title: Ultraviolet Radiation and Kaposi Sarcoma Incidence in a Nationwide US Cohort of HIV-Infected Men.
abstract: Although ultraviolet radiation (UVR) is established as both an inducer of herpes simplex virus reactivation and as the primary risk factor for many common skin cancers, its relationship with human herpes virus 8 (HHV8) infection or risk of Kaposi sarcoma (KS) is unknown.
  
  
  
  Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the association between ambient UVR, history of nonmelanoma skin cancer (NMSC; as a biomarker of personal cumulative UVR dose), and incidence of first primary KS in a nationwide US cohort of white and African American male veterans infected with HIV between 1986 and 1996 (prior to the widespread availability of treatment) using Cox regression. All statistical tests were two-sided.
  
  
  
  Based on discharge records, there were 422 newly diagnosed KS cases among 17 597 HIV-infected veterans. Cohort members with prior NMSC had a statistically significantly increased risk of KS (HR = 8.64, 95% CI = 6.23 to 11.96) in the total population. Risk of KS was higher for quartile 4 vs 1 among the total population (HR = 1.49, 95% CI = 1.02 to 2.16, PtrendUVR quartile [coded 1 to 4] = .02) and among whites (HR = 1.75, 95% CI = 1.11 to 2.78, Ptrend= .009), but not among African Americans (HR = 1.23, 95% CI = 0.71 to 2.15, Ptrend= .23).
  
  
  
  KS risk was elevated among HIV-infected men with NMSC diagnosis and in those living in locations with high ambient UVR at time of HIV diagnosis. Our novel findings suggesting that UVR exposure may increase KS risk warrant further investigation.
authors.affiliation: Affiliations of authors: Radiation Epidemiology Branch (EKC, MF), Infectious and Immunoepidemiology Branch (EAE), and Biostatistics Branch (RMP), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland (MN).
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Cahoon
authors.affiliation: Affiliations of authors: Radiation Epidemiology Branch (EKC, MF), Infectious and Immunoepidemiology Branch (EAE), and Biostatistics Branch (RMP), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland (MN).
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.affiliation: Affiliations of authors: Radiation Epidemiology Branch (EKC, MF), Infectious and Immunoepidemiology Branch (EAE), and Biostatistics Branch (RMP), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland (MN).
authors.forename: D Michal
authors.initials: DM
authors.lastname: Freedman
authors.affiliation: Affiliations of authors: Radiation Epidemiology Branch (EKC, MF), Infectious and Immunoepidemiology Branch (EAE), and Biostatistics Branch (RMP), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland (MN).
authors.forename: Mary
authors.initials: M
authors.lastname: Norval
authors.affiliation: Affiliations of authors: Radiation Epidemiology Branch (EKC, MF), Infectious and Immunoepidemiology Branch (EAE), and Biostatistics Branch (RMP), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland (MN).
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
mesh_terms: D000328:Adult; D001741:Black or African American; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D014466:Ultraviolet Rays / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D044465:White People