Bohlius Julia, Valeri Fabio, Maskew Mhairi, Prozesky Hans, Garone Daniela, Sengayi Mazvita, Fox Matthew P, Davies Mary-Ann, Egger Matthias
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Int J Cancer. 2014 Dec 1;135(11):2644-52. doi: 10.1002/ijc.28894. Epub 2014 May 2.
The incidence of Kaposi's Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV-infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time-updated CD4 cell counts and HIV-1 RNA. A total of 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person-years follow-up 162 patients developed KS. The incidence was 1,682/100,000 person-years (95% confidence interval [CI] 1,406-2,011) among patients not receiving ART and 138/100,000 person-years (95% CI 102-187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13-0.28). Low CD4 cell counts (time-updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9-80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to prevent KS and KS-associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV.
卡波西肉瘤（KS）在南非的发病率很高，但抗逆转录病毒疗法（ART）的影响尚不明确。我们研究了参加南非ART项目的HIV感染患者中KS的发病率和生存率。我们分析了三个ART项目的数据：开普敦的Khayelitsha镇和泰格堡医院项目以及约翰内斯堡的Themba Lethu项目。我们纳入了年龄大于16岁的患者。ART被定义为至少三种药物的治疗方案。我们估计了接受ART和未接受ART患者的KS发病率。我们计算了根据年龄、性别以及时间更新的CD4细胞计数和HIV-1 RNA进行调整的Cox模型。总共纳入了18254名患者（中位年龄34.5岁，64%为女性，入组时CD4细胞计数中位数为105个/μL）。在37488人年的随访期间，有162名患者发生了KS。未接受ART的患者中发病率为1682/100000人年（95%置信区间[CI] 1406 - 2011），接受ART的患者中发病率为138/100000人年（95% CI 102 - 187）。将接受ART的时间与未接受ART的时间进行比较的调整后风险比为0.19（95% CI 0.13 - 0.28）。低CD4细胞计数（时间更新）和男性性别也与KS相关。KS患者一年的估计生存率为72.2%（95% CI 64.9 - 80.2），男性高于女性。接受ART时KS的发病率显著低于未接受ART时。在南非以及非洲其他HIV负担较重的地区，及时启动ART对于预防KS以及与KS相关的发病率和死亡率至关重要。
