Publication

Journal	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Title of proceedings	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
DOI	10.1093/cid/cix480

URL	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850623/
Type of Open Access	Repository (Green Open Access)

We compared Kaposi sarcoma (KS) risk in adults who initiated antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. We included cohort data of HIV-positive adults who initiated ART after 1995 within the framework of two large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). We included 208,140 patients from 57 countries. Over 1,066,572 person-years (pys) 2,046 KS cases were diagnosed. KS incidence rates per 100,000 pys were 52 in the Asia-Pacific, and ranged between 180 and 280 in the other regions. KS risk was five times higher in South African women (aHR 4.56, 95% confidence intervals [CI] 2.73-7.62) and two times higher in South African men (aHR 2.21, 95% CI 1.34-3.63) compared to their European counterparts. In Europe, Latin, and North America KS risk was six times higher in men who have sex with men (MSM, aHR 5.95, 95% CI 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µl to those with CD4 counts <50 cells/µl, KS risk was halved in South Africa (aHR 0.53, 95% CI 0.17-1.63), but reduced by ≥95% in other regions. Despite important ART-related declines in KS incidence, men and women in South Africa and MSM remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintaining high CD4 cell counts are essential to further reduce KS incidence worldwide, but especially in Southern Africa additional measures might be needed.