TY - JOUR
T1 - Sexual Activity and Kaposi's Sarcoma Among Human Immunodeficiency Virus Type 1 and Human Herpesvirus Type 8-Coinfected Men
AU - Nawar, Eric W.
AU - Cole, Stephen R.
AU - Farzadegan, Homayoon
AU - Witt, Mallory D.
AU - Jenkins, Frank J.
AU - Margolick, Joseph B.
AU - Phair, John P.
AU - Jacobson, Lisa P.
PY - 2008/7
Y1 - 2008/7
N2 - Purpose: There is notable heterogeneity in the progression to Kaposi's sarcoma (KS) among men coinfected with HIV-1 and human herpesvirus type 8 (HHV-8); additional determinants of KS likely exist. Here, we explore sexual activity as a proxy for a sexually transmitted determinant beyond HIV-1 and HHV-8. Methods: The association between sexual activity and incident KS was estimated with data from 1354 HIV-1- and HHV-8-coinfected homosexual men who were followed for up to 10 years in the Multicenter AIDS Cohort Study. Results: As expected, white race, low CD4 cell count, and the acquisition of HHV-8 after HIV-1 infection increased, whereas smoking decreased, the hazard of KS. The unadjusted hazard of KS among those with high sexual activity was 0.68 relative to the hazard of those with low sexual activity (95% confidence interval, 0.49-0.93) and was somewhat muted after adjustment for characteristics measured at study entry (i.e., race, smoking, CD4 cell count, infection order, history of sexual activity, and sexually transmitted diseases). However, adjustment for time-varying covariates, particularly CD4 cell count, resulted in a nullification of the association (adjusted hazard ratio = 1.06; 95% confidence interval, 0.77-1.48). Conclusion: Once HIV-1 and HHV-8 coinfection is established in homosexual men, progression to KS does not appear to be caused by a third pathogen transmitted by sexual activity.
AB - Purpose: There is notable heterogeneity in the progression to Kaposi's sarcoma (KS) among men coinfected with HIV-1 and human herpesvirus type 8 (HHV-8); additional determinants of KS likely exist. Here, we explore sexual activity as a proxy for a sexually transmitted determinant beyond HIV-1 and HHV-8. Methods: The association between sexual activity and incident KS was estimated with data from 1354 HIV-1- and HHV-8-coinfected homosexual men who were followed for up to 10 years in the Multicenter AIDS Cohort Study. Results: As expected, white race, low CD4 cell count, and the acquisition of HHV-8 after HIV-1 infection increased, whereas smoking decreased, the hazard of KS. The unadjusted hazard of KS among those with high sexual activity was 0.68 relative to the hazard of those with low sexual activity (95% confidence interval, 0.49-0.93) and was somewhat muted after adjustment for characteristics measured at study entry (i.e., race, smoking, CD4 cell count, infection order, history of sexual activity, and sexually transmitted diseases). However, adjustment for time-varying covariates, particularly CD4 cell count, resulted in a nullification of the association (adjusted hazard ratio = 1.06; 95% confidence interval, 0.77-1.48). Conclusion: Once HIV-1 and HHV-8 coinfection is established in homosexual men, progression to KS does not appear to be caused by a third pathogen transmitted by sexual activity.
KW - HHV-8
KW - HIV-1
KW - Kaposi's sarcoma
KW - Sexual activity
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U2 - 10.1016/j.annepidem.2008.03.009
DO - 10.1016/j.annepidem.2008.03.009
M3 - Article
C2 - 18504143
AN - SCOPUS:44849140140
SN - 1047-2797
VL - 18
SP - 517
EP - 521
JO - Annals of epidemiology
JF - Annals of epidemiology
IS - 7
ER -