HI January 2009 to December 2018, and included 262 patients for analysis. Of the patients, 30% were receiving ART at the time of KS diagnosis and one-fourth were first diagnosed with HIV and KS at the same time. Regarding disease stage, 46% of patients had T1, 75% had I1 and 54% had S1 stage disease. Of the included patients with KS, 30.9% died, with a median survival duration of 11 months from KS diagnosis. Black patients had the highest mortality of all race/ethnic groups, including white and Hispanic patients. According to Dr. Knights, U.S. Surveillance, Epidemiology, and End Results program data indicate an expected five-year survival rate of about 77% in KS, but in the current study, that rate for Black patients was 69%. The five-year survival rate was 78% for white patients and 81% for Hispanic patients. A multivariable analysis showed Black patients had a mortality risk twice that of white or Hispanic patients (hazard ratio, 2.07; 95% CI, 1.12-3.82). Black race was found to be independently associated with mortality. “Although white and Hispanic patients had slightly better mortality than expected in our study, Black patients had worse mortality than expected,” Dr. Knights said.
Implications Dr. Knights and her colleagues found Black patients had more advanced KS disease at diagnosis, and often were younger than other ethnicities, which could explain the mortality difference. “What’s not clear from our study is why these patients are presenting with more advanced disease,” Dr. Knights said. “Could these patients be infected with a specific genotype of KS-associated herpesvirus that may be associated with more advanced disease? Could there be a complex combination of socioeconomic factors involved that are difficult to measure?” She said they were unable to answer this question in this study, but hope to do so in future studies. Dr. Knights said according to the CDC’s HIV Surveillance program, Black people in the southern United States have the highest death rates from HIV, too. “I suspect that whatever the underlying etiology of the mortality disparity in KS is, it is most likely related to the same factors that contribute to higher mortality in HIV deaths in the southern United States,” Dr. Knights said. “We as HIV providers still have a lot of work to do to help ■ identify and alleviate healthcare disparities.” Dr. Dittmer reported a position as an investigator with the AIDS Malignancy Consortium. Dr. Knights reported grant funding from the UT Southwestern Simmons Comprehensive Cancer Center Pilot Award.
News
Risk for HIV Depends On Who You Are BY MARIE ROSENTHAL, MS
D
espite the tremendous progress made in reducing new HIV transmissions in the United States, the disease continues to affect some groups more than others, according to Sonia Singh, PhD, an epidemiologist with the CDC’s Division of HIV Prevention, who calculated the lifetime risk for HIV among various groups. “Overall, the lifetime risk for an HIV diagnosis in the United States was one in 120,” Dr. Singh said, an 11% decrease from the last analysis in 2014 (CROI 2022). One in 76 males and one in 309 females will receive a diagnosis of HIV in their lifetime, but the probable risk sharply increases based on sex and race with Black and Hispanic males having a greater risk than white or Asian males. The analysis used data from the National HIV Surveillance System, the National Center for Health Statistics and census data to calculate the probability of a diagnosis of HIV at a given age, assuming 2017-2019 diagnosis rates continue. These probabilities were applied to a hypothetical cohort to obtain risk estimates. The lifetime risk is the probability of being diagnosed with HIV from birth. The lifetime risk for Black males was one in 27, whereas the lifetime risk for Hispanic males was one in 50—both higher than the overall lifetime risk for males. Asian males experienced the lowest lifetime risk at one in 187. The risk for white males was one in 171. For American Indian/Alaskan Native men, the lifetime risk was one in 116, and one in 89 for Native Hawaiian and other Pacific Islander men. Females fared better across the board. The risk for an HIV diagnosis was one in 75 for Black females; one in 287 for Hispanic females; one in 435 for American Indian/Alaskan Native females; one in 611 for Native Hawaiian and other Pacific Islander females; one in 874 for white females; and one in 1,298 for Asian females. The states with the highest lifetime risk for being diagnosed with HIV were Georgia, Florida, Louisiana, Nevada and Maryland. “Nine of the 10 areas of residence with the highest possibility of a lifetime HIV diagnosis were located in the South,” she said. The lifetime risk for a disease is used to compare the burden of disease across populations, she explained, and is frequently used to describe cancer risk but not necessarily the risk for HIV. Lifetime risk could be a “useful tool for clinicians, outreach workers and ■ policymakers when describing a burden of HIV,” she said.
INFECTIOUS DISEASE SPECIAL EDITION • SPRING 2022
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