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

Abstract

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.

Kaposi sarcoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy

“…A similar temporal pattern was observed for KS in Australia (Grulich et al, 2001) and in European countries (Dal Maso et al, 1995;Rezza et al, 2000;Franceschi et al, 2003;Mocroft et al, 2004;Clifford et al, 2005), but detailed data on the long-term trends of KS incidence in Europe are limited. We therefore took advantage of the more than 20 years of follow-up data available from the Swiss HIV Cohort Study (SHCS) to assess changes in the incidence of and risk factors for KS before and after HAART use.…”

Kaposi's Sarcoma-Associated Herpesvirus/Human Herpesvirus 8 ORF50/Rta Lytic Switch Protein Functions as a Tetramer

“…Reactivation of KSHV from latency is a crucial step in KS development. The viral load in the peripheral blood is directly proportional to the risk of KS progression and the stage of KS (1,5,9,26,69,94), and treatments that reduce the KSHV load are accompanied by KS regression (6,11,12,39,40,45,56,59,66,70,76,95). Most of the candidate pathogenic genes of KSHV (encoding proteins with cell growth deregulatory and immunomodulatory functions) are expressed in the delayed early class of the lytic-gene expression program (7,14,19,23,24,27,28,38,43,48,65,72,82).…”

Metastatic Kaposi’s Sarcoma Causing Gastrointestinal Bleeding: Report of an Unusual Case

“…AIDS-related KS preferentially affects homosexual or bisexual men compared with women, drug users, or transfusion recipients. Although the rate of AIDS related KS has decreased dramatically since the introduction of highly active antiretroviral therapy (HAART), KS remains the most common malignancy among patients with AIDS [10][11][12].…”