Coghill Anna E, Thompson Zachary, Bamford Laura, Burkholder Greer, Enron Joseph, Gopal Satish, Kitahata Mari M, Mayer Kenneth H, Moore Richard, Yendewa George, Dickey Brittney L, Yanik Elizabeth, Achenbach Chad
Cancer Epidemiology Program, Division of Population Science, Moffitt Cancer Center.
Biostatistics and Bioinformatics Program, Moffitt Cancer Center.
AIDS. 2025 Jul 18. doi: 10.1097/QAD.0000000000004303.
Access to antiretroviral therapy (ART) has resulted in a decline in Kaposi sarcoma (KS) incidence among people with HIV (PWH). However, KS is still occurring among PWH receiving ART, and it is important to understand the degree to which risk of KS is impacted by response to ART.
We examined the changing epidemiology of KS among >20,000 PWH receiving HIV care between 1996 and 2016 in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We evaluated the association of KS with CD4 count and HIV viral load at ART initiation, within 6-12 months, and during clinical follow-up.
A total of 344 PWH were diagnosed with KS. CD4 count <200 cells/uL at ART initiation was associated with a >6-fold increased KS risk. Likewise, an HIV viral load >50,000 copies/mL at ART initiation was associated with a >3-fold increased KS risk. For every 100 cells/uL increase in CD4 count or log-unit decrease in HIV viral load during the 12-18 months after ART initiation, we observed 11% and 7% lower KS risks, respectively. During clinical follow-up after ART initiation, every 10% increase in time with a CD4 count >350 cells/uL or an HIV viral load <500 copies/mL was associated with 24% and 26% lower KS risks, respectively. All results reported here were statistically significant at the p < 0.05 threshold.
KS risk among PWH receiving HIV care was significantly impacted by not only CD4 count and viral load at ART initiation, but also long-term suppression of HIV after ART initiation.
获得抗逆转录病毒疗法（ART）已导致艾滋病毒感染者（PWH）中卡波西肉瘤（KS）的发病率下降。然而，接受ART的PWH中仍有KS发生，了解ART反应对KS风险的影响程度很重要。
我们在综合临床系统艾滋病研究网络中心（CNICS）研究了1996年至2016年间接受艾滋病毒护理的20000多名PWH中KS流行病学的变化。我们评估了KS与ART开始时、6至12个月内以及临床随访期间的CD4细胞计数和艾滋病毒病毒载量之间的关联。
共有344名PWH被诊断为KS。ART开始时CD4细胞计数<200个/微升与KS风险增加6倍以上相关。同样，ART开始时艾滋病毒病毒载量>50000拷贝/毫升与KS风险增加3倍以上相关。在ART开始后的12至18个月内，CD4细胞计数每增加100个/微升或艾滋病毒病毒载量每降低1个对数单位，我们分别观察到KS风险降低11%和7%。在ART开始后的临床随访期间，CD4细胞计数>350个/微升或艾滋病毒病毒载量<500拷贝/毫升的时间每增加10%，分别与KS风险降低24%和26%相关。此处报告的所有结果在p<0.05阈值时具有统计学意义。
接受艾滋病毒护理的PWH中的KS风险不仅受到ART开始时的CD4细胞计数和病毒载量的显著影响，还受到ART开始后艾滋病毒的长期抑制的显著影响。
