Epidemiology of Kaposi's sarcoma-associated herpesvirus in HIV-1-infected US persons in the era of combination antiretroviral therapy. (19th June 2015)

• Record Type: Journal Article
• Authors: Labo, Nazzarena; Miley, Wendell; Benson, Constance A.; Campbell, Thomas B.; Whitby, Denise
• Is Part Of: AIDS. Volume 29:Number 10(2015)
• Publication Date: 2015-06-19
• Subjects: AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000682
• Languages: English
• ISSNs: 0269-9370

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To determine the effect of the introduction of combination antiretroviral treatment (cART) in the HIV-1-infected US population on the epidemiology of Kaposi's sarcoma-associated herpesvirus (KSHV).</p> </sec> <sec> <title>Design, setting and participants:</title> <p>We investigated the epidemiology of KSHV in 5022 HIV-1-infected, antiretroviral-naive US persons participating in six AIDS Clinical Trials Group (ACTG)-randomized clinical trials, and followed in a long-term cohort study. We tested the first and last available sera of each participant for antibodies to KSHV K8.1 and ORF73.</p> </sec> <sec> <title>Main outcome measures:</title> <p>We studied prevalence and incidence of KSHV infection, incidence of Kaposi's sarcoma, and overall survival.</p> </sec> <sec> <title>Results:</title> <p>KSHV prevalence was 38.1% [95% confidence interval (CI) 36.8–39.5%]. Male sex, Caucasian race, age between 30 and 49 years, residence in north-eastern or western United States, and enrolment after 2001 were independently associated with prevalent infection. KSHV incidence was 4.07/100 person-years (95% CI 3.70–4.47). Male sex, Caucasian race, age below 30, and enrolment after 2001 were associated with incident infection. CD4<sup>+</sup> cell count increase following cART was associated with lower risk. Kaposi's sarcoma incidence was 104.05/100 000 person-years (95% CI 71.17–146.89). Higher baseline CD4<sup>+</sup> cell count, but not increase in CD4<sup>+</sup> cell count after cART, was associated with lower hazard of Kaposi's sarcoma. Randomized assignment of protease inhibitors was not associated with better KSHV outcomes.</p> </sec> <sec> <title>Conclusions:</title> <p>HIV-1-infected individuals, in particular Caucasian men, remain at a significant risk for KSHV co-infection and Kaposi's sarcoma. Thus, optimal management of HIV-1 infection should continue to include vigilance for manifestations of KSHV co-infection, including Kaposi's sarcoma.</p> </sec> <sec> <title>Video abstract:</title> <p> <ext-link ext-link-type="uri" xlink:href="https://vimeo.com/126172348" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">https://vimeo.com/126172348</ext-link> </p> </sec> </abstract>