Risk Factors for Kaposi's Sarcoma in Patients With Advanced Human Immunodeficiency Virus Disease Treated With Zidovudine

Gallant, Joel E.; Moore, Richard D.; Richman, Douglas D.; Keruly, Jeanne C.; Chaisson, Richard E.

doi:10.1001/archinte.1994.00420050132012

Cited by 19 publications

(5 citation statements)

References 72 publications

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“…In other studies, the incidence of disease has often been quoted as a proportion of patients who develop disease within 1 or 2 years of the CD4 lymphocyte count dropping below some arbitrary level. [16][17][18] Those studies that address the increasing incidence of disease as CD4 lymphocyte counts decrease report similar findings to this study, that is, that the incidence of disease increases as CD4 lymphocyte counts decrease, 19,20 although the categories of CD4 lymphocyte counts used in other studies are much wider than those used here. This study is unique in the number of patients included, the number of incident AIDS-defining illnesses, and its use of follow-up CD4 lymphocyte counts, which enable the occurrence of a disease to be related to the CD4 lymphocyte count at which it occurs more accurately.…”

Section: Methodssupporting

confidence: 78%

“…24 There was also a reduced risk of Kaposi sarcoma in all exposure groups compared with homosexual men. Kaposi sarcoma has been reported to be up to 10 times more common in homosexual men, 17,26 and it has been reported in most other exposure groups to a certain extent. 27 A woman's risk of developing Kaposi sarcoma may be closely associated with her partner's exposure category.…”

mentioning

confidence: 97%

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The Incidence of AIDS-Defining Illnesses in 4883 Patients With Human Immunodeficiency Virus Infection

Mocroft¹

1998

Arch Intern Med

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Section: Methodssupporting

confidence: 78%

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confidence: 97%

The Incidence of AIDS-Defining Illnesses in 4883 Patients With Human Immunodeficiency Virus Infection

Mocroft¹

1998

Arch Intern Med

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“…Current viral load was not related to KS incidence after adjustment for current CD4 count; this finding suggests that more prognostic information is captured by CD4 count than by viral load, as has been suggested elsewhere 36. KS risk was found to be significantly higher among homosexual men, as was also reported before the introduction of HAART2, 3, 7, 8; however, unlike the AIDS in Europe Study Group, which examined patients with AIDS before the advent of HAART,2 we did not find any difference in the incidence of KS according to gender or geographic location after adjustment for CD4 count. In addition, we could not confirm previous reports that patients receiving antiherpes agents had a reduced incidence of KS 10, 11.…”

Section: Discussionsupporting

confidence: 58%

“…The incidence of KS, which has been diagnosed predominantly among homosexual men,3 was reported to be decreasing even before the introduction of highly active antiretroviral therapy (HAART) 4, 5. Widely reported risk factors for KS include acquisition of HIV via homosexual contact6 and advanced immunosuppression,7 and KS risk also exhibits a certain degree of geographic variation 2, 8. Various studies have suggested that an infectious agent may be the cause of KS.…”

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confidence: 99%

The changing pattern of Kaposi sarcoma in patients with HIV, 1994–2003

Mocroft

Kirk

Clumeck

et al. 2004

Cancer

131

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BACKGROUNDThe introduction of highly active antiretroviral therapy (HAART) has radically changed the clinical course of human immunodeficiency virus (HIV) infection. The goals of the current study were to assess the change in the incidence of Kaposi sarcoma (KS) among European patients with HIV since the introduction of HAART and to identify the factors associated with the development of KS among patients receiving HAART.METHODSThe incidence of KS and the factors associated with the development of this malignancy in patients receiving HAART were evaluated using Poisson regression. Patients examined in the current study were among the 9803 individuals with HIV who were enrolled in the EuroSIDA study, a pan‐European multicenter investigation.RESULTSThere was an estimated annual reduction of 39% (95% confidence interval [CI], 35–43%; P < 0.0001) in the incidence of KS between 1994 and 2003. The proportion of acquired immunodeficiency syndrome (AIDS) diagnoses made due to KS during prospective follow‐up ranged from 4.1% to 7.5%, and there was no significant change over time in this figure (P = 0.97). Four thousand fourteen patients began receiving HAART during prospective follow‐up; 41 of these 4014 were subsequently diagnosed with KS (1.0%). After adjustment in multivariate analyses, patients with higher current CD4 counts were found to have a decreased incidence of KS (incidence rate ratio [IRR], 0.60; 95% CI, 0.53–0.68; P < 0.0001), as were those for whom more time had elapsed since the initiation of HAART (IRR, 0.77; 95% CI, 0.60–0.98; P = 0.037). In contrast, homosexual men were found to have a significantly increased incidence of KS (IRR, 2.12; 95% CI, 1.00–4.54; P = 0.050)CONCLUSIONSThe current incidence of KS among patients with HIV is less than 10% of the incidence reported in 1994; the proportion of AIDS diagnoses made on the basis of KS diagnoses remains near 6%. Most individuals who developed KS while receiving HAART began treatment with low CD4 cell counts and developed KS within 6 months of the initiation of HAART. There continues to be an increased incidence of KS among homosexual men and a greatly reduced incidence of KS among patients with higher CD4 counts. Cancer 2004. © 2004 American Cancer Society.

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“…Indeed, herpesvirus-like particles in tissue culture of KS specimens from different geographic regions was observed more than 30 years ago (182), and an association with human cytomegalovirus (HCMV) infection had originally been proposed (170,183). However, the major breakthrough in the hunt for the KS agent came in 1994, when Chang et al used representational difference analysis to discover two DNA fragments associated uniquely with diseased dermal tissue from a KS lesion of a patient with AIDS (90).…”

Section: Introductionmentioning

confidence: 99%

Molecular Genetics of Kaposi's Sarcoma-Associated Herpesvirus (Human Herpesvirus 8) Epidemiology and Pathogenesis

Dourmishev

Palmeri

et al. 2003

Microbiol Mol Biol Rev

309

367

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Kaposi's sarcoma had been recognized as unique human cancer for a century before it manifested as an AIDS-defining illness with a suspected infectious etiology. The discovery of Kaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus-8, in 1994 by using representational difference analysis, a subtractive method previously employed for cloning differences in human genomic DNA, was a fitting harbinger for the powerful bioinformatic approaches since employed to understand its pathogenesis in KS. Indeed, the discovery of KSHV was rapidly followed by publication of its complete sequence, which revealed that the virus had coopted a wide armamentarium of human genes; in the short time since then, the functions of many of these viral gene variants in cell growth control, signaling apoptosis, angiogenesis, and immunomodulation have been characterized. This critical literature review explores the pathogenic potential of these genes within the framework of current knowledge of the basic herpesvirology of KSHV, including the relationships between viral genotypic variation and the four clinicoepidemiologic forms of Kaposi's sarcoma, current viral detection methods and their utility, primary infection by KSHV, tissue culture and animal models of latent- and lytic-cycle gene expression and pathogenesis, and viral reactivation from latency. Recent advances in models of de novo endothelial infection, microarray analyses of the host response to infection, receptor identification, and cloning of full-length, infectious KSHV genomic DNA promise to reveal key molecular mechanisms of the candidate pathogeneic genes when expressed in the context of viral infection

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Risk Factors for Kaposi's Sarcoma in Patients With Advanced Human Immunodeficiency Virus Disease Treated With Zidovudine

Abstract: Kaposi's sarcoma contributes to human immunodeficiency virus-related morbidity and mortality, especially among male homosexuals. This large cohort study provides further evidence for an association between risk for cytomegalovirus infection and KS.

Cited by 19 publications

References 72 publications

The Incidence of AIDS-Defining Illnesses in 4883 Patients With Human Immunodeficiency Virus Infection

The Incidence of AIDS-Defining Illnesses in 4883 Patients With Human Immunodeficiency Virus Infection

The changing pattern of Kaposi sarcoma in patients with HIV, 1994–2003

Molecular Genetics of Kaposi's Sarcoma-Associated Herpesvirus (Human Herpesvirus 8) Epidemiology and Pathogenesis

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