Comparison of Kaposi Sarcoma risk in human immunodeficiency virus-positive adults across 5 continents: A multiregional multicohort study

Eliane Rohner, Lukas Bütikofer, Kurt Schmidlin, Mazvita Sengayi, Mhairi Maskew, Janet Giddy, Daniela Garone, Richard D. Moore, Gypsyamber D'Souza, James J. Goedert, Chad Achenbach, M. John Gill, Mari M. Kitahata, Pragna Patel, Michael J. Silverberg, Jessica Castilho, Catherine McGowan, Yi Ming Arthur Chen, Matthew Law, Ninon TaylorVassilios Paparizos, Fabrice Bonnet, Annelies Verbon, Gerd Fätkenheuer, Frank A. Post, Caroline Sabin, Amanda Mocrof, Vincent Le Moing, Fernando Dronda, Niels Obel, Sophie Grabar, Vincenzo Spagnuolo, Andrea Antinori, Eugenia Quiros-Roldan, Cristina Mussini, José M. Miro, Laurence Meyer, Barbara Hasse, Deborah Konopnicki, Bernardino Roca, Diana Barger, Dorthe Raben, Gary M. Cliford, Silvia Franceschi, Norbert Brockmeyer, Rana Chakraborty, Matthias Egger, Julia Bohlius

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Background: We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. Methods: We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). Results: We included 208 140 patients from 57 countries. Over a period of 1 066 572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100 000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/μL with those whose counts were <50 cells/μL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. Conclusions. Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.

Original languageEnglish
Pages (from-to)1316-1326
Number of pages11
JournalClinical Infectious Diseases
Issue number8
Publication statusPublished - Oct 1 2017
Externally publishedYes


  • Antiretroviral therapy
  • Cohort study
  • HIV
  • Kaposi sarcoma

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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