Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia.

Abstract

BACKGROUND:

The burden of Kaposi sarcoma (KS) in human immunodeficiency virus (HIV)-infected children and adolescents on combination antiretroviral therapy (cART) has not been compared globally.

METHODS:

We analyzed cohort data from the International Epidemiologic Databases to Evaluate AIDS and the Collaboration of Observational HIV Epidemiological Research in Europe. We included HIV-infected children aged <16 years at cART initiation from 1996 onward. We used Cox models to calculate hazard ratios (HRs), adjusted for region and origin, sex, cART start year, age, and HIV/AIDS stage at cART initiation.

RESULTS:

We included 24 991 children from eastern Africa, southern Africa, Europe and Asia; 26 developed KS after starting cART. Incidence rates per 100 000 person-years (PYs) were 86 in eastern Africa (95% confidence interval [CI], 55-133), 11 in southern Africa (95% CI, 4-35), and 81 (95% CI, 26-252) in children of sub-Saharan African (SSA) origin in Europe. The KS incidence rates were 0/100 000 PYs in children of non-SSA origin in Europe (95% CI, 0-50) and in Asia (95% CI, 0-27). KS risk was lower in girls than in boys (adjusted HR [aHR], 0.3; 95% CI, .1-.9) and increased with age (10-15 vs 0-4 years; aHR, 3.4; 95% CI, 1.2-10.1) and advanced HIV/AIDS stage (CDC stage C vs A/B; aHR, 2.4; 95% CI, .8-7.3) at cART initiation.

CONCLUSIONS:

HIV-infected children from SSA but not those from other regions, have a high risk of developing KS after cART initiation. Early cART initiation in these children might reduce KS risk.

• Authors: Pediatric AIDS-Defining Cancer Project Working Group for IeDEA Southern Africa, TApHOD, and COHERE in EuroCoord, Eliane Rohner, Kurt Schmidlin, Marcel Zwahlen, Rana Chakraborty, Gary Clifford, Niels Obel, Sophie Grabar, Annelies Verbon, Antoni Noguera-Julian, Intira Jeannie Collins, Pablo Rojo, Norbert Brockmeyer, Maria Campbell, Geneviève Chêne, Hans Prozesky, Brian Eley, D Cristina Stefan, Alan Davidson, Cleophas Chimbetete, Shobna Sawry, Mary-Ann Davies, Azar Kariminia, Ung Vibol, Annette Sohn, Matthias Egger, Julia Bohlius
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 63 Issue 9 Pg. 1245-1253 (11 01 2016) ISSN: 1537-6591 [Electronic] United States
• PMID: 27578823 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail [email protected].

Chemical References

• Anti-HIV Agents

Topics

• Adolescent
• Africa South of the Sahara (epidemiology)
• Anti-HIV Agents (therapeutic use)
• Asia (epidemiology)
• Child
• Child, Preschool
• Cohort Studies
• Drug Therapy, Combination
• Europe (epidemiology)
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Incidence
• Infant
• Infant, Newborn
• Male
• Risk Assessment
• Sarcoma, Kaposi (complications, epidemiology)
• Time-to-Treatment