Physicians in San Francisco Identify Kaposi's Sarcoma Cluster Among HIV-Positive MSM

Physicians from San Francisco General Hospital last month in a letter published in the New England Journal of Medicine said they had identified between November 2004 and January 2006 a cluster of nine cases of Kaposi's sarcoma among HIV-positive men who have sex with men, the San Francisco Chronicle reports.

Kaposi's sarcoma is a skin disease triggered by a herpes virus, called HHV-8, which causes purple lesions to develop. About 80% people living with HIV/AIDS in the U.S. developed the disease before the introduction of antiretroviral drugs in 1995, and many died when it spread to their lungs, lymph nodes and throat. Kaposi's sarcoma still is common in sub-Saharan Africa, where 75% of people who need antiretrovirals do not have access to them.

The total number of confirmed cases of Kaposi's sarcoma among HIV-positive MSM in San Francisco has increased to 15 since the letter was published last month, the Chronicle reports. The majority of people in treatment for the condition are in their 40s and 50s, have been HIV-positive for almost 20 years and have undetectable HIV viral loads. Unlike Kaposi's sarcoma cases prior to widespread use of antiretrovirals in the U.S., the new cases have not been aggressive, invasive or deadly; however, the lesions are "unsightly, difficult to treat and raise uncomfortable questions about what weaknesses" might occur in the immune systems of aging HIV-positive people, the Chronicle reports.

"The normal treatment for KS among HIV patients is to treat the virus and boost the immune system," Toby Maurer, chief of dermatology at SFGH, said, adding, "But in these patients, their immune system is already boosted." Maurer added that the "big question" is whether physicians will be able to control other viruses or infections in aging HIV-positive people if they are unable to control HHV-8. "That's why we are following this very closely," she said (Russell, San Francisco Chronicle, 10/12).

Online The NEJM letter is available online.

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