Epidemiologic Analysis of Kaposi's Sarcoma as an Early and Later AIDS Outcome in Homosexual Men

Hoover, Donald R.; Black, Cynthia; Jacobson, Lisa P.; Martı́nez-Maza, Otoniel; Seminara, Daniela; Saah, Alfred J.; Roenn, Jamie Von; Anderson, Roger; Armenian, Haroutune K.

doi:10.1093/oxfordjournals.aje.a116855

Cited by 78 publications

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“…While this finding is consistent with prior studies [6,17], ours results were limited by the fact that 78% of the study population was co-prevalent. Prior to our study, smoking had been associated with a decreased incident of both classic and AIDS-related KS [20,30]. Goedert et al [20] observed that subjects with classic KS were only 25% as likely to be current or former smokers as compared to non-KS controls.…”

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confidence: 67%

Sexual Activity and Kaposi's Sarcoma Among Human Immunodeficiency Virus Type 1 and Human Herpesvirus Type 8-Coinfected Men

Nawar

Cole

Farzadegan

et al. 2008

Annals of Epidemiology

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Purpose-There is notable heterogeneity in the progression to Kaposi's Sarcoma (KS) among men coinfected with HIV-1 and HHV-8; additional determinants of KS likely exist. Here, we explore sexual activity as a proxy for a sexually transmitted determinant beyond HIV-1 and HHV-8. Methods-The association between sexual activity and incident KS was estimated using data from 1,354 HIV-1 and HHV-8 coinfected homosexual men followed for up to 10 years in the Multicenter AIDS Cohort Study.Results-As expected, white race, low CD4 cell count and acquiring HHV-8 after HIV-1 infection increased, while smoking decreased, the hazard of KS. The unadjusted hazard of KS among those with high sexual activity was 0.68 relative to the hazard of those with low sexual activity (95% confidence interval [CI]: 0.49, 0.93), and was somewhat muted after adjustment for characteristics measured at study entry (i.e. race, smoking, CD4 cell count, infection order, history of sexual activity, and sexually transmitted diseases). However, adjustment for time-varying covariates, particularly CD4 cell count, resulted in a nullification of the association (adjusted hazard ratio = 1.06; 95% CI: 0.77, 1.48).Conclusion-Once HIV-1 and HHV-8 coinfection is established in homosexual men, progression to KS does not appear to be due to a third pathogen transmitted by sexual activity. Health, 615 N. Wolfe Street, E7640, Baltimore, MD 21205, Tel: 410-955-4342, Fax: 410-955-7587, scole@jhsph.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access METHODS Study PopulationThe Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of the natural and treated histories of HIV-1 infection and AIDS in homosexual and bisexual men in the US that began in 1984. Before 2001, a total of 5622 participants were enrolled from sites in Baltimore, Chicago, Pittsburgh, and Los Angeles, and have been seen at semiannual followup visits. All participants provided written consent and study protocols were approved by institutional review boards at each study site.During each follow-up visit, an interviewer administered a detailed questionnaire including questions about sexual behavior. Blood samples were collected and stored in a central repository. HIV-1 seropositivity was ascertained using ELISA and confirmed by Western blot tests. Evidence of HHV-8 infection was determined by the presence of antibodies against lytic HHV-8 viral proteins. Detailed descriptions of the MACS [22,23], as well as the HHV-8 serological methods used [17], have been previously published.The current study began in March 1985, th...

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confidence: 67%

Sexual Activity and Kaposi's Sarcoma Among Human Immunodeficiency Virus Type 1 and Human Herpesvirus Type 8-Coinfected Men

Nawar

Cole

Farzadegan

et al. 2008

Annals of Epidemiology

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“…In a study restricted to HHV-8 seropositives, Goedert et al 22 observed that subjects with classical KS were only 25% as likely to be current or former smokers as compared to non-KS controls. In the Multicenter AIDS Cohort Study of HIV-positive male homosexuals, Hoover et al 23 examined KS risk without regard to HHV-8 serostatus and found a 30-39% reduction in smokers. These consistent findings suggest the association is real, warranting further study to elucidate the mechanism.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for Kaposi's sarcoma among HHV‐8 seropositive homosexual men with AIDS

Nawar

Mbulaiteye

Gallant

et al. 2005

Intl Journal of Cancer

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Kaposi's sarcoma (KS) is a frequent complication of the acquired immunodeficiency syndrome (AIDS) in homosexual men. Risk factors for developing this malignancy are uncertain, other than immunosuppression and coinfection with human herpesvirus 8 (HHV-8). We therefore examined factors associated with KS in a cross-sectional analysis of 99 cases among 503 HHV-8 seropositive homosexual men with AIDS. Data were collected by computerassisted personal interviews and medical chart reviews. HHV-8 seroreactivity was determined by enzyme-linked immunosorbent assay for antibodies against HHV-8 K8.1 glycoprotein. KS was significantly less common in blacks compared to whites [risk ratio (RR) = 0.4; 95% CI = 0.2=0.8] and more common in subjects who had completed college (RR = 1.7; 95% CI = 1.1-2.7) or had annual income greater than $30,000 (RR = 1.5; 95% CI = 1.1-2.2). KS was less common in cigarette smokers (RR = 0.6; 95% CI = 0.5-0.9) and users of crack cocaine (RR = 0.4; 95% CI = 0.1-0.8). KS was less common in bisexual men compared to men who were exclusively homosexual (estimated RR = 0.6; 95% CI = 0.4-0.9) and inversely associated with number of female partners. KS was also less common in men who had received pay for sex (RR = 0.6; 95% CI = 0.4-1.0). These cross-sectional associations could be biased by potential differences in relative timing of HHV-8 and HIV infection, a postulated determinant of KS risk. Alternatively, our findings may reflect factors protective against KS in individuals infected with HHV-8. Future research should focus on identifying practical measures for countering KS that do not increase the risk of other diseases. Published 2005 Wiley-Liss, Inc.Key words: Kaposi's sarcoma; human herpesvirus; AIDS-related malignancy Human immunodeficiency virus (HIV)-related Kaposi's sarcoma (KS) is an opportunistic neoplasm caused by coinfection with human herpesvirus 8 (HHV-8).1-3 Previous studies of acquired immunodeficiency syndrome (AIDS) patients have identified risk factors for infection with HHV-8, including sexual activity among homosexual men, intravenous drug use and blood transfusion. [4][5][6][7][8][9] However, only a few studies have investigated risk factors for progression to KS among individuals coinfected with HIV and HHV-8.Homosexual men may be at greater risk of AIDS-related KS than are members of other HIV transmission groups, even adjusted for differences in prevalence of HHV-8.1 Furthermore, HHV-8-infected individuals progress to KS at different rates or frequently not at all, 10-12 suggesting the existence of cofactors that influence risk. We therefore examined potential associations with KS in a cross-sectional analysis of HHV-8 seropositive homosexual men with AIDS enrolled in the AIDS Cancer Cohort Study. Material and methodsThe National Cancer Institute's AIDS Cancer Cohort Study is directed toward identifying rates and risk factors for HIV-associated malignancies. From October 1997 to January 2000, 2,803 persons with Centers for Disease Control and Prevention-defined AIDS 13 were enro...

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“…Overall, AIDS report in developed countries is approximately 85% complete (Buehler et al, 1992). About one-third of KS in HIV-positive individuals develop after AIDS diagnosis (Hoover et al, 1993). Furthermore, the 1993-94 incidence is influenced by the correction for reporting delay, a procedure that is less reliable for the most recent period (Dal Maso et al, 1995).…”

Section: Discussionmentioning

confidence: 99%

Trends of Kaposi's sarcoma at AIDS diagnosis in Europe and the United States, 1987-94

Franceschi

Maso²,

Re³

et al. 1997

Br J Cancer

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Summary As a proportion of AIDS-defining illnesses, Kaposi's sarcoma (KS) decreased from 1987-89 to 1993-94 in homosexual and bisexual men in all European regions and in the United States. Albeit underestimated, AIDS KS rates in the general male population at ages 25-49 are higher than those of the majority of cancer sites in the same age group.Keywords: Kaposi's sarcoma; AIDS; incidence A steady decline, in terms of the percentage of Kaposi's sarcoma (KS) as an AIDS-defining illness, was first reported among homosexual and bisexual men in the United States (US) (Des Jarlais et al, 1987). The broadening of the definition of an AIDS case in 1987 does not entirely explain this decline, as it persists when analyses of trends are restricted to KS and Pneumocystis carinii (i.e. two conditions that have always been part of AIDS definition) (Beral et al, 1990).The relative decline in KS was confirmed in AIDS surveillance data or clinical series in several developed countries, such as the United Kingdom (UK) (Peters et al, 1991), Germany (Schwartlander et al, 1992), Italy (Serraino et al, 1992) and Australia (Elford et al, 1993). It is at least partly attributed to the shorter latency period between HIV infection and KS onset than in other AIDS-defining illnesses (Hermans et al, 1996). According to some investigators (Elford et al, 1993;Dore et al, 1996), however, the relative decrease in KS might reflect a reduced prevalence and/or virulence of the postulated KS agent following the adoption of safer sexual practices by homosexual men.Up to the end of 1994, approximately 440 000 AIDS cases had been recorded in official data in the US and about 140 000 in Europe. About 20% of AIDS patients had KS at the time of presentation. It is therefore possible to review systematically recent trends in KS in major European regions, and to assess separately non-homosexual men and women, groups that were little studied in the early phase of the epidemic on account of the low frequency of the disease. Finally, in order to quantify the minimum size of the epidemic of AIDS-associated KS at a population level, age-standardized incidence rates have been computed from AIDS surveillance data.

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Epidemiologic Analysis of Kaposi's Sarcoma as an Early and Later AIDS Outcome in Homosexual Men

Cited by 78 publications

References 0 publications

Sexual Activity and Kaposi's Sarcoma Among Human Immunodeficiency Virus Type 1 and Human Herpesvirus Type 8-Coinfected Men

Sexual Activity and Kaposi's Sarcoma Among Human Immunodeficiency Virus Type 1 and Human Herpesvirus Type 8-Coinfected Men

Risk factors for Kaposi's sarcoma among HHV‐8 seropositive homosexual men with AIDS

Trends of Kaposi's sarcoma at AIDS diagnosis in Europe and the United States, 1987-94

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