Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia

EuroCoord, Cohere in; Rohner, Eliane; Schmidlin, Kurt; Zwahlen, Marcel; Chakraborty, Rana; Clifford, Gary M.; Obel, Niels; Grabar, Sophie; Verbon, Annelies; Noguera-Julián, Antoni; Judd, Ali; Collins, Intira Jeannie; Rojo, Pablo; Brockmeyer, Norbert H.; Campbell, Maria; Chêne, Geneviève; Prozesky, Hans; Eley, Brian; Stefan, Daniela Cristina; Davidson, Alan; Chimbetete, Cleophas; Sawry, Shobna; Davies, Mary‐Ann; Egger, Matthias; Bohlius, Julia; Tanser, Frank; Vinikoor, Michael J.; Eusébio, Macete; Wood, Robin; Stinson, Kathryn; Garone, Daniela; Fatti, Geoffrey; Phiri, Sam; Giddy, Janet; Malisita, Kennedy; Fritz, Christiane; Hobbins, Michael; Kamenova, Kamelia; Fox, Matthew P.; Technau, Karl-Günter; Zangerle, Robert; Touloumi, Giota; Warszawski, Josiane; Meyer, Laurence; Dabis, François; Krause, M; Ghosn, Jade; Leport, Catherine; Wittkop, Linda; Reiss, Peter; Wit, Ferdinand W; Prins, Maria; Bucher, Heiner C.; Sabin, Caroline; Gibb, Diana; Fätkenheuer, Gerd; Amo, Julia del; Thorne, Claire; Mocroft, Amanda; Kirk, Ole; Stephan, Christoph; Pérez-Hoyos, Santiago; Hamouda, Osamah; Bartmeyer, Barbara; Chkhartishvili, Nikoloz; Antinori, Andrea; Monforte, Antonella d′Arminio; Prieto, Luís; Soriano‐Arandes, Antoni; Battegay, Manuel; Kouyos, Roger D.; Mussini, Cristina; Tookey, P; Casabona, Jordi; Miró, José M.; Castagna, Antonella; Konopnick, Deborah; Goetghebuer, Tessa; Sönnerborg, Anders; Torti, Carlo; Teira, Ramón; Garrido, Myriam; Haerry, David; Wit, Stéphane De; Costagliola, Dominique; Raben, Dorthe; Barger, Diana; Schwimmer, Christine; Termote, Monique; Frederiksen, Casper Møller; Friis-Møller, Nina; Berenguer, Juan; Bouteloup, Vincent; Cozzi‐Lepri, Alessandro; Davies, Miranda; Dorrucci, Maria; Dunn, David S.; Furrer, Hansjakob; Guiguet, Marguerite; Lambotte, Olivier; Leroy, Valériane; Lodi, Sara; Matheron, Sophie; Monge, Susana; Nakagawa, Fumiyo; Paredes, Roger; Peters, Lars; Phillips, Andrew; Puoti, Massimo; Schomaker, Michael; Smit, Colette; Sterne, J. A. C.; Thiébaut, Rodolphe; Valk, Marc van der; Ly, Penh Sun; Khol, V.; Sarun, S. M.; Vibol, Ung; Tucker, John; Kumarasamy, N.; Saghayam, Suneeta; Chandrasekaran, Ezhilarasi; Wati, Dewi Kumara; Atmikasari, Luh Putu Primi; Malino, Imanuel Yulius; Kurniati, Nia; Muktiarti, Dina; Fong, Siew Moy; Lim, Michael; Daut, F.; Yusoff, Nik Khairulddin Nik; Mohamad, P.; Razali, Kamarul Azahar Mohd; Mohamed, Thahira Jamal; Mohammed, N. A. D. R.; Nallusamy, Revathy; Chan, Kwai Cheng; Sudjaritruk, Tavitiya; Sirisanthana, Virat; Aurpibul, Linda; Oberdorfer, Peninnah; Hansudewechakul, Rawiwan; Denjanta, S.; Srisuk, W.; Kongphonoi, A.; Lumbiganon, Pagakrong; Kosalaraksa, Pope; Tharnprisan, Piangjit; Udomphanit, T.; Jourdain, Gonzague; Bunupuradah, Torsak; Puthanakit, Thanyawee; Prasitsuebsai, Wasana; Chanthaweethip, W.; Chokephaibulkit, Kulkanya; Lapphra, Keswadee; Phongsamart, Wanatpreeya; Sricharoenchai, Sirintip; Truong, K. H.; Du, Q. T.; Nguyen, C. H.; C., V.; Ha, TM; An, Vu Thien; Nguyen, Lam Van; Khu, D.T.K.; Pham, Anh Nguyet; Nguyen, LT; Le, ON; Sohn, Annette H.; Sethaputra, Chuenkamol; Cooper, DA; Law, Matthew; Kariminia, Azar

doi:10.1093/cid/ciw519

Cited by 13 publications

(15 citation statements)

References 32 publications

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“…This problem was addressed in a recent multiregional cohort study that directly compared the risk of developing KS in children starting cART in different geographic regions. Of the 24,991 HIV-infected children from Eastern Africa, Southern Africa and Europe starting cART, 26 children developed incident KS [15]. The study showed that KS (caused by an infection with Human Herpes Virus 8 (HHV-8)), is a frequent cancer in sub-Saharan Africa (SSA) and in SSA migrants in Europe, but cases are rare in children outside of this regions.…”

Section: Epidemiology Of Cancer In Hiv-infected Childrenmentioning

confidence: 99%

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HIV-associated malignancies in children

Singh

Naidu

Davies

et al. 2017

Current Opinion in HIV and AIDS

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Purpose of review HIV-infected children are at increased risk of developing cancer. Many of the cancers in HIV-infected children are linked to immunosuppression and oncogenic co-infections. Worldwide most HIV-infected children live in sub-Saharan Africa, but cancer data for this population are scarce. In this article we review the current literature on the epidemiology and prevention of cancer in HIV-infected children. Recent findings Combined antiretroviral therapy (cART) reduces the risk of developing cancer in HIV-infected children. Cancer risk remains increased in children who start cART at older ages or more advanced immunosuppression as compared to children who start cART at younger age and with mild immunosuppression. Starting cART before severe immunosuppression develops is key to prevent cancer in HIV-infected children but most children in low-income countries start cART at severe immunosuppression levels. Vaccination against high risk variants of human papilloma virus may protect again HPV-associated cancer later in life. However, tailoring of HPV-vaccination guidelines for HIV-infected children and young women awaits answers to determine the best vaccination strategies. Summary Better data on the short and long-term risk of developing cancer and the effects of preventive measures in HIV-infected children from regions with high burden of HIV/AIDS are urgently needed.

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Section: Epidemiology Of Cancer In Hiv-infected Childrenmentioning

confidence: 99%

“…Kaposi Sarcoma incidence rates per 100,000 person-years with 95% confidence intervals, adapted from [15]…”

Section: Figurementioning

confidence: 99%

HIV-associated malignancies in children

Singh

Naidu

Davies

et al. 2017

Current Opinion in HIV and AIDS

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“…The overwhelming prevalence of HIV in a region where HHV-8 is endemic explains the staggering discrepancy in KS incidence in HIV-infected children globally. 11 In the pre-antiretroviral therapy (ART) era in the US and Europe, there were merely 14 cases of childhood KS reported over a 20-year span of multiple HIV-cancer registries. 12 – 17 In comparison, several reports describing relatively large cohorts of children and adolescents with KS in sub-Saharan Africa have been published in the last decade.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

El‐Mallawany¹,

McAtee²,

Campbell³

et al. 2018

PHMT

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The global experience with pediatric Kaposi sarcoma (KS) has evolved immensely since the onset of HIV (human immunodeficiency virus). In this review, current perspectives on childhood KS are discussed in the context of the HIV epidemic in sub-Saharan Africa. Endemic (HIV-unrelated) KS was first described over 50 years ago in central and eastern Africa, regions where human herpesvirus-8, the causative agent of KS, is endemic. With the alarming rise in HIV prevalence over the past few decades, KS has become not only the most common HIV-related malignancy in Africa, but also one of the most common overall childhood cancers throughout the central, eastern, and southern regions of the continent. The unique clinical features of pediatric KS that were described in those early endemic KS reports have been re-affirmed by the contemporary experience with HIV-related KS. These characteristics include a predilection for primary lymph node involvement, significant proportions of patients lacking prototypical cutaneous lesions, and the potential for fulminant disease progression. Other clinical features that distinguish childhood KS from adult disease include disease presentation with severe cytopenias, and the common occurrence of childhood KS without severe CD4 count suppression. Distinct clinical heterogeneity in disease presentation and treatment response have been demonstrated. Long-term complete remission and event-free survival can be achieved—especially in children with lymphadenopathic KS—utilizing treatment with antiretroviral therapy plus mild–moderate chemotherapy regimens that are well tolerated, even in low-income settings. A pediatric-specific staging classification and risk-stratification platform have been retrospectively validated, and may help guide therapeutic strategies. With expansion of the HIV treatment infrastructure throughout Africa, coupled with recent developments in establishing comprehensive pediatric oncology programs, there is great potential for improving outcomes for children with KS. Increased awareness of the unique clinical nuances and collaborative evaluations of pediatric-specific treatment paradigms are required to optimize survival for children with KS.

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“…Currently, the most frequent cancers in AYALHIV are, depending on geographic region, Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL) and leiomyosarcoma [4,9–11]. KS is associated with Human Herpes virus 8 (HHV-8) infection; leiomyosarcoma and some NHL subtypes - with Epstein Barr virus (EBV) infection [12,13].…”

Section: Introductionmentioning

confidence: 99%

Cancer in adolescents and young adults living with HIV

Bohlius

Foster²,

Naidu

et al. 2018

Current Opinion in HIV and AIDS

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Although data are sparse, the increased cancer risk for AYALHIV is the cause for concern and must be modified by improving global access and uptake of antiretroviral therapy, human papilloma virus (HPV) and hepatitis B virus (HBV) vaccination, screening for hepatitis B and C infection, and optimized cancer screening programs. Education aimed at reducing traditional modifiable cancer risk factors should be embedded within multidisciplinary services for AYALHIV.

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Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia

Abstract: HIV-infected children from SSA but not those from other regions, have a high risk of developing KS after cART initiation. Early cART initiation in these children might reduce KS risk.

Cited by 13 publications

References 32 publications

HIV-associated malignancies in children

HIV-associated malignancies in children

Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

Cancer in adolescents and young adults living with HIV

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