title: Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case-control study in Kenya.
abstract: OBJECTIVE
  This study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients.
  
  
  METHODS
  We conducted a retrospective nested case-control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5 years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS.
  
  
  RESULTS
  Only 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2-105.1]. Patients with low latest CD4 count (≤350 cells/mm3) had a seven-times greater risk of developing KS than did their counterparts (HRs: 7.1, 95% CI: 1.4-36.2).
  
  
  CONCLUSIONS
  Imperfect HAART adherence and low latest CD4 count are significantly associated with KS development.
authors.affiliation: Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
authors.forename: Rodgers
authors.initials: R
authors.lastname: Lupia
authors.affiliation: Comprehensive Care Clinic Department, ACK Maseno Hospital, Maseno, Kenya.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Wabuyia
authors.affiliation: Comprehensive Care Clinic Department, ACK Maseno Hospital, Maseno, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Otiato
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Fang
authors.affiliation: Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. Electronic address: jeanfjtsai@tmu.edu.tw.
authors.forename: Feng-Jen
authors.initials: FJ
authors.lastname: Tsai
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000821:virology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D060085:Coinfection / Q000453:epidemiology* / Q000821:virology; D004522:Educational Status; D005260:Female; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000188:drug therapy / Q000453:epidemiology*; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Kaposi's sarcoma; Kenya; Maseno; antiretroviral therapy; highly active antiretroviral therapy; human immunodeficiency virus/AIDS treatment