Prospective evaluation of the impact of potent antiretroviral therapy on the incidence of Kaposi’s Sarcoma in East Africa: findings from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium

Martin, Jeffrey N.; Wenger, Megan; Busakhala, Naftali; Buziba, Nathan; Bwana, Mwebesa; Muyindike, Winnie; Mbabazi, Ruth; Amerson, Erin; Yiannoutsos, Constantin T.; Musick, Beverly; LeBoit, Philip E.; McCalmont, Timothy H.; Ruben, Beth S.; Maurer, Toby; Wools‐Kaloustian, Kara

doi:10.1186/1750-9378-7-s1-o19

Cited by 11 publications

(27 citation statements)

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“…13 However, to date, no standard definition of incident KS exists and cut offs are chosen arbitrarily with lag times commonly ranging between 0 and 90 days. 8;11;14 In our as in other studies KS incidence rate was highest within the first six months after ART initiation and declined steeply thereafter. 15;16 The high KS incidence rate observed within the first six months on ART might partly be explained by prevalent cases which have been misclassified as incident cases, but also by unmasking immune reconstitution inflammatory syndrome (IRIS).…”

Section: Discussionsupporting

confidence: 76%

“…The incidence rate we estimated (in adult patients 173/100,000) is not far from incidence rates observed in adult HIV-infected patients on ART in Uganda (201/100,000), Kenya (270/100,000) 8 and Switzerland (130/100,000), 11 see Table 3. Fink et al .…”

Section: Discussionmentioning

confidence: 52%

“…This finding is consistent with those of previous studies conducted in high-income 19;29 and low-income settings. 8 Because maintaining CD4 cell counts ≥500 cells/µl decreases the risk of developing KS, it seems likely that starting ART at CD4 cell counts <500 cells/µl – as recently recommended by the WHO 30 – could further reduce the incident KS burden.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies conducted in Africa found KS incidence rates between 138/100,000 and 340/100,000 person-years in patients treated with ART. 5;8;9 These estimates suggest that the risk of developing KS in patients on ART is still substantial. In order to effectively plan and implement measures to reduce the KS burden in Africa, more reliable information on the KS risk in patients on ART and associated risk factors is needed.…”

Section: Introductionmentioning

confidence: 99%

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Incidence Rate of Kaposi Sarcoma in HIV-Infected Patients on Antiretroviral Therapy in Southern Africa

Rohner

Valeri

Maskew

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The risk of Kaposi sarcoma (KS) among HIV-infected persons on antiretroviral therapy (ART) is not well defined in resource-limited settings. We studied KS incidence rates and associated risk factors in children and adults on ART in Southern Africa. Methods We included patient data of six ART programs in Botswana, South Africa, Zambia, and Zimbabwe. We estimated KS incidence rates in patients on ART measuring time from 30 days after ART initiation to KS diagnosis, last follow-up visit, or death. We assessed risk factors (age, sex, calendar year, WHO stage, tuberculosis, and CD4 counts) using Cox models. Findings We analyzed data from 173,245 patients (61% female, 8% children aged <16 years) who started ART between 2004 and 2010. 564 incident cases were diagnosed during 343,927 person-years (pys). KS incidence rate overall was 164/100,000 pys (95% confidence interval [CI] 151–178). The incidence rate was highest 30 to 90 days after ART initiation (413/100,000 pys; 95% CI 342–497) and declined thereafter (86/100,000 pys[95% CI 71–105]>2 years after ART initiation). Male sex (adjusted hazard ratio [HR] 1.34; 95% CI 1.12–1.61), low current CD4 counts (≥500 cells/µL versus <50 cells/µL, adjusted HR 0.36; 95% CI 0.23–0.55) and age (5 to 9 years versus 30 to 39 years, adjusted HR 0.20; 95% CI 0.05–0.79) were relevant risk factors for developing KS. Interpretation Despite ART, KS risk in HIV-infected persons in Southern Africa remains high. Early HIV testing and maintaining high CD4 counts is needed to further reduce KS-related morbidity and mortality.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence Rate of Kaposi Sarcoma in HIV-Infected Patients on Antiretroviral Therapy in Southern Africa

Rohner

Valeri

Maskew

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…One Ugandan study utilized data from the Kampala Cancer Registry (KCR) to compared cancer rates in patients from a large HIV clinic to those in the general population, and observed significantly elevated cancer risk associated with an AIDS diagnosis [15]. Data from Uganda and Kenya have also recently demonstrated declines in individual Kaposi sarcoma (KS) risk in HIV-infected patients after ART treatment [16]. However, the association between successful HIV treatment and declining KS incidence on a population level in Uganda is not as clear as the dramatic declines observed after the introduction of ART in the US [13,17–22].…”

Section: Introductionmentioning

confidence: 99%

Contribution of HIV infection to mortality among cancer patients in Uganda

Coghill

Newcomb

Madeleine

et al. 2013

Aids

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Objective HIV infection is associated with cancer risk. This relationship has resulted in a growing cancer burden, especially in resource-limited countries where HIV is highly prevalent. Little is known, however, about how HIV affects cancer survival in these settings. We therefore investigated the role of HIV in cancer survival in Uganda. Design Retrospective cohort (N = 802). Methods Eligible cancer patients were residents of Kyadondo County, at least 18 years of age at cancer diagnosis, and diagnosed between 2003 and 2010 with one of the following: breast cancer, cervical cancer, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, or esophageal cancer. Patients were classified as HIV-infected at cancer diagnosis based on a documented positive HIV antibody test, medical history indicating HIV infection, or an HIV clinic referral letter. The primary outcome, vital status at 1 year following cancer diagnosis, was abstracted from the medical record or determined through linkage to the national hospice database. The risk of death during the year after cancer diagnosis was compared between cancer patients with and without evidence of HIV infection using Cox proportional hazards regression. Results HIV-infected cancer patients in Uganda experienced a more than two-fold increased risk of death during the year following cancer diagnosis compared to HIV-uninfected cancer patients [hazard ratio 2.28; 95% confidence interval (CI) 1.61–3.23]. This association between HIV and 1-year cancer survival was observed for both cancers with (hazard ratio 1.56; 95% CI 1.04–2.34) and without (hazard ratio 2.68; 95% CI 1.20–5.99) an infectious cause. Conclusion This study demonstrates the role of HIV in cancer survival for both cancers with and without an infectious cause in a resource-limited, HIV-endemic setting.

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Kaposi's Sarcoma in HIV‐infected patients in South Africa: Multicohort study in the antiretroviral therapy era

Bohlius

Valeri

Maskew

et al. 2014

Intl Journal of Cancer

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The incidence of Kaposi’s Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV-infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time-updated CD4 cell counts and HIV-1 RNA. 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person-years follow-up 162 patients developed KS. The incidence was 1,682/100,000 person-years (95% confidence interval [CI] 1,406–2,011) among patients not receiving ART and 138/100,000 person-years (95% CI 102–187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13–0.28). Low CD4 cell counts (time-updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9–80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to preventing KS and KS-associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV.

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Prospective evaluation of the impact of potent antiretroviral therapy on the incidence of Kaposi’s Sarcoma in East Africa: findings from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium

Abstract: Martin et al.: Prospective evaluation of the impact of potent antiretroviral therapy on the incidence of Kaposi's Sarcoma in East Africa: findings from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium. Infectious Agents and Cancer 2012 7 (Suppl 1):O19.

Cited by 11 publications

References 0 publications

Incidence Rate of Kaposi Sarcoma in HIV-Infected Patients on Antiretroviral Therapy in Southern Africa

Incidence Rate of Kaposi Sarcoma in HIV-Infected Patients on Antiretroviral Therapy in Southern Africa

Contribution of HIV infection to mortality among cancer patients in Uganda

Kaposi's Sarcoma in HIV‐infected patients in South Africa: Multicohort study in the antiretroviral therapy era

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