Ultraviolet Radiation and Kaposi Sarcoma Incidence in a Nationwide US Cohort of HIV-Infected Men

Ek, Cahoon; Engels, EA; Dm, Freedman; Norval, Mary; Pfeiffer, RM

doi:10.1093/jnci/djw267

Cited by 16 publications

(8 citation statements)

References 41 publications

(48 reference statements)

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“…Although based on small numbers, we found that KS risk was significantly higher in transplant recipients with diagnosis of squamous cell carcinoma. Notably, this finding supports our previous finding of increased KS risk in HIV‐infected men with non‐KS skin cancers and several case studies reported in the literature . Rather than being explained by UVR, our findings may instead be explained by drug‐induced immunosuppression causing both KS and non‐KS skin cancers in the same people.…”

Section: Discussionsupporting

confidence: 92%

“…KS risk was not related to ambient UVR in this transplant population. In contrast, we recently found a significantly increased risk of KS with high ambient UVR in a population of HIV‐infected men . Since all subjects had HIV in that study, and because HIV and HHV8 infection often co‐occur in the same groups (e.g., men who have sex with men [MSM]), the associations with ambient UVR were somewhat protected from confounding by geographic differences in HHV8 prevalence.…”

Section: Discussionmentioning

confidence: 86%

“…Internationally, KS incidence varies notably due to large differences in the prevalence of HHV8 infection. Recently, increased risk of KS has been associated with higher ambient ultraviolet radiation (UVR) and history of cutaneous basal or squamous cell carcinoma (referred to collectively as “keratinocyte carcinomas”) among HIV‐infected men . Transplant recipients have a very high risk of keratinocyte carcinoma, but the association of ambient UVR or non‐KS skin cancers with KS risk has not been assessed among transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of Kaposi sarcoma after solid organ transplantation in the United States

Cahoon

Linet

Clarke

et al. 2018

Intl Journal of Cancer

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Due to treatment with immunosuppressive medications, solid organ transplant recipients have elevated risk for Kaposi sarcoma (KS), which is caused by human herpesvirus 8 (HHV8). Other risk factors for KS are poorly understood. We linked the United States solid organ transplant registry with 17 population-based cancer registries to ascertain KS incidence among 244,964 transplant recipients from 1987-2014. To compare incidence rates of KS according to patient and transplant characteristics, we calculated incidence rate ratios (IRRs) using Poisson regression. To compare associations of KS with other skin cancers occurring before or within 12 months of KS diagnosis, we computed odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression. All statistical tests were two-sided. We identified 163 KS cases during follow-up. Among transplant recipients, we found significantly increased risk of KS associated with male sex (IRR = 1.87; 95%CI:1.32,2.71), nonwhite race (IRR = 2.67; 95%CI:1.92,3.72), non-US citizenship (IRR = 2.10; 95%CI:1.19,3.47), lung transplant (IRR = 2.22; 95%CI:1.03,4.24, vs. kidney), and older age at transplant. KS risk decreased significantly with time since transplant and recent calendar year, however, no specific induction or maintenance medication was associated with KS. KS incidence was not significantly associated with ambient ultraviolet radiation (IRR = 1.32 95%CI:0.87,2.02, tertile 3 vs. 1). KS incidence has decreased in recent calendar years. In a cross-sectional sample, we found cutaneous squamous cell carcinoma was associated with KS (OR = 4.83; 95%CI:1.30,14.69). KS risk factors included those potentially associated with HHV8 infection and increased immunosuppression. Our findings suggest that transplant recipients with a non-KS skin cancer may also be at high KS risk.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Risk of Kaposi sarcoma after solid organ transplantation in the United States

Cahoon

Linet

Clarke

et al. 2018

Intl Journal of Cancer

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“…Average annual residential UVB exposure was calculated by linking residential zip codes to daily estimates of cloud-adjusted noon-time UVB radiation from a national database, 18 a method that has effectively been used to capture sun exposure in prior studies. 19,20 Cox regression was used to estimate the associations of these characteristics with melanoma incidence in the HIV population using study follow-up time as the time scale. Associations of time-updated CD4 count, time-updated HIV RNA level, and time-updated ART status with incident melanoma were also estimated after adjusting for sex, time-updated age and calendar year, average annual residential UVB, and cohort.…”

Section: Methodsmentioning

confidence: 99%

Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada

Yanik

Hernández-Ramírez

Qin³

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Another common skin tumour in HIV-positive individuals is Kaposi's sarcoma, although its incidence has declined markedly since the advent of antiretroviral therapy. There is limited evidence from epidemiological studies to indicate that exposure to solar UVR increases the risk of Kaposi's sarcoma [42].…”

Section: Risk Factors For the Development Of Skin Cancer In Southern mentioning

confidence: 99%

The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa

Wright

Preez

Millar

et al. 2020

IJERPH

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Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized.

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Ultraviolet Radiation and Kaposi Sarcoma Incidence in a Nationwide US Cohort of HIV-Infected Men

Abstract: 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.

Cited by 16 publications

References 41 publications

Risk of Kaposi sarcoma after solid organ transplantation in the United States

Risk of Kaposi sarcoma after solid organ transplantation in the United States

Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada

The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa

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