Epidemiology of KSHV in HIV-1-infected US persons in the Era of Combination Antiretroviral Therapy

Abstract

Objective

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 herpesvirus (KSHV).

Design, setting and participants

We investigated the epidemiology of KSHV in 5022 HIV-1-infected, antiretroviral naïve 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.

Main outcome measures

We studied prevalence and incidence of KSHV infection, incidence of Kaposi’s sarcoma (KS), and overall survival.

Results

KSHV prevalence was 38.1% (95% CI 36.8-39.5%). Male gender, Caucasian race, age between 30 and 49, residence in North-eastern or Western US, 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 gender, Caucasian race, age below 30, and enrolment after 2001 were associated with incident infection. CD4 count increase following cART was associated with lower risk.

KS incidence was 104.05/100,000 person/years (95% CI 71.17-146.89). Higher baseline CD4 count, but not increase in CD4 count after cART, was associated with lower hazard of KS. Randomized assignment of protease inhibitors was not associated with better KSHV outcomes.

Conclusions

HIV-1 infected individuals, in particular Caucasian men, remain at significant risk for KSHV co- infection and KS. Thus, optimal management of HIV-1 infection should continue to include vigilance for manifestations of KSHV co-infection, including KS.

Video abstract at http://ncifrederick.cancer.gov/services/spgm/filedownload/pdsDownload.aspx?id=c472803f-1d66–4391-b18b-24e367b6b190