CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

618

Risk of Kaposi Sarcoma in HIV-Positive Adults on ART: A Global Analysis Eliane Rohner 1 ; Julia Bohlius 1 ; Lukas Bütikofer 2 ; Mhairi Maskew 3 ;Yi-Ming A. Chen 4 ;Valeria Fink 5 ; Chad Achenbach 6 ; Matthias Egger 7 ; for the International Epidemiologic Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord 1 Inst of Social and Preventive Med, Univ of Bern, Bern, Switzerland; 2 Univ of Bern, Bern, Switzerland; 3 Univ of the Witwatersrand, Wits Hlth Consortium, Johannesburg, South Africa; 4 Kaohsiung Med Univ, Kaohsiung, Taiwan; 5 Fundación Huésped, Buenos Aires, Argentina; 6 Northwestern Univ, Chicago, IL, USA; 7 Univ Hosp Bern, Bern, Switzerland Background: No comparisons of Kaposi sarcoma (KS) risk are available between regions with different HIV and Human Herpesvirus 8 (HHV-8) prevalence. We examined KS risk in adults on combination antiretroviral therapy (ART) in the IeDEA and COHERE in EuroCoord cohort collaborations. Methods: We included HIV-positive adults (≥ 16 years) who started ART from 1996 onwards. We compared the risk of incident KS between regions using flexible parametric survival models with region-specific baseline hazards, adjusted for age, sex and its interaction with region, time-updated CD4 counts and year of ART start. We excluded Asia- Pacific and Australia frommultivariable analyses due to the small sample size. We present hazard ratios (HR) and 95% confidence intervals (CI) by time on ART and at 2 years after ART start. Results: We included 352,013 patients from Asia-Pacific, Australia, Latin and North America, Southern Africa, and Europe. Median age at ART start was 36 years and similar across regions. Median CD4 count at ART start was <200 cells/µL in Asia, Southern Africa and Latin America, and >200 cells/µL in Australia, Europe and North America. The proportion of men and the subset who have sex with men (MSM) was highest in Australia, followed by North and Latin America and Europe. Over 1.3 million person-years (pys) 2,935 adults developed KS for an overall incidence rate of 199/100,000 pys (95%CI 192-207). After 2 years on ART KS incidence was higher in women from Southern Africa than in European women (adjusted HR 2.5, 95%CI 2.0-3.1), and similar to European women in women from Latin and North America. In men crude KS risk was higher in North America compared to Europe (HR 1.5, 95%CI 1.3-1.9), in multivariable analyses this risk declined to HR 1.1 (95%CI 0.9-1.4). The change was mainly explained by adjusting for time-updated CD4 counts. KS risk was similar in men from other regions (Figure). Conclusions: Women in Southern Africa had a higher KS risk than women in Europe which was not explained by HIV-related risk factors. In men KS risk was similar across regions after adjusting for HIV-related risk factors. This pattern likely reflects different HHV-8 risk profiles: while men were at high risk of HHV-8 infection in most regions (MSM or resident in HHV-8 endemic regions) the main risk factor for HHV-8 infection in women was residence in endemic regions. Migration data were not available for all regions and hence not considered in the analysis.

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Kaposi Sarcoma Risk in Children on ART From Africa, Europe, and Asia Eliane Rohner ; Julia Bohlius; for the on behalf of the International Epidemiologic Databases to Evaluate AIDS Southern Africa, the Collaboration of Observational HIV Epidemiological Research in Europe in EuroCoord, and theTREAT Asia Pediatric HIV Observational Database Inst of Social and Preventive Med, Univ of Bern, Bern, Switzerland Background: Epidemic Kaposi sarcoma (KS) is caused by human herpesvirus 8 (HHV-8) infection and HIV-induced immunosuppression. HHV-8 prevalence and access to HIV care vary between regions. HHV-8 prevalence is higher in Eastern Africa than Southern Africa, and lower in Europe and Asia. We compared the KS burden in HIV-positive children on combination antiretroviral therapy (ART) between Asia, Europe, Eastern and Southern Africa. Methods: We analyzed cohort data of the International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord, and the TREAT Asia Pediatric HIV Observational Database (TApHOD). We included HIV-positive children aged <16 years who started ART between 1996 and 2014. We calculated KS incidence rates per 100,000 person-years (pys) and hazard ratios (HR) from Cox regression adjusted for region, sex, age at ART start, ART regimen, and ART start year. We used CD4 cell counts and CD4% to define degree of immunodeficiency at ART start according to WHO criteria. Results: We included 24,383 children from Asia (Cambodia, India, Indonesia, Malaysia, Vietnam, Thailand), Europe (Denmark, France, Germany, Spain, Netherlands, UK), Eastern Africa (Zambia, Zimbabwe) and Southern Africa (South Africa). Median age at ART start was 5.1 years and lower in Southern Africa than in the other regions, see Table. Most

Poster Abstracts

children (55%) started ART with advanced or severe immunodeficiency; 10% of children were in CDC stage C. We observed 25 incident KS cases on ART (68% boys; median age at KS diagnosis 10.0 years). KS incidence rates were 85/100,000 pys (95% confidence interval [CI] 55-132) in Eastern Africa, 26/100,000 pys (95% CI 9-82) in Europe, and 9/100,000 pys (95% CI 2-37) in Southern Africa. All KS cases in Europe were in children who originated in sub-Saharan Africa (KS incidence rate 82/100,000 pys). We observed no incident KS in Asia. KS risk increased with age (10-15 versus 0-4 years; adjusted HR 4.1; 95% CI 1.4-12.1) and with advanced stage of HIV/AIDS (CDC stage C versus A/B; adjusted HR 3.1; 95% CI 1.1-8.7) at ART start. Conclusions: KS risk is substantial in HIV-positive children of sub-Saharan African origin, whether they live in Africa or Europe. In the absence of measures to prevent HHV-8 infection, ART should be initiated in a timely fashion, before advanced HIV/AIDS stage is reached, to reduce KS risk in these children.

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CROI 2016