Kaposi Sarcoma Incidence, Burden, and Prevalence in United States People with HIV, 2000–2015

Abstract

Background: The introduction of combination antiretroviral therapy (cART) has led to a significant reduction in Kaposi sarcoma (KS) incidence among people with HIV (PWH). However, it is unclear if incidence has declined similarly across key demographic and HIV transmission groups and the annual number of incident and prevalent KS cases remains unquantified. Methods: Using population-based registry linkage data, we evaluated temporal trends in KS incidence using adjusted Poisson regression. Incidence and prevalence estimates were applied to CDC HIV surveillance data, to obtain the number of incident (2008–2015) and prevalent (2015) cases in the United States. Results: Among PWH, KS rates were elevated 521-fold [95% confidence intervals (CI), 498–536] compared with the general population and declined from 109 per 100,000 person-years in 2000 to 47 per 100,000 person-years in 2015, at an annual percentage change of −6%. Rates declined substantially (Ptrend < 0.005) across all demographic and HIV transmission groups. Of the 5,306 new cases estimated between 2008 and 2015, 89% occurred among men who have sex with men. At the end of 2015, 1,904 PWH (0.20%) had been diagnosed with KS in the previous 5 years. Conclusions: A consistent gradual decline in KS incidence has occurred among PWH in the United States during the current cART era. This decrease is uniform across key demographic and HIV transmission groups, though rates remain elevated relative to the general population. Impact: Continued efforts to control HIV through early cART initiation and retention in care need to be maintained and possibly expanded to sustain declines.

Burden of Kaposi sarcoma according to HIV status: A systematic review and global analysis

“…Of note, in the United States, the proportion of KS cases diagnosed among PLWHIV (ie, PAF) has been shown to remain relatively stable in the cART era, 35 despite that the risk of KS for PLWHIV has substantially declined. 9 Given that even experienced clinicians can misdiagnose KS, 18,36 histological confirmation is highly important to studies of the epidemiology of KS, and was widespread in most of the research studies contributing to PAF estimates. However, histological confirmation is lacking in a majority of KS cases in SSA, 37 and subsequently in the registry data that underpin the GLOBOCAN KS rates 11 (cancer registries have little influence on the availability, or use, of pathology services within their catchment area).…”

“…The introduction of combination antiretroviral therapy (cART) subsequently led to a dramatic decline in KS incidence in people living with HIV (PLWHIV) in high‐income settings 7,8 . As an example, relative to the general population, KS rates in PLWHIV in the United States decreased from 2800‐fold in the pre‐cART era (1991‐1995) and to 260‐fold in 2009 to 2012 9 . However, decreases have not been uniform by geography and ethnicity, even within the United States 10 .…”

Epidemiology of Kaposi’s Sarcoma

“…With the advent of combined antiretroviral treatment (cART) in 1996, and the resulting virological and immunological control of HIV infection, the incidence rate of KS has dramatically declined over time [20,22,[31][32][33][34][35]. The relative reduction of the incidence of KS between the pre-and post-cART era has been more than 60% [22,36,37], from more than 3000 to less than 100/100,000 person years [35,38,39]. The decline was sharper during the first periods of cART availability and for MSM [31,33].…”

“…The most recent data from the USA indicate that the risk of KS is still decreasing [35,38]. In a comprehensive analysis of KS trends among PLHIV in America between 2008 and 2016, a significant continuous decline was reported nationally (−3.2% per year) but also showed stagnation of this decline in certain states and in younger and black PLHIV, probably explained by unequal access to HIV medical care, calling for a continuous effort towards the early diagnosis and treatment of HIV [38].…”

Transcriptional analysis identifies overlapping and tissue-distinct profiles between Kaposi sarcoma tumors of the skin and gastrointestinal tract

“…These conditions can occur alone or concurrently in the same patient and have different prognoses (6,7). Within the United States, KS is seen predominantly among people living with HIV (PLWH), although the incidence of HIV-associated KS has decreased over time with advances in HIV treatment (8). However, KS remains one of the most common HIV-associated tumors in the US (noted as epidemic KS) and is one of the most common cancers overall in parts of sub-Saharan Africa, where endemic KS and epidemic KS contribute significantly to morbidity and mortality in this region (9).…”