Kaposi Sarcoma Incidence, Burden, and Prevalence in United States People with HIV, 2000-2015.
Kaposi Sarcoma Incidence, Burden, and Prevalence in United States People with HIV, 2000-2015.
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DOI：
10.1158/1055-9965.epi-21-0008
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发表时间：
2021-09
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影响因子：
--
通讯作者：
Shiels MS
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作者：
Peprah S;Engels EA;Horner MJ;Monterosso A;Hall HI;Johnson AS;Pfeiffer RM;Shiels MS
联合抗逆转录病毒疗法（cART）的引入导致艾滋病毒（PWH）感染者中卡波西肉瘤（KS）的发病率显著降低。然而，目前尚不清楚发病率是否在关键人口和艾滋病毒传播群体中同样下降，每年发生和流行的KS病例数仍然无法量化。使用基于人群的登记关联数据，我们使用调整后的泊松回归评估KS发病率的时间趋势。将发病率和流行率估计值应用于CDC HIV监测数据，以获得美国的发病（2008-2015）和流行（2015）病例数。在PWH中，KS发生率比一般人群高521倍（95%置信区间[CI]：498，536），从2000年的每10万人年109例下降到2015年的每10万人年47例，年百分比变化为-6%。在所有人口和艾滋病毒传播群体中，发病率大幅下降（p趋势<0.005）。在2008年至2015年期间估计的5，306例新病例中，89%发生在男男性行为者中。截至2015年底，1，904名PWH（0.20%）在过去5年中被诊断患有KS。在当前的cART时代，美国PWH中KS发病率持续逐渐下降。这一下降在主要人口群体和艾滋病毒传播群体中是一致的，尽管相对于一般人口，发病率仍然较高。需要继续努力，通过早期启动cART和保持护理来控制艾滋病毒，并可能扩大以维持下降。
The introduction of combination antiretroviral therapy (cART) has led to a significant reduction in Kaposi sarcoma (KS) incidence among people with HIV (PWH). However, it is unclear if incidence has declined similarly across key demographic and HIV transmission groups and the annual number of incident and prevalent KS cases remains unquantified. Using population-based registry linkage data, we evaluated temporal trends in KS incidence using adjusted Poisson regression. Incidence and prevalence estimates were applied to CDC HIV surveillance data, to obtain the number of incident (2008–2015) and prevalent (2015) cases in the United States. Among PWH, KS rates were elevated 521-fold (95% confidence intervals [CI]: 498, 536) compared to the general population and declined from 109 per 100,000 person-years in 2000 to 47 per 100,000 person-years in 2015, at an annual percentage change of −6%. Rates declined substantially (p-trend<0∙005) across all demographic and HIV transmission groups. Of the 5,306 new cases estimated between 2008 and 2015, 89% occurred among men who have sex with men. At the end of 2015, 1,904 PWH (0.20%) had been diagnosed with KS in the previous 5 years. A consistent gradual decline in KS incidence has occurred among PWH in the United States during the current cART era. This decrease is uniform across key demographic and HIV transmission groups, though rates remain elevated relative to the general population. Continued efforts to control HIV through early cART initiation and retention in care need to be maintained and possibly expanded to sustain declines.