Jessica L Castilho1, Ahra Kim2, Cathy A Jenkins2, Beatriz Grinsztejn3, Eduardo Gotuzzo4, Valeria Fink5, Denis Padgett6, Pablo F Belaunzaran-Zamudio7, Brenda Crabtree-Ramírez7, Maria Mercedes Escuder8, Rosa Alencar Souza9, Simone B Tenore9, Sidnei R Pimentel9, Maria Letícia Rodrigues Ikeda10,11, Paulo R de Alencastro10, Unai Tupinanbas12, Carlos Brites13, Estela Luz13, Juliana Netto3, Claudia P Cortes14, Alexandre Grangeiro15, Bryan E Shepherd2, Catherine C McGowan1. 1. Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA. 2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Instituto Nacional de Infectiologia Evandro Chagas, Fiocruz, Brazil. 4. Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru. 5. Fundación Huésped, Investigaciones Clínicas, Buenos Aires, Argentina. 6. Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario, Tegucigalpa, Honduras. 7. Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico. 8. São Paulo State Department of Health, Institute of Health, São Paulo, Brazil. 9. São Paulo State Department of Health, AIDS Reference and Training Center, São Paulo, Brazil. 10. Care and Treatment Clinic of the Partenon Sanatorium, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil. 11. University of Vale do Rio dos Sinos, São Leopoldo, Brazil. 12. Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil. 13. Edgar Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil. 14. Fundaciòn Arriaran and University of Chile School of Medicine, Santiago, Chile. 15. Department of Preventive Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
Abstract
INTRODUCTION: Kaposi's sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PWH) in Latin America. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART). METHODS: Cohorts in Brazil, Peru, Mexico, Honduras, Argentina and Chile contributed clinical data of PWH ≥16 years old from 2000 to 2017, excluding patients with KS diagnosed before clinic enrolment. We compared KS incidence over time using multivariable incidence rate ratios. Predictors of KS before/at or after ART initiation and of mortality after KS were examined using Cox regression. RESULTS: Of 25 981 PWH, 481 had incident KS, including 200 ART-naïve and 281 ART-treated patients. From 2000 to 2017, the incidence of KS decreased from 55.1 to 3.0 per 1000 person-years. In models adjusting for CD4 and other factors, the relative risk for KS decreased from 2000 to 2008. Since 2010, the adjusted risk of KS increased in the periods before and ≤90 days after ART initiation but decreased >90 days after ART. In addition to low CD4 and male-to-male sex, KS risk after ART was associated with age and history of other AIDS-defining illnesses. Mortality after KS (approximately 25% after five years) was not associated with either year of KS diagnosis nor timing of diagnosis relative to ART initiation. CONCLUSIONS: KS incidence in Latin America has remained stable in recent years and risk is highest before and shortly after ART initiation. Early diagnosis of HIV and ART initiation remain critical priorities in the region.
INTRODUCTION: Kaposi's sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PWH) in Latin America. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART). METHODS: Cohorts in Brazil, Peru, Mexico, Honduras, Argentina and Chile contributed clinical data of PWH ≥16 years old from 2000 to 2017, excluding patients with KS diagnosed before clinic enrolment. We compared KS incidence over time using multivariable incidence rate ratios. Predictors of KS before/at or after ART initiation and of mortality after KS were examined using Cox regression. RESULTS: Of 25 981 PWH, 481 had incident KS, including 200 ART-naïve and 281 ART-treated patients. From 2000 to 2017, the incidence of KS decreased from 55.1 to 3.0 per 1000 person-years. In models adjusting for CD4 and other factors, the relative risk for KS decreased from 2000 to 2008. Since 2010, the adjusted risk of KS increased in the periods before and ≤90 days after ART initiation but decreased >90 days after ART. In addition to low CD4 and male-to-male sex, KS risk after ART was associated with age and history of other AIDS-defining illnesses. Mortality after KS (approximately 25% after five years) was not associated with either year of KS diagnosis nor timing of diagnosis relative to ART initiation. CONCLUSIONS: KS incidence in Latin America has remained stable in recent years and risk is highest before and shortly after ART initiation. Early diagnosis of HIV and ART initiation remain critical priorities in the region.
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