VIRUSMYTH HOMEPAGE
AIDS AND KAPOSI SARCOMA PRE-1979
By Robert Root-Bernstein
The Lancet 21 April 1990
Sir, - Professor FreidmanKien and colleagues (Jan 20, p.168) describe
cases of Kaposi sarcoma (KS) in HlVnegative homosexual men and seek
information on other cases. My review of publications on KS, done in light
of the Centers for Disease Control criteria for diagnosing AIDS has revealed
a large number of cases hat may fit FreidmanKien's description.
Kamer and Pankey (1) have reviewed 28 cases of KS among previously healthy
men under the age of 60 that were reported in the United States and Europe
between 1902 and 1966 and which resulted in death in less than 2 ½
years. Dutz and Stout (2) record another 23 cases of KS not associated
with other diseases or treatments among European and American children
under the age of 16 for the years 190850. 6 of those children died
in less than 2 years. These childhood cases represent about 4% of the total
cases of KS reported for that period, and the cases identified by Kamer
and Pankey represent an equivalent proportion. These historical cases of
KS might have qualified as AIDS cases under the current definition.
Kaposi himself described the earliest known cases of this now eponymous
sarcoma in 1872. Of 5 patients 2 were men in their 40s. A sixth case, diagnosed
by Billroth, was a boy of 10. (3) No underlying or associated diseases
are mentioned. A decade later de Amici described 12 more cases, all in
males; 2 patients were in their 30s, 3 in their 40s, 1 in his 50s, and
1 was a 5yearold.(4) 3 of the younger men, including the boy,
had penile lesions and died within a year with fulminating disease or respiratory
failure accompanying high fever and possibly pneumonia. There are other
examples of series of KS in the preAIDS era, with short survival at
a young age -for instance, the patients reported from the US Armed Forces
Institute of Pathology in 1959, 16 of whom were under 60; (5) the 23 patients
reported from Stockholm between 1915 and 1939, of whom 3 were under 50,
the tumours being more malignant in younger patients, as is typical of
AIDS; (6) and Degosand colleagues' 28 cases in France between 1954 and
1964, 8 of whom contracted the disease before the age of 50. (7)
My review of these and other reports suggests that 1520% of KS
cases published before 1979 were of the type described above. Since the
incidence of KS in the United States was 0.36 per 100 000 for the years
197380, (8) the number of AIDSlike cases of KS that went unrecognised
before 1979 may have 100 or more per year.
There was no test for HIV until 1984 but if we accept that HIV is a
new retrovirus that entered North America and Europe in the past two or
three decades, then all of the cases listed above must have been HIVfree.
If so, several hypotheses must be entertained (9,10) -that AIDS is not
new; that HIV is only one of several possible causes of AIDS; or that HIV
is itself a new, opportunistic infection that takes advantage of previously
immunosuppressed individuals. (11) If, however, one argues that KS in otherwise
healthy young men is always associated with HIV, these historical cases
would indicate that HIV is not a new disease agent, and it would follow
that AIDS is not a new disease and that the current epidemic is due not
to the introduction of a new virus but to changes in lifestyle creating
new populations of susceptible individuals and/or extending modes of transmission.
The existence of HIVfree AIDS cases requires us to reevaluate
the theory that AIDS is a new disease and that HIV is the necessary and
sufficient cause. Incidentally, my review of the history of pneumocystis
pneumonia, cryptococcosis, disseminated cytomegalovirus and candida infections,
and the other opportunistic diseases associated today with AIDS is revealing
the same pattern of unrecognised AIDSlike cases.
I thank Heather Conlee for tracking down many of the references.
ROBERT S. ROOT-BERNSTEIN
Department of Physiology.
Michigan State University
East Lansing Michigan 48824 USA
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79: 106872.
2. Dutz, W, Stout AP. Kaposi's sarcomas in infants and
children. Cancer 1960 13:68494.
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JJ. Incidence of Kaposi's 197381. 7 NCI 1984;73:8994.
9. Sonnabend JA. AIDS an explanation for its occurrence
among homosexual men. In: Ma P, Armstrong D, ed. AIDS and opportunistic
infections of homosexual men. Stoneham Masssachusetts: Butterworth,
1989:44970
10. RootBernstein RS. Do we know the cause(s) of
AIDS? Persp Biol Med (in press).
11. Rubin H. Etiology of AIDS. Science 1988: 241:
138990.
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