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Cancer Reemerging in HIV Patients

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Cancer Reemerging in HIV Patients

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Cancer Reemerging in HIV Patients

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MADELEINE BRAND, host:

An illness associated with AIDS, Kaposi's sarcoma, is resurfacing. Kaposi's sarcoma can be lethal. It's triggered by a herpes virus and it causes disfiguring purple skin lesions. In the early days of the AIDS epidemic, about 80 percent of AIDS patients had it.

ALEX COHEN, host:

But with the introduction of antiretroviral drugs in 1995, Kaposi's sarcoma cases in the U.S. were virtually wiped out. Now the cancer has resurfaced in more than a dozen HIV-positive gay men.

Jeff Martin is an epidemiologist at the University of California, San Francisco.

Dr. JEFFREY MARTIN (University of California, San Francisco): The unusual aspect of what we're seeing right now is just that these have come in people who appear to have reconstituted immune systems, or repaired immune systems.

COHEN: And that was the trouble, as I understand it, at the beginning of the onset of AIDS, is that people had these compromised immune systems and therefore weren't able to battle off K.S. If this is occurring in men who have stronger immune systems, will this cancer be as much of a problem? Is it a concern?

Dr. MARTIN: Well, I think certainly the occurrence of these cases, which probably now number around 15, do represent a concern to us. We just don't know really what the future is going to hold.

COHEN: Is there any treatment for K.S.?

Dr. MARTIN: Chemotherapy is available. The use of antiretroviral drugs per se that are usually used in HIV-infected individuals often results in regression of lesions, although in this case the K.S. has occurred despite effective antiretroviral therapy. So that potential line of agents has not been as successful in these individuals.

COHEN: What about the men themselves who've been afflicted? I mean, these lesions had such a stigma back in the '80s. I would imagine it was very frightening for them when they all of a sudden discovered that they had these deep purple marks.

Dr. MARTIN: Yeah. I think that is correct, although we do know that in these individuals their course of disease has not been very aggressive, and that is in contradistinction to what the typical course of disease was early in the epidemic. Nonetheless, you know, simply the presence of these lesions, with all the stigma that they have carried in the past, is certainly alarming for any patient who develops it.

COHEN: And I understand that these men are typically younger than those who would more often be afflicted with K.S.?

Dr. MARTIN: If you're speaking of the occurrence of K.S. in the general population, I mean, for example, in Italy, there is a rather robust frequency of the virus that causes K.S. We see there, even without HIV disease, that K.S. will occur in elderly individuals, typically elderly men. The people that have been studied here in San Francisco are developing their K.S. at a younger age, which has really led to the concern, is this really causing an aging in the immune system such that perhaps they are developing diseases that would typically only be seen in older individuals? But I think it's important not to be alarmist. I think these individuals that have been studied so far represent a proof of concept that this can occur. What remains to be seen is really how frequently we will see this.

COHEN: Dr. Jeffrey Martin of University of California San Francisco School of Medicine, thank you so much.

Dr. MARTIN: Thank you very much, Alex, for having me on today.

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