@article{3177445,
    title = "Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency
Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort
Study",
    author = "Rohner, Eliane and Butikofer, Lukas and Schmidlin, Kurt and Sengayi, and Mazvita and Maskew, Mhairi and Giddy, Janet and Garone, Daniela and and Moore, Richard D. and D'Souza, Gypsamber and Goedert, James J. and and Achenbach, Chad and Gill, M. John and Kitahata, Mari M. and Patel, and Pragna and Silverberg, Michael J. and Castilho, Jessica and McGowan, and Catherine and Chen, Yi-Ming Arthur and Law, Matthew and Taylor, Ninon and and Paparizos, Vassilios and Bonnet, Fabrice and Verbon, Annelies and and Fatkenheuer, Gerd and Post, Frank A. and Sabin, Caroline and Mocroft, and Amanda and Le Moing, Vincent and Dronda, Fernando and Obel, Niels and and Grabar, Sophie and Spagnuolo, Vincenzo and Antinori, Andrea and and Quiros-Roldan, Eugenia and Mussini, Cristina and Miro, Jose M. and and Meyer, Laurence and Hasse, Barbara and Konopnicki, Deborah and Roca, and Bernardino and Barger, Diana and Raben, Dorthe and Clifford, Gary M. and and Franceschi, Silva and Brookmeyer, Norbert and Chakraborty, Rana and and Egger, Matthias and Bohlius, Julia and The Aids-Defining Cancer Project and and Cohere In EuroCoord",
    journal = "Clinical Infectious Diseases",
    year = "2017",
    volume = "65",
    number = "8",
    pages = "1316-1326",
    publisher = "OXFORD UNIV PRESS INC",
    issn = "1058-4838, 1537-6591",
    doi = "10.1093/cid/cix480",
    keywords = "Kaposi sarcoma; HIV; antiretroviral therapy; cohort study",
    abstract = "Background. We compared Kaposi sarcoma (KS) risk in adults who started
antiretroviral therapy (ART) across the Asia-Pacific, South Africa,
Europe, Latin, and North America.
Methods. We included cohort data of human immunodeficiency virus
(HIV)-positive adults who started ART after 1995 within the framework of
2 large collaborations of observational HIV cohorts. We present
incidence rates and adjusted hazard ratios (aHRs).
Results. We included 208 140 patients from 57 countries. Over a period
of 1 066 572 person-years, 2046 KS cases were diagnosed. KS incidence
rates per 100 000 person-years were 52 in the Asia-Pacific and ranged
between 180 and 280 in the other regions. KS risk was 5 times higher in
South African women (aHR, 4.56; 95% confidence intervals [CI],
2.73-7.62) than in their European counterparts, and 2 times higher in
South African men (2.21; 1.34-3.63). In Europe, Latin, and North America
KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95%
CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell
counts >= 700 cells/mu L with those whose counts were <50 cells/mu L,
the KS risk was halved in South Africa (aHR, 0.53; 95% CI,.17-1.63) but
reduced by >= 95% in other regions.
Conclusions. Despite important ART-related declines in KS incidence, men
and women in South Africa and men who have sex with men remain at
increased KS risk, likely due to high human herpesvirus 8 coinfection
rates. Early ART initiation and maintenance of high CD4 cell counts are
essential to further reducing KS incidence worldwide, but additional
measures might be needed, especially in Southern Africa."
}