title: Kaposi's Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era.
abstract: The incidence of Kaposi's Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV-infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time-updated CD4 cell counts and HIV-1 RNA. A total of 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person-years follow-up 162 patients developed KS. The incidence was 1,682/100,000 person-years (95% confidence interval [CI] 1,406-2,011) among patients not receiving ART and 138/100,000 person-years (95% CI 102-187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13-0.28). Low CD4 cell counts (time-updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9-80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to prevent KS and KS-associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Bohlius
authors.forename: Fabio
authors.initials: F
authors.lastname: Valeri
authors.forename: Mhairi
authors.initials: M
authors.lastname: Maskew
authors.forename: Hans
authors.initials: H
authors.lastname: Prozesky
authors.forename: Daniela
authors.initials: D
authors.lastname: Garone
authors.forename: Mazvita
authors.initials: M
authors.lastname: Sengayi
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012514:Sarcoma, Kaposi / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV/AIDS; Kaposi Sarcoma incidence; South Africa; antiretroviral therapy; epidemiology
references.citation: Curr Opin Virol. 2012 Aug;2(4):482-8
references.pmid: 22795202
references.citation: Lancet Oncol. 2007 Feb;8(2):167-76
references.pmid: 17267331
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1999 Apr 1;20(4):337-41
references.pmid: 10096577
references.citation: Lancet Oncol. 2008 Jul;9(7):683-92
references.pmid: 18598933
references.citation: Lancet. 2000 Jul 22;356(9226):291-6
references.pmid: 11071184
references.citation: J Clin Oncol. 2006 Jul 20;24(21):3408-14
references.pmid: 16849755
references.citation: Int J Cancer. 2003 Jan 1;103(1):142-4
references.pmid: 12455069
references.citation: J Med Virol. 2011 Mar;83(3):384-90
references.pmid: 21264857
references.citation: Int J Epidemiol. 2012 Oct;41(5):1256-64
references.pmid: 21593078
references.citation: Glob Health Action. 2012 Dec 27;5:1-19
references.pmid: 23273252
references.citation: AIDS. 2013 Feb 20;27(4):635-43
references.pmid: 23196937
references.citation: Lancet Oncol. 2012 Aug;13(8):745-6
references.pmid: 22846827
references.citation: Int J Cancer. 2013 Aug 1;133(3):721-9
references.pmid: 23364833
references.citation: J Acquir Immune Defic Syndr. 2009 May 1;51(1):105-6
references.pmid: 19390330
references.citation: J Clin Virol. 2006 Apr;35(4):442-9
references.pmid: 16414306
references.citation: PLoS One. 2013;8(1):e53145
references.pmid: 23301033
references.citation: J Acquir Immune Defic Syndr. 2005 Jul 1;39(3):293-9
references.pmid: 15980688
references.citation: AIDS. 2008 Feb 19;22(4):519-26
references.pmid: 18301065
references.citation: Int J Epidemiol. 2013 Apr;42(2):430-9
references.pmid: 22434860
references.citation: Lancet Oncol. 2009 Dec;10(12):1152-9
references.pmid: 19818686
references.citation: J Natl Cancer Inst. 2010 Jun 2;102(11):784-92
references.pmid: 20442214
references.citation: Lancet. 2006 Aug 5;368(9534):505-10
references.pmid: 16890837
references.citation: AIDS. 2010 Feb 20;24(4):563-72
references.pmid: 20057311
references.citation: BMJ. 1999 Jul 3;319(7201):23-4
references.pmid: 10390454
references.citation: Cancer Lett. 2011 Jun 28;305(2):150-62
references.pmid: 21377267
references.citation: JAMA. 1999 Dec 15;282(23):2220-6
references.pmid: 10605973
references.citation: J Natl Cancer Inst. 2000 Nov 15;92(22):1823-30
references.pmid: 11078759
references.citation: J Acquir Immune Defic Syndr. 2007 Mar 1;44(3):306-8
references.pmid: 17146369
references.citation: Trop Med Int Health. 2010 Apr;15(4):405-13
references.pmid: 20180931
references.citation: AIDS. 2011 Feb 20;25(4):463-71
references.pmid: 21139489
references.citation: Lancet Oncol. 2003 Sep;4(9):537-47
references.pmid: 12965274
references.citation: Curr Opin Oncol. 2012 Sep;24(5):522-30
references.pmid: 22729153
references.citation: N Engl J Med. 1998 Apr 2;338(14):948-54
references.pmid: 9521982
references.citation: Infect Agent Cancer. 2011 Nov 17;6:22
references.pmid: 22093140
references.citation: Int J Cancer. 2008 Jul 1;123(1):187-94
references.pmid: 18435450
references.citation: Br J Cancer. 2008 Sep 2;99(5):800-4
references.pmid: 18665172
references.citation: J Int AIDS Soc. 2010 Jul 08;13:23
references.pmid: 20615222
references.citation: N Engl J Med. 1999 Jun 17;340(24):1863-71
references.pmid: 10369849
references.citation: J Natl Cancer Inst. 2005 Mar 16;97(6):425-32
references.pmid: 15770006
references.citation: Int J Cancer. 2010 Nov 15;127(10):2420-9
references.pmid: 20162610
references.citation: J Acquir Immune Defic Syndr. 2012 Jun 1;60(2):150-7
references.pmid: 22395672