S.F. Doctors
Report Kaposi's Comeback

Doctors in San Francisco have reported an outbreak among long-term AIDS patients of Kaposi's sarcoma, the viral skin disease whose purple lesions were a telltale sign of advancing disease before drugs were developed to treat the epidemic.

The 15 patients under treatment are all doing well on antiretroviral therapy, and none is in danger, Toby Maurer, chief of dermatology at San Francisco General Hospital, told the San Francisco Chronicle.

Unlike the Kaposi's of the 1980s, the condition does not appear to spread to internal organs or to be a harbinger of declining health, Maurer said.

Still, the condition's recurrence is puzzling. Doctors think some other virus or latent infection may trigger HHV-8, the herpes virus that causes Kaposi's, in otherwise stable patients.

Kaposi's was originally seen almost exclusively in older Mediterranean men; the new outbreaks appear to be much like the earlier, more benign form of the disease.

"This is nothing like what we saw 25 years ago," dermatologist Marcus Conant, who discovered the first clusters of Kaposi's patients at that time, told the Chronicle.

In addition to systemic AIDS drugs, the new patients have been treated topically with liquid nitrogen or injections of chemotherapy drugs to remove the lesions, the newspaper said.

"The normal treatment for KS among HIV patients is to treat the virus and boost the immune system," Maurer told the Chronicle. "But in these patients, their immune system is already boosted."

Maurer described the cases in a letter published September 27 in The New England Journal of Medicine.

The patients' average age is 51; they have been HIV-positive for 18 years, on average, and have been on antiretrovirals for seven. They were diagnosed with Kaposi's between November 2004 and January 2006. (Barbara Wilcox, The Advocate)