Pj. Veugelers et al., IS THE HUMAN IMMUNODEFICIENCY VIRUS-RELATED KAPOSIS-SARCOMA EPIDEMIC COMING TO AN END - INSIGHTS FROM THE TRICONTINENTAL SEROCONVERTER STUDY, Epidemiology, 6(4), 1995, pp. 382-386
A decline in the proportion of Kaposi's sarcoma among AIDS cases since
the 1980s has been attributed to changes in sexual behavior among hom
osexual men and a decreasing exposure to a hypothesized Kaposi's sarco
ma cofactor. Recent studies have shown that the incidence rate of Kapo
si's sarcoma has remained relatively stable, which seems to argue agai
nst the hypothesis of a declining exposure to the putative cofactor, T
o examine this paradox, we evaluated the incidence of Kaposi's sarcoma
, using Cox proportional hazard analyses, and per formed a simulation
to compare incidences of different AIDS outcomes among 407 homosexual
men with documented dates of seroconversion. Our data show that men wh
o seroconverted early in the epidemic did not progress faster to Kapos
i's sarcoma than men who seroconverted more recently, A lower incidenc
e rate of Kaposi's sarcoma would be expected among the latter group if
exposure to the hypothesized cofactor is decreasing over time, The pe
rcentage of Kaposi's sarcoma among incident AIDS cases decreased over
the years following seroconversion, but not over calendar time. This s
tudy demonstrates that the decline in the proportion of Kaposi's sarco
ma among AIDS cases should not be interpreted as a decline in the inci
dence of Kaposi's sarcoma and that there is no evidence that a hypothe
sized Kaposi's sarcoma cofactor is declining over calendar time.