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

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Cancer Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume (Issue) 63(10)
Page(s) 1373 - 1379
Title of proceedings Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
DOI 10.1093/cid/ciw562

Open Access

URL https://doi.org/10.1093/cid/ciw562
Type of Open Access Publisher (Gold Open Access)

Abstract

 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.  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.  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).  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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