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. 2021 Oct 5;73(7):e2226-e2233.
doi: 10.1093/cid/ciaa999.

Kaposi Sarcoma Rates Among Persons Living With Human Immunodeficiency Virus in the United States: 2008-2016

Qianlai Luo  1 , Anna Satcher Johnson  2 , H Irene Hall  2 , Elizabeth K Cahoon  3 , Meredith Shiels  1
Affiliations

Kaposi Sarcoma Rates Among Persons Living With Human Immunodeficiency Virus in the United States: 2008-2016

Qianlai Luo et al. Clin Infect Dis. .

Abstract

Background: Recent studies have suggested that Kaposi sarcoma (KS) rates might be increasing in some racial/ethnic groups, age groups, and US regions. We estimated recent US trends in KS incidence among people living with human immunodeficiency virus (HIV; PLWH).

Methods: Incident KS patients aged 20-59 years were obtained from 36 cancer registries and assumed to be living with HIV. The number of PLWH was obtained from national HIV surveillance data from 2008 to 2016. Age-standardized KS rates and annual percent changes (APCs) in rates were estimated by age, sex, race/ethnicity, state, and region.

Results: Between 2008 and 2016, the age-adjusted KS rate among PLWH was 116/100 000. Rates were higher among males, in younger age groups, and among white PLWH. Washington, Maine, and California had the highest KS rates among PLWH. KS rates among PLWH decreased significantly (average APC = -3.2% per year, P < .001) from 136/100 000 to 97/100 000 between 2008 and 2016. There were no statistically significant increases in KS rates in any age, sex, or racial/ethnic group or in any geographic region or state. However, there were nondecreasing trends in some states and in younger age groups, primarily among black PLWH.

Conclusions: KS incidence rates among PLWH have decreased nationally between 2008 and 2016. Though there were no statistically significant increases in KS rates in any demographic or geographic group, nondecreasing/stagnant KS trends in some states and among younger and black PLWH highlight the need for early diagnosis and treatment of HIV infection.

Keywords: AIDS; HIV; Kaposi sarcoma; epidemiology; rates.

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Figures

Figure 1.
Figure 1.
Heat map of age-standardized KS rates among persons living with HIV in the United States (2008–2016). States in white were not included in the analysis. Shaded states were suppressed (ie, <6 KS cases occurred during the time period). Abbreviations: HIV, human immunodeficiency virus; KS, Kaposi sarcoma.
Figure 2.
Figure 2.
Trends in KS among persons living with human immunodeficiency virus by (A) sex, (B) age group, (C) race/ethnicity, and (D) region in the United States (2008–2016). Symbols represent age-standardized KS rates, and dashed lines represent modeled trends. *Indicates statistically significant (P < .05) AAPC. Abbreviations: AAPC, average annual percent change; KS, Kaposi sarcoma.
Figure 3.
Figure 3.
AAPC of age-standardized Kaposi sarcoma rates among persons living with human immunodeficiency virus by state, 2008–2016. Dots represent AAPCs, and lines indicate 95% confidence intervals. *Indicates statistically significant (P < .05) AAPC. Abbreviations: AAPC, average annual percent change.
Figure 4.
Figure 4.
Trends in KS among persons living with human immunodeficiency virus by age group among (A) whites and (B) blacks in the United States (2008–2016). Symbols represent age-standardized KS rates, and dashed lines represent modeled trends. *Indicates statistically significant (P < .05) AAPC. Note: Data on Hispanics were excluded as numbers of KS cases in this group was limited. Abbreviations: AAPC, average annual percent change; CI, confidence interval; KS, Kaposi sarcoma.
Figure 5.
Figure 5.
Rates of KS among PLWH vs percentages of MSM among PLWH by state (2008–2016). Points indicate individual states. The line represents a fitted regression line, with 95% confidence intervals indicated with dashed lines. Abbreviations: KS, Kaposi sarcoma; MSM, men who have sex with men; PLWH, persons with human immunodeficiency virus. AL, Alabama; AZ, Arizona; CA, California; CT, Connecticut; GA, Georgia; HI, Hawaii; IL, Illinois; IA, Iowa; KY, Kentucky; LA, Louisiana; ME, Maine; MA, Massachusetts; MI, Michigan; MS, Mississippi; NE, Nebraska; NJ, New Jersey; NY, New York; OH, Ohio; OK, Oklahoma; OR, Oregon; PA, Pennsylvania; RI, Rhode Island; SC, South Carolina; TN, Tennessee; TX, Texas; UT, Utah; VA, Virginia; WA, Washington; WV, West Virginia; WI, Wisconsin.
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