Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies.
Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies.
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DOI：
10.1093/cid/ciw562
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发表时间：
2016-11
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通讯作者：
N. Wyss;M. Zwahlen;G. Clifford;M. Campbell;R. Chakraborty;F. Bonnet;G. Chêne;F. Bani-Sadr;A. Verbon;R. Zangerle;V. Paparizos;M. Prins;F. Dronda;V. Moing;A. Antinori;E. Quiros-Roldan;C. Mussini;J. Miró;L. Meyer;J. Vehreschild;N. Obel;A. Mocroft;N. Brockmeyer;F. Boué;C. Sabin;V. Spagnuolo;B. Hasse;S. Wit;B. Roca;M. Egger;J. Bohlius
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作者：
N. Wyss;M. Zwahlen;G. Clifford;M. Campbell;R. Chakraborty;F. Bonnet;G. Chêne;F. Bani-Sadr;A. Verbon;R. Zangerle;V. Paparizos;M. Prins;F. Dronda;V. Moing;A. Antinori;E. Quiros-Roldan;C. Mussini;J. Miró;L. Meyer;J. Vehreschild;N. Obel;A. Mocroft;N. Brockmeyer;F. Boué;C. Sabin;V. Spagnuolo;B. Hasse;S. Wit;B. Roca;M. Egger;J. Bohlius
卡波西肉瘤（KS）仍然是开始联合抗逆转录病毒治疗（cART）的人类免疫缺陷病毒（HIV）阳性患者中常见的癌症。我们研究了欧洲观察性HIV队列患者在开始cART后不同时期发生KS的发病率和风险因素。我们纳入了1996年1月1日之后开始cART的HIV阳性成人。我们分析了cART开始后90天和180天以及1年、2年、5年和8年内发生KS的发病率和风险因素，并拟合了单变量和多变量考克斯回归模型。结果：我们纳入了来自欧洲21个前瞻性临床队列的109461例患者，其中916例发生KS病例。每10万人年的发病率在开始cART后6个月最高，为953（95%置信区间，866-1048），5-8年后下降至82（68-100）。在校正暴露组、来源、年龄、一线治疗方案类型和日历年的多变量分析中，低当前CD 4细胞计数增加了cART启动后所有观察期内发生KS的风险。缺乏病毒控制与cART开始后第一年发生KS的危险无关，但随着时间的推移，自开始cART以来，病毒控制与KS的危险正相关（相互作用P <0.001）。结论在开始cART的患者中，KS的发生率和危险因素均随开始cART后的时间而变化。尽管在开始cART后不久，低CD 4细胞计数是主要的风险因素，但可检测的HIV-1 RNA病毒载量在几年前开始cART的患者中成为越来越重要的风险因素，与免疫缺陷无关。
BACKGROUND Kaposi sarcoma (KS) remains a frequent cancer in human immunodeficiency virus (HIV)-positive patients starting combination antiretroviral therapy (cART). We examined incidence rates and risk factors for developing KS in different periods after starting cART in patients from European observational HIV cohorts. METHODS We included HIV-positive adults starting cART after 1 January 1996. We analyzed incidence rates and risk factors for developing KS up to 90 and 180 days and 1, 2, 5, and 8 years after cART start and fitted univariable and multivariable Cox regression models. RESULTS We included 109 461 patients from 21 prospective clinical cohorts in Europe with 916 incident KS cases. The incidence rate per 100 000 person-years was highest 6 months after starting cART, at 953 (95% confidence interval, 866-1048), declining to 82 (68-100) after 5-8 years. In multivariable analyses adjusted for exposure group, origin, age, type of first-line regimen, and calendar year, low current CD4 cell counts increased the risk of developing KS throughout all observation periods after cART initiation. Lack of viral control was not associated with the hazard of developing KS in the first year after cART initiation, but was over time since starting cART increasingly positively associated (P < .001 for interaction). CONCLUSION In patients initiating cART, both incidence and risk factors for KS change with time since starting cART. Whereas soon after starting cART low CD4 cell count is the dominant risk factor, detectable HIV-1 RNA viral load becomes an increasingly important risk factor in patients who started cART several years earlier, independently of immunodeficiency.