Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia
Authors:   The Pediatric AIDS-Defining Cancer Project Working Group for IeDEA Southern Africa, TApHOD, and COHERE in EuroCoord,   The Pediatric AIDS-Defining Cancer Project Working Group for IeDEA Southern Africa, TApHOD, and COHERE in EuroCoord, Rohner Eliane , Schmidlin Kurt , Zwahlen Marcel , Chakraborty Rana , Clifford Gary , Obel Niels , Grabar Sophie , Verbon Annelies , Noguera-Julian Antoni , Judd Ali , Collins Intira Jeannie , Rojo Pablo , Brockmeyer Norbert , Campbell Maria , Chêne Geneviève , Prozesky Hans , Eley Brian , Stefan D Cristina , Davidson Alan , Chimbetete Cleophas , Sawry Shobna , Davies Mary-Ann , Kariminia Azar , Vibol Ung , Sohn Annette , Egger Matthias , Bohlius Julia , Tanser Frank , Vinikoor Michael , Macete Eusebio , Wood Robin , Stinson Kathryn , Garone Daniela , Fatti Geoffrey , Phiri Sam , Giddy Janet , Chimbetete Cleophas , Malisita Kennedy , Eley Brian , Fritz Christiane , Hobbins Michael , Kamenova Kamelia , Fox Matthew , Prozesky Hans , Technau Karl , Sawry Shobna , Zangerle Robert , Touloumi Giota , Warszawski Josiane , Meyer Laurence , Dabis François , Krause Murielle Mary , Ghosn Jade , Leport Catherine , Wittkop Linda , Reiss Peter , Wit Ferdinand , Prins Maria , Bucher Heiner , Sabin Caroline , Gibb Diana , Fätkenheuer Gerd , Del Amo Julia , Obel Niels , Thorne Claire , Mocroft Amanda , Kirk Ole , Stephan Christoph , Pérez-Hoyos Santiago , Hamouda Osamah , Bartmeyer Barbara , Chkhartishvili Nikoloz , Noguera-Julian Antoni , Antinori Andrea , Monforte Antonella d′Arminio , Brockmeyer Norbert , Prieto Luis , Rojo Pablo , Soriano-Arandes Antoni , Battegay Manuel , Kouyos Roger , Mussini Cristina , Tookey Pat , Casabona Jordi , Miró Jose M. , Castagna Antonella , Konopnick Deborah , Goetghebuer Tessa , Sönnerborg Anders , Torti Carlo , Teira Ramon , Garrido Myriam , Haerry David , De Wit Stéphane , Miró Jose M. , Costagliola Dominique , Monforte Antonella d′Arminio , Castagna Antonella , del Amo Julia , Mocroft Amanda , Raben Dorthe , Chêne Geneviève , Judd Ali , Rojo Pablo , Barger Diana , Schwimmer Christine , Termote Monique , Wittkop Linda , Campbell Maria , Frederiksen Casper , Friis-Møller Nina , Raben Dorthe , Berenguer Juan , Bohlius Julia , Bouteloup Vincent , Bucher Heiner , Cozzi-Lepri Alessandro , Dabis François , Monforte Antonella d′Arminio , Davies Mary-Anne , del Amo Julia , Dorrucci Maria , Dunn David , Egger Matthias , Furrer Hansjakob , Guiguet Marguerite , Grabar Sophie , Judd Ali , Kirk Ole , Lambotte Olivier , Leroy Valériane , Lodi Sara , Matheron Sophie , Meyer Laurence , Miró Jose M. , Mocroft Amanda , Monge Susana , Nakagawa Fumiyo , Paredes Roger , Peters Lars , Phillips Andrew , Puoti Massimo , Schomaker Michael , Smit Colette , Sterne Jonathan , Thiebaut Rodolphe , Thorne Claire , Torti Carlo , van der Valk Marc , Wittkop Linda , Ly P. S. , Khol V. , Sarun S. M. , Ung V. B. , Tucker J. , Kumarasamy N. , Saghayam S. , Chandrasekaran E. , Wati D. K. , Atmikasari L. P. P. , Malino I. Y. , Kurniati N. , Muktiarti D. , Fong S. M. , Lim M. , Daut F. , Yusoff N. K. Nik , Mohamad P. , Razali K. A. , Mohamed T. J. , Mohammed N. A. D. R. , Nallusamy R. , Chan K. C. , Sudjaritruk T. , Sirisanthana V. , Aurpibul L. , Oberdorfer P. , Hansudewechakul R. , Denjanta S. , Srisuk W. , Kongphonoi A. , Lumbiganon P. , Kosalaraksa P. , Tharnprisan P. , Udomphanit T. , Jourdain G. , Bunupuradah T. , Puthanakit T. , Prasitsuebsai W. , Chanthaweethip W. , Chokephaibulkit K. , Lapphra K. , Phongsamart W. , Sricharoenchai S. , Truong K. H. , Du Q. T. , Nguyen C. H. , Do V. C. , Ha T. M. , An V. T. , Nguyen L. V. , Khu D. T. K. , Pham A. N. , Nguyen L. T. , Le O. N. , Sohn A. H. , Sethaputra C. , Cooper D. A. , Law M. G. , Kariminia A. 
Published: August 2016

Abstract
Background.  The burden of Kaposi sarcoma (KS) in human immunodeficiency virus (HIV)–infected children and adolescents on combination antiretroviral therapy (cART) has not been compared globally.
Methods.  We analyzed cohort data from the International Epidemiologic Databases to Evaluate AIDS and the Collaboration of Observational HIV Epidemiological Research in Europe. We included HIV-infected children aged &lt;16 years at cART initiation from 1996 onward. We used Cox models to calculate hazard ratios (HRs), adjusted for region and origin, sex, cART start year, age, and HIV/AIDS stage at cART initiation.
Results.  We included 24 991 children from eastern Africa, southern Africa, Europe and Asia; 26 developed KS after starting cART. Incidence rates per 100 000 person-years (PYs) were 86 in eastern Africa (95% confidence interval [CI], 55–133), 11 in southern Africa (95% CI, 4–35), and 81 (95% CI, 26–252) in children of sub-Saharan African (SSA) origin in Europe. The KS incidence rates were 0/100 000 PYs in children of non-SSA origin in Europe (95% CI, 0–50) and in Asia (95% CI, 0–27). KS risk was lower in girls than in boys (adjusted HR [aHR], 0.3; 95% CI, .1–.9) and increased with age (10–15 vs 0–4 years; aHR, 3.4; 95% CI, 1.2–10.1) and advanced HIV/AIDS stage (CDC stage C vs A/B; aHR, 2.4; 95% CI, .8–7.3) at cART initiation.
Conclusions.  HIV-infected children from SSA but not those from other regions, have a high risk of developing KS after cART initiation. Early cART initiation in these children might reduce KS risk.