Kaposi sarcoma risk in HIV-infected children and adolescents on combination antiretroviral therapy from sub-Saharan Africa, Europe, and Asia

• Main Authors: Eliane Rohner, Kurt Schmidlin, Marcel Zwahlen, Rana Chakraborty, Gary Clifford, Niels Obel, Sophie Grabar, Annelies Verbon, Antoni Noguera-Julian, Ali Judd, Intira Jeannie Collins, Pablo Rojo, Norbert Brockmeyer, Maria Campbell, Geneviève Chene, 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, Frank Tanser, Michael Vinikoor, Eusebio Macete, Robin Wood, Kathryn Stinson, Daniela Garone, Geoffrey Fatti, Sam Phiri, Janet Giddy, Kennedy Malisita, Christiane Fritz, Michael Hobbins, Kamelia Kamenova, Matthew Fox, Karl Technau, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Linda Wittkop, Peter Reiss, Ferdinand Wit, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Osamah Hamouda, Barbara Bartmeyer, Nikoloz Chkhartishvili, Andrea Antinori, Antonella D.Arminio Monforte, Luis Prieto, Antoni Soriano-Arandes, Manuel Battegay, Roger Kouyos, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M. Miró, Antonella Castagna, Deborah Konopnick, Tessa Goetghebuer, Anders Sönnerborg, Carlo Torti, Ramon Teira, Myriam Garrido, David Haerry, Stéphane De Wit, Dominique Costagliola, Dorthe Raben, Diana Barger, Christine Schwimmer, Monique Termote, Casper Frederiksen, Nina Friis-Møller, Juan Berenguer, Vincent Bouteloup, Alessandro Cozzi-Lepri, Maria Dorrucci
• Other Authors: University of KwaZulu-Natal
• Format: Article
• Published: 2018
• Subjects: Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/41091
• Institution: Mahidol University

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. 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.