Epidemiology of Kaposi's sarcoma-associated herpesvirus in HIV-1-infected US persons in the era of combination antiretroviral therapy.
Epidemiology of Kaposi's sarcoma-associated herpesvirus in HIV-1-infected US persons in the era of combination antiretroviral therapy.
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DOI：
10.1097/qad.0000000000000682
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发表时间：
2015-06-19
期刊：
影响因子：
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通讯作者：
Whitby D
中科院分区：
文献类型：
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作者：
Labo N;Miley W;Benson CA;Campbell TB;Whitby D
目的：确定在美国HIV-1感染人群中引入抗逆转录病毒联合治疗（cART）对卡波西肉瘤疱疹病毒（KSHV）流行病学的影响。我们调查了5022名hiv -1感染、抗逆转录病毒naïve美国人的KSHV流行病学，这些人参加了6项艾滋病临床试验组（ACTG）随机临床试验，并进行了长期队列研究。我们检测了每位参与者的第一份和最后一份血清中KSHV K8.1和ORF73的抗体。我们研究了KSHV感染的患病率和发病率、卡波西肉瘤（KS）的发病率和总生存率。KSHV患病率为38.1% （95% CI 36.8-39.5%）。男性性别、高加索人种、年龄在30至49岁之间、居住在美国东北部或西部、2001年以后入组与流行感染独立相关。KSHV发病率为4.07/100人/年（95%CI 3.70-4.47）。男性、白种人、年龄在30岁以下、2001年以后入组与感染事件相关。cART后CD4计数增加与较低的风险相关。KS发病率为104.05/100,000人/年（95% CI 71.17-146.89）。较高的基线CD4计数与较低的KS风险相关，但cART后CD4计数未增加。随机分配蛋白酶抑制剂与更好的KSHV结果无关。HIV-1感染者，特别是白种人男性，仍然存在KSHV合并感染和KS的重大风险。因此，HIV-1感染的最佳管理应继续包括警惕KSHV合并感染的表现，包括KS。视频摘要：http://ncifrederick.cancer.gov/services/spgm/filedownload/pdsDownload.aspx?id=c472803f-1d66 -4391-b18b-24e367b6b190
To determine the effect of the introduction of combination antiretroviral treatment (cART) in the HIV-1 infected US population on the epidemiology of Kaposi’s sarcoma herpesvirus (KSHV). We investigated the epidemiology of KSHV in 5022 HIV-1-infected, antiretroviral naïve US persons participating in six AIDS Clinical Trials Group (ACTG) randomized clinical trials, and followed in a long-term cohort study. We tested the first and last available sera of each participant for antibodies to KSHV K8.1 and ORF73. We studied prevalence and incidence of KSHV infection, incidence of Kaposi’s sarcoma (KS), and overall survival. KSHV prevalence was 38.1% (95% CI 36.8-39.5%). Male gender, Caucasian race, age between 30 and 49, residence in North-eastern or Western US, and enrolment after 2001 were independently associated with prevalent infection. KSHV incidence was 4.07/100 person/years (95%CI 3.70-4.47). Male gender, Caucasian race, age below 30, and enrolment after 2001 were associated with incident infection. CD4 count increase following cART was associated with lower risk. KS incidence was 104.05/100,000 person/years (95% CI 71.17-146.89). Higher baseline CD4 count, but not increase in CD4 count after cART, was associated with lower hazard of KS. Randomized assignment of protease inhibitors was not associated with better KSHV outcomes. HIV-1 infected individuals, in particular Caucasian men, remain at significant risk for KSHV co- infection and KS. Thus, optimal management of HIV-1 infection should continue to include vigilance for manifestations of KSHV co-infection, including KS. Video abstract at http://ncifrederick.cancer.gov/services/spgm/filedownload/pdsDownload.aspx?id=c472803f-1d66–4391-b18b-24e367b6b190