SAN FRANCISCO — San Francisco doctors have reported a cluster among gay men of unusual cases of Kaposi’s sarcoma, the cancerlike skin disease whose disfiguring purple lesions were a terrifying signature of a bygone era of the AIDS epidemic.
All 15 patients under treatment for the condition are long-term survivors of HIV whose infections are firmly under control with antiviral drugs. So far, none of them appears to be in any danger.
The new cases of Kaposi’s sarcoma have not been aggressive, invasive or lethal the way the disease behaved in patients with uncontrolled HIV during the 1980s.
Still, the lesions are unsightly, difficult to treat and raise uncomfortable questions about what weaknesses might lurk in the immune systems of thousands of aging survivors of the epidemic.
The re-emergence of this classic AIDS illness in these outwardly healthy patients is an unsettling echo from the past and a warning that this 26-year-old plague still has the capacity to surprise.
“This could either be the canary in the coal mine, or it could just be a collection of rare events that will continue to occur when people are given what appears to be effective treatment,” said Dr. Jeffrey Miller, a San Francisco General Hospital epidemiologist and Kaposi’s sarcoma expert.
Kaposi’s sarcoma was one of the first visible manifestations of the HIV epidemic. At the time, it was popularly known as “gay cancer.” About 80 percent of early AIDS patients suffered from it, and when it migrated to the lungs, lymph nodes and throat, many died.
With the widespread use of combinations of antiviral drugs beginning in 1995, however, the lesions disappeared, and AIDS-related Kaposi’s sarcoma has seldom been seen in the United States except among impoverished patients whose HIV is untreated.
Columbia University researchers proved in 1994 that Kaposi’s sarcoma is caused by a herpes virus, dubbed HHV-8. Both the rampant AIDS-related Kaposi’s sarcoma, and the more benign Mediterranean variety, are caused by the same virus. In the case of uncontrolled HIV infection, the Kaposi’s sarcoma virus takes off because the patient’s immune system is destroyed. In the case of the Mediterranean men, their immune system is simply old.
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