Castilho Jessica L, Kim Ahra, Jenkins Cathy A, Grinsztejn Beatriz, Gotuzzo Eduardo, Fink Valeria, Padgett Denis, Belaunzaran-Zamudio Pablo F, Crabtree-Ramírez Brenda, Escuder Maria Mercedes, Souza Rosa Alencar, Tenore Simone B, Pimentel Sidnei R, Ikeda Maria Letícia Rodrigues, de Alencastro Paulo R, Tupinanbas Unai, Brites Carlos, Luz Estela, Netto Juliana, Cortes Claudia P, Grangeiro Alexandre, Shepherd Bryan E, McGowan Catherine C
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
J Int AIDS Soc. 2021 Jan;24(1):e25658. doi: 10.1002/jia2.25658.
Kaposi's sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PWH) in Latin America. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART).
Cohorts in Brazil, Peru, Mexico, Honduras, Argentina and Chile contributed clinical data of PWH ≥16 years old from 2000 to 2017, excluding patients with KS diagnosed before clinic enrolment. We compared KS incidence over time using multivariable incidence rate ratios. Predictors of KS before/at or after ART initiation and of mortality after KS were examined using Cox regression.
Of 25 981 PWH, 481 had incident KS, including 200 ART-naïve and 281 ART-treated patients. From 2000 to 2017, the incidence of KS decreased from 55.1 to 3.0 per 1000 person-years. In models adjusting for CD4 and other factors, the relative risk for KS decreased from 2000 to 2008. Since 2010, the adjusted risk of KS increased in the periods before and ≤90 days after ART initiation but decreased >90 days after ART. In addition to low CD4 and male-to-male sex, KS risk after ART was associated with age and history of other AIDS-defining illnesses. Mortality after KS (approximately 25% after five years) was not associated with either year of KS diagnosis nor timing of diagnosis relative to ART initiation.
KS incidence in Latin America has remained stable in recent years and risk is highest before and shortly after ART initiation. Early diagnosis of HIV and ART initiation remain critical priorities in the region.
卡波西肉瘤（KS）仍是拉丁美洲艾滋病毒感染者（PWH）中最常见的恶性肿瘤。我们研究了在抗逆转录病毒疗法（ART）可及性增加的时代，拉丁美洲临床机构中KS的发病趋势及转归。
巴西、秘鲁、墨西哥、洪都拉斯、阿根廷和智利的队列提供了2000年至2017年16岁及以上PWH的临床数据，排除入组前已诊断为KS的患者。我们使用多变量发病率比来比较KS发病率随时间的变化。使用Cox回归分析ART启动前/时或后KS的预测因素以及KS后的死亡率预测因素。
在25981名PWH中，481例发生了KS，其中200例未接受过ART治疗，281例接受过ART治疗。从2000年到2017年，KS发病率从每1000人年55.1例降至3.0例。在调整CD4及其他因素的模型中，2000年至2008年KS的相对风险降低。自2010年以来，ART启动前及启动后≤90天期间KS的校正风险增加，但ART启动后>90天风险降低。除了CD4水平低和男男性行为外，ART后KS风险还与年龄及其他艾滋病界定疾病史有关。KS后的死亡率（五年后约为25%）与KS诊断年份及相对于ART启动的诊断时间均无关。
近年来拉丁美洲KS发病率保持稳定，风险在ART启动前及启动后不久最高。在该地区，艾滋病毒的早期诊断和ART启动仍然是关键优先事项。
