Risk of Kaposi sarcoma during the first months on combination antiretroviral therapy
Jean-Marc Lacombe, François Boue, Sophie Grabar, Nathalie Viget, Sandrine Gazaignes, Anne-Sophie Lascaux-Cametz, Jérome Pacanowski, Marialuisa Partisani, Odile Launay, Sophie Matheron, Eric Rosenthal, Elisabeth Rouveix, Pierre Tattevin, Pierre de Truchis, Dominique Costagliola, James J Goedert, Jean-Marc Lacombe, François Boue, Sophie Grabar, Nathalie Viget, Sandrine Gazaignes, Anne-Sophie Lascaux-Cametz, Jérome Pacanowski, Marialuisa Partisani, Odile Launay, Sophie Matheron, Eric Rosenthal, Elisabeth Rouveix, Pierre Tattevin, Pierre de Truchis, Dominique Costagliola, James J Goedert
Abstract
Objective: To determine whether incident AIDS-defining Kaposi sarcoma or Pneumocystis jiroveci pneumonia (PJP) is associated with combination antiretroviral therapy (cART) initiation.
Design: Compare risk for Kaposi sarcoma and PJP by time on cART and CD4 reconstitution.
Methods: : In the FHDH-ANRS CO4 cohort (N = 66 369), Kaposi sarcoma (N = 1811) and PJP (N = 1718) incidence rates were computed by demographic and HIV strata. Crude and adjusted relative risk (RR) with 95% confidence intervals (CIs) following cART initiation were calculated by Poisson regression with untreated patients during 1996-2009 as reference. CD4 cell counts were compared by Wilcoxon rank sum tests.
Results: The risk of Kaposi sarcoma was very high during months 1-3 on cART (N = 160, RRCrude 3.94, 95% CI 3.26-4.76), which was incompletely attenuated by adjustment for demographics and contemporaneous CD4 cell count (RRAdj 1.25, 95% CI 1.02-1.53). Corresponding PJP risk was minimally elevated (N = 84, RRCrude 1.80, 95% CI 1.42-2.30) and markedly reduced with adjustment on the same variables and PJP prophylaxis (RRAdj 0.52, CI 0.41-0.67). HIV load had no added effect. Median CD4 cell count at cART initiation was much lower in patients with incident Kaposi sarcoma (82 cells/μl) or PJP (61 cells/μl) within 3 months than in those who did not develop these conditions (>250 cells/μl). Notably, median CD4 cell count change was +44 cells/μl per month with incident Kaposi sarcoma within 3 months of cART initiation versus 0 cells/μl per month with incident PJP (P = 0.0003).
Conclusion: Failure of CD4 cell count reconstitution during months 1-3 on cART fully accounted for incident PJP. In contrast, there were 1.6 additional Kaposi sarcoma cases per 1000 person-years during months 1-3 on cART, suggesting that immune reconstitution may contribute to the risk for AIDS-defining Kaposi sarcoma.
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Source: PubMed