KS Back In San Francisco

Horrible news of out San Francisco.

San Francisco doctors have reported a cluster among gay men of unusual cases of Kaposi's sarcoma, the cancer-like 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 Martin, a San Francisco General Hospital epidemiologist and Kaposi's sarcoma expert.

Anybody who was around in the early plague years remembers the incredible stigma of KS, "the purple mark of death," as so gruesomely depicted in the movie Philadelphia. Perhaps more than lymphoma or pneumocystis, the appearance of KS would cause some gay men to plummet emotionally, often prompting suicide. I had several friends die from complications of KS, although anybody who made it to the advent of the cocktail in '96 saw their lesions fade. Even if this resurgence proves to be relatively benign, and we can only hope desperately that it will be, this news is a horrible blow.
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