Risk of Kaposi sarcoma during the first months on combination antiretroviral therapy.
AIDS
; 27(4): 635-43, 2013 Feb 20.
Article
em En
| MEDLINE
| ID: mdl-23196937
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 (Nâ=â66â369), Kaposi sarcoma (Nâ=â1811) and PJP (Nâ=â1718) 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 (Nâ=â160, 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 (Nâ=â84, 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 (82âcells/µl) or PJP (61âcells/µl) within 3 months than in those who did not develop these conditions (>250âcells/µl). Notably, median CD4 cell count change was +44âcells/µl per month with incident Kaposi sarcoma within 3 months of cART initiation versus 0âcells/µl per month with incident PJP (Pâ=â0.0003).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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumonia por Pneumocystis
/
Sarcoma de Kaposi
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Soropositividade para HIV
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Fármacos Anti-HIV
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Síndrome Inflamatória da Reconstituição Imune
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
França