; Paparizos, Vassilios ; Prins, Maria ; Dronda, Fernando ; Le Moing, Vincent ; Antinori, Andrea ; Quiros-Roldan, Eugenia ; Mussini, Cristina ; Miro, Jose M. ; Meyer, Laurence ; Vehreschild, Janne ; Obel, Niels ; Mocroft, Amanda ; Brockmeyer, Norbert ; Boue, François ; Sabin, Caroline ; Spagnuolo, Vincenzo ; Hasse, Barbara ; De Wit, Stéphane ; Roca, Bernardino ; Egger, Matthias ; Bohlius, Julia. / 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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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.

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