Le. Eberly et al., Kaposi's sarcoma and central nervous system disease: a real association oran artifact of the control group?, AIDS, 14(8), 2000, pp. 995-1000
Objectives: To test the hypothesis that Kaposi's sarcoma (KS) protects agai
nst four central nervous system (CNS) diseases in HIV-1-infected individual
s.
Study population and design: The study population of 9404 subjects included
participants in Terry Beirn Community Programs for Clinical Research on AI
DS (CPCRA) protocols who were enrolled between September 1990 and September
1998. This was an observational study.
Methods: Proportional hazards regression was used to estimate adjusted rela
tive risks for predictors of four central nervous system diseases. Covariat
es included occurrence of Kaposi's sarcoma, occurrence of other opportunist
ic infections or malignancies, baseline CD4+ count, and other baseline char
acteristics.
Results: Among the 5944 participants without progression to AIDS at entry,
451 developed a CNS disease. The adjusted relative risk of any CNS disease
for those who developed Kaposi's sarcoma versus those who did not develop a
ny AIDS-defining event was 1.41 [95% confidence interval (Cl), 0.98-2.03; P
= 0.06]. In contrast, the adjusted relative risk of any CNS disease for th
ose with Kaposi's sarcoma versus those with some other non-Kaposi's sarcoma
AIDS-defining event was 0.37 (95% Cl, 0.24-0.57; P < 0.0001). Among the 34
60 participants with progression to AIDS at entry, the adjusted relative ri
sk of any CNS disease for those with Kaposi's sarcoma versus those with som
e other non-Kaposi's sarcoma AIDS-defining event was 0.71 (95% Cl, 0.40-1.2
5; P = 0.23).
Conclusions: Our analyses indicate that the risk of CNS disease associated
with Kaposi's sarcoma depends strongly on the reference or control group ch
osen. When compared to individuals with other non-Kaposi's sarcoma AIDS-def
ining diseases, Kaposi's sarcoma is associated with a lower risk of CNS dis
ease in HIV-1 positive individuals. However, when compared to individuals w
ith no AIDS-defining disease or with a similarly mild AIDS-defining disease
such as invasive candidiasis, Kaposi's sarcoma is associated with an equiv
alent risk of CNS disease. (C) 2000 Lippincott Williams & Wilkins.