The association of immunosuppression and HIV control with Kaposi sarcoma among patients on antiretroviral therapy

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OBJECTIVE: Access to antiretroviral therapy (ART) has resulted in a decline in Kaposi sarcoma incidence among people with HIV (PWH). However, Kaposi sarcoma is still occurring among PWH receiving ART, and it is important to understand the degree to which risk of Kaposi sarcoma is impacted by response to ART. METHODS: We examined the changing epidemiology of Kaposi sarcoma among more than 20, 000 PWH receiving HIV care between 1996 and 2016 in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We evaluated the association of Kaposi sarcoma with CD4 + T-cell count and HIV viral load at ART initiation, within 6-12 months of ART initiation, and during clinical follow-up after ART initiation. RESULTS: A total of 344 PWH were diagnosed with Kaposi sarcoma. CD4 + T-cell count less than 200 cells/μl at ART initiation was associated with a more than six-fold increased Kaposi sarcoma risk. Likewise, an HIV viral load more than 50, 000 copies/ml at ART initiation was associated with a more than three-fold increased Kaposi sarcoma risk. For every 100 cells/μl increase in CD4 + T-cell count or log-unit decrease in HIV viral load during the 12-18 months after ART initiation, we observed 11 and 7% lower Kaposi sarcoma risk, respectively. During clinical follow-up after ART initiation, every 10% increase in time with a CD4 + T-cell count greater than 350 cells/μl or an HIV viral load less than 500 copies/ml was associated with 24 and 26% lower Kaposi sarcoma risk, respectively. All results reported here were statistically significant at the P < 0.05 threshold. CONCLUSION: Kaposi sarcoma risk among PWH receiving HIV care was significantly impacted by not only CD4 + T-cell count and viral load at ART initiation but also by long-term suppression of HIV after ART initiation.

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