Red to those without KS (27 vs. 10 ). The rate of LTFU after ART initiation was 13.0/100 py among those with KS compared to 3.9/100 py among those without KS. Epigenetics Individuals with KS had higher mortality rates at all durations after ART initiation compared to those without KS: 28.3/100 person-years (100 py) vs. 7.4/100 py within the first year and 4.1/100 py vs. 1.8/100 py after the first year. Cumulative incidence curves showed higher incidence of mortality for those with KS after ART initiation with the greatest differences in mortality occurring within the first year on treatment (Figure 1). The risk of death for those with KS was over three times that of those without KS at any time point after ART initiation (adjusted HR: 3.62; 95 CI: 2.71?.84) and four times greater within the first year after ART initiation (adjusted HR: 4.05; 95 CI: 2.95?.55) (Table 2). Among those who survived to a year on treatment, the risk of death was still greater in the KS group though the magnitude of this effect was smaller (adjusted HR: 2.30; 95 CI: 1.08?.89). We also analyzed the effect of time of KS diagnosis in relation to ART initiation on mortality. The mortality rate after ART initiation was greater among those diagnosed with KS before ART initiation than those diagnosed with KS after ART initiation (14.2/100 py vs. 9.8/100 py) though both of these were greater than the proportion who died among those without KS (3.9/ 100 py). The hazard of death among those diagnosed with KS before ART initiation was higher than the hazard among those diagnosed with KS after ART initiation (HR = 4.14 95 CI 2.97?5.77 vs. HR = 2.61 95 CI 1.47?.62) comparing both groups to those without KS.Table 1. Baseline characteristics of 13,847 adults initiating ART in Cape Town and Autophagy Johannesburg, South Africa, stratified by presence of Kaposi sarcoma.Characteristics Sex Age at ART Initiation (years) Initiating treatment site Male Median (IQR) Khayelitsha Themba Lethu Year of ART Initiation Before 2004 2004 2005 2006 2007 CD4 at ART Initiation (cells/mm3) Median (IQR) 0?0 51?00 101?00 200?50 First-line ART Regimen d4T/3TC/EFV d4T/3TC/NVP Other TB at Initiation YesNo Kaposi Sarcoma (n = 13,600) 4893 (36.0 ) 35 (30?1) 6583 (48.4 ) 7017 (51.6 ) 581 (4.3 ) 1947 (14.3 ) 3185 (23.4 ) 4149 (30.5 ) 3738 (27.5 ) 85 (33?50) 4256 (34.3 ) 2747 (22.1 ) 4518 (36.4 ) 899 (7.2 ) 9200 (68.1 ) 3000 (22.2 ) 1562 (11.7 ) 3247 (29.5 )Kaposi Sarcoma (n = 247) 121 (49.0 ) 35 (30?1) 153 (61.9 ) 94 (38.1 ) 20 (8.1 ) 42 (17.0 ) 74 (30.0 ) 64 (25.9 ) 47 (19.0 ) 74 (29?52) 86 (37.9 ) 46 (20.3 ) 67 (29.5 ) 28 (12.3 ) 169 (69.3 ) 52 (21.3 ) 23 (9.4 ) 71 (36.6 )TB = tuberculosis; IQR = interquartile range, ART = antiretroviral therapy; d4T = stavudine, 3TC = lamivudine, EFV = efavirenz, NVP = nevirapine. Number of patients ( ) are shown unless otherwise stated. doi:10.1371/journal.pone.0064392.tKaposi Sarcoma and ART in HIV-Positive PopulationCrude HR (95 CI) {Adjusted HR (95 CI)`Table 2. The effect of Kaposi Sarcoma on mortality and loss to follow-up after initiation of ART among 13,065 adult HIV-infected patients initiating ART in Cape Town and Johannesburg, South Africa.1.58 (1.16?.14)1.69 (1.14?.49)1.1.1.1.44 (0.89?.32)A greater proportion of individuals with KS were LTFU after ART initiation compared to those without KS (18 vs. 14 ). The rate of LTFU after ART initiation was 8.8/100 py among those with KS compared to 5.5/100 py among those without KS. Among those with KS, the rate of LTFU was greatest.Red to those without KS (27 vs. 10 ). The rate of LTFU after ART initiation was 13.0/100 py among those with KS compared to 3.9/100 py among those without KS. Individuals with KS had higher mortality rates at all durations after ART initiation compared to those without KS: 28.3/100 person-years (100 py) vs. 7.4/100 py within the first year and 4.1/100 py vs. 1.8/100 py after the first year. Cumulative incidence curves showed higher incidence of mortality for those with KS after ART initiation with the greatest differences in mortality occurring within the first year on treatment (Figure 1). The risk of death for those with KS was over three times that of those without KS at any time point after ART initiation (adjusted HR: 3.62; 95 CI: 2.71?.84) and four times greater within the first year after ART initiation (adjusted HR: 4.05; 95 CI: 2.95?.55) (Table 2). Among those who survived to a year on treatment, the risk of death was still greater in the KS group though the magnitude of this effect was smaller (adjusted HR: 2.30; 95 CI: 1.08?.89). We also analyzed the effect of time of KS diagnosis in relation to ART initiation on mortality. The mortality rate after ART initiation was greater among those diagnosed with KS before ART initiation than those diagnosed with KS after ART initiation (14.2/100 py vs. 9.8/100 py) though both of these were greater than the proportion who died among those without KS (3.9/ 100 py). The hazard of death among those diagnosed with KS before ART initiation was higher than the hazard among those diagnosed with KS after ART initiation (HR = 4.14 95 CI 2.97?5.77 vs. HR = 2.61 95 CI 1.47?.62) comparing both groups to those without KS.Table 1. Baseline characteristics of 13,847 adults initiating ART in Cape Town and Johannesburg, South Africa, stratified by presence of Kaposi sarcoma.Characteristics Sex Age at ART Initiation (years) Initiating treatment site Male Median (IQR) Khayelitsha Themba Lethu Year of ART Initiation Before 2004 2004 2005 2006 2007 CD4 at ART Initiation (cells/mm3) Median (IQR) 0?0 51?00 101?00 200?50 First-line ART Regimen d4T/3TC/EFV d4T/3TC/NVP Other TB at Initiation YesNo Kaposi Sarcoma (n = 13,600) 4893 (36.0 ) 35 (30?1) 6583 (48.4 ) 7017 (51.6 ) 581 (4.3 ) 1947 (14.3 ) 3185 (23.4 ) 4149 (30.5 ) 3738 (27.5 ) 85 (33?50) 4256 (34.3 ) 2747 (22.1 ) 4518 (36.4 ) 899 (7.2 ) 9200 (68.1 ) 3000 (22.2 ) 1562 (11.7 ) 3247 (29.5 )Kaposi Sarcoma (n = 247) 121 (49.0 ) 35 (30?1) 153 (61.9 ) 94 (38.1 ) 20 (8.1 ) 42 (17.0 ) 74 (30.0 ) 64 (25.9 ) 47 (19.0 ) 74 (29?52) 86 (37.9 ) 46 (20.3 ) 67 (29.5 ) 28 (12.3 ) 169 (69.3 ) 52 (21.3 ) 23 (9.4 ) 71 (36.6 )TB = tuberculosis; IQR = interquartile range, ART = antiretroviral therapy; d4T = stavudine, 3TC = lamivudine, EFV = efavirenz, NVP = nevirapine. Number of patients ( ) are shown unless otherwise stated. doi:10.1371/journal.pone.0064392.tKaposi Sarcoma and ART in HIV-Positive PopulationCrude HR (95 CI) {Adjusted HR (95 CI)`Table 2. The effect of Kaposi Sarcoma on mortality and loss to follow-up after initiation of ART among 13,065 adult HIV-infected patients initiating ART in Cape Town and Johannesburg, South Africa.1.58 (1.16?.14)1.69 (1.14?.49)1.1.1.1.44 (0.89?.32)A greater proportion of individuals with KS were LTFU after ART initiation compared to those without KS (18 vs. 14 ). The rate of LTFU after ART initiation was 8.8/100 py among those with KS compared to 5.5/100 py among those without KS. Among those with KS, the rate of LTFU was greatest.