Infectious and Epidemic Disease in History
Department of History
University of California, Irvine
Instructor: Dr. Barbara J. Becker
Gay Cancer, GRID, and AIDS (1981-1983)
- July 3, 1981 -
RARE CANCER SEEN IN 41 HOMOSEXUALS
Outbreak Occurs Among Men in New York and California -- 8 Died Inside 2
By LAWRENCE K. ALTMAN
Doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and often rapidly fatal form of cancer. Eight of the victims died less than 24 months after the diagnosis was made.
The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors who have made the diagnoses, mostly in New York City and the San Francisco Bay area, are alerting other physicians who treat large numbers of homosexual men to the problem in an effort to help identify more cases and to reduce the delay in offering chemotherapy treatment.
The sudden appearance of the cancer, called Kaposi's Sarcoma, has prompted a medical investigation that experts say could have as much scientific as public health importance because of what it may teach about determining the causes of more common types of cancer.
First Appears in Spots
Doctors have been taught in the past that the cancer usually appeared first in spots on the legs and that the disease took a slow course of up to 10 years. But these recent cases have shown that it appears in one or more violet-colored spots anywhere on the body. The spots generally do not itch or cause other symptoms, often can be mistaken for bruises, sometimes appear as lumps and can turn brown after a period of time. The cancer often causes swollen lymph glands, and then kills by spreading throughout the body.
Doctors investigating the outbreak believe that many cases have gone undetected because of the rarity of the condition and the difficulty even dermatologists may have in diagnosing it.
In a letter alerting other physicians to the problem, Dr. Alvin E. Friedman-Kien of New York University Medical Center, one of the investigators, described the appearance of the outbreak as "rather devastating."
Dr. Friedman-Kien said in an interview yesterday that he knew of 41 cases collated in the last five weeks, with the cases themselves dating to the past 30 months. The Federal Centers for Disease Control in Atlanta is expected to publish the first description of the outbreak in its weekly report today, according to a spokesman, Dr. James Curran. The report notes 26 of the cases -- 20 in New York and six in California.
There is no national registry of cancer victims, but the nationwide incidence of Kaposi's Sarcoma in the past had been estimated by the Centers for Disease Control to be less than six-one-hundredths of a case per 100,000 people annually, or about two cases in every three million people. However, the disease accounts for up to 9 percent of all cancers in a belt across equatorial Africa, where it commonly affects children and young adults.
In the United States, it has primarily affected men older than 50 years. But in the recent cases, doctors at nine medical centers in New York and seven hospitals in California have been diagnosing the condition among younger men, all of whom said in the course of standard diagnostic interview that they were homosexual. Although the ages of the patients have ranged from 26 to 51 years, many have been under 40, with the mean at 39.
Nine of the 41 cases known to Dr. Friedman-Kien were diagnosed in California, and several of those victims reported that they had been in New York in the period preceding the diagnosis. Dr. Friedman-Kien said that his colleagues were checking on reports of two victims diagnosed in Copenhagen, one of whom had visited New York.
Viral Infections Indicated
No one medical investigator has yet interviewed all the victims. Dr. Curran said. According to Dr. Friedman-Kien, the reporting doctors said that most cases had involved homosexual men who have had multiple and frequent sexual encounters with different partners, as many as 10 sexual encounters each night up to four times a week.
Many of the patients have also been treated for viral infections such as herpes, cytomegalovirus and hepatitis B as well as parasitic infections such as amebiasis and giardiasis. Many patients also reported that they had used drugs such as amyl nitrite and LSD to heighten sexual pleasure.
Cancer is not believed to be contagious, but conditions that might precipitate it, such as particular viruses or environmental factors, might account for an outbreak among a single group.
The medical investigators say some indirect evidence actually points away from contagion as a cause. None of the patients knew each other, although the theoretical possibility that some may have had sexual contact with a person with Kaposi's Sarcoma at some point in the past could not be excluded, Dr. Friedman-Kien said.
Dr. Curran said there was no apparent danger to nonhomosexuals from contagion. "The best evidence against contagion," he said, "is that no cases have been reported to date outside the homosexual community or in women."
Dr. Friedman-Kien said he had tested nine of the victims and found severe defects in their immunological systems. The patients had serious malfunctions of two types of cells called T and B cell lymphocytes, which have important roles in fighting infections and cancer.
But Dr. Friedman-Kien emphasized that the researchers did not know whether the immunological defects were the underlying problem or had developed secondarily to the infections of drug use.
The research team is testing various hypotheses, one of which is a possible link between past infection with cytomegalovirus and development of Kaposi's Sarcoma.
- June 18, 1982 -
Clue Found on Homosexuals' Precancer Syndrome
By LAWRENCE K. ALTMAN
Federal epidemiologists investigating a serious disorder of the body's immune system that has mostly afflicted male homosexuals reported new evidence yesterday suggesting that the outbreak is linked to an infectious agent.
"We think the findings are important but they don't solve the problem," Dr. Harold W. Jaffe, one of the epidemiologists at the Centers for Disease Control in Atlanta, said in an interview. "They do show pretty convincingly that this is not occurring as a random event among homosexual men."
No specific infectious agent has been identified, he said, but scientists at the Atlanta facilities are intensifying laboratory efforts to identify a virus, bacteria or other micro-organism as a possible cause.
The immune system breakdown has been implicated in a rare form of cancer, called Kaposi's sarcoma, and seems to lead to a wide variety of serious disorders. Scientists have designated the immune disorder GRID, for "gay-related immunodeficiency disease."
The Suspected Infectious Agent
From the time the disorder came to public attention a year ago, epidemiologists have suspected that it might be attributable to an infectious agent, although they have investigated several alternative hypotheses.
The latest clue to an infectious origin came from an intensive medical investigation of a cluster of 19 cases in Los Angeles and Orange Counties in California. It was the first detailed study of such a cluster in the syndrome.
Investigating epidemiologists from the Atlanta center and those in California said that "within five years of the onset of symptoms, nine patients had had sexual contact with other patients" with the syndrome.
They made that determination by interviewing the eight survivors among the 19 cases as well as friends of seven of the 11 who died. From those 15 cases, the epidemiologists obtained data on sexual partners for 13.
Of the nine people who had had exposure to other cases, they found that four had had contact with more than one case.
Links Are Interconnected
Further, they said, "The nine patients from Los Angeles and Orange Counties directly linked to other patients are part of an interconnected series of cases that may include 16 additional patients from eight other cities."
Epidemiologists are planning to conduct further study of the links to the cases outside southern California and to seek similar clusters elsewhere.
"The more cases you put together in a diagramatic fashion, the more that supports an infectious agent, although it certainly does not exclude other possibilities," Dr. Jaffe said. "We would like to see how far we can go pursuing connections outside of southern California."
Scientists are using "as many ways as we can think of to identify" the infectious agent in the laboratory, he said.
However, the epidemiologists said in their weekly report that they were still considering alternative hypotheses. One, they said, is that sexual contact with patients with GRID syndrome does not lead directly to the breakdown of the immunological system, "but simply indicates a certain style of life."
"The number of homosexually active males who share this life style," he said, "may be much smaller than the number of homosexual males in the general population."
Still another hypothesis under investigation is that the syndrome is related in some way to drugs, other environmental agents or some other common factors not yet detected.
- March 17, 1982 -
Disease of Immune System Becoming a U.S. Epidemic
By Christine Russell
In late 1980, a 4-month-old baby entered a Newark N.J., hospital with pneumonia. Within a month, she was dead, her immune system devastated.
More than a year later a heroin addict was referred to a Newark laboratory for blood tests. He was a suspected victim of Acquired Immune Deficiency Syndrome (AIDS), a new disease that wipes out the body's immune defenses and leaves its victims vulnerable to cancer, pneumonia and a host of other deadly infections.
Dr. James Oleske recognized the addict. He was the infant's father.
"That was a dramatic moment," Oleske said. "A light was turned on. I was convinced at that point there was a possible connection."
The death of a baby, and the chance of discovery that her father may carry AIDS, is one of the clues scientists are using to track the elusive cause of the new American epidemic. Despite one of the longest and most extensive searches in the history of the Public Health Service, doctors don't known what causes AIDS or exactly how it spreads.
It was first discovered in 1981 in the homosexual communities of New York and Los Angeles. Then it turned up in drug addicts, Haitians, children and sexual partners of AIDS victims. Some hemophiliacs and recipients of blood transfusions also have begun to die of AIDS.
Whatever it is, modern life seems to nourish it, and life styles and technology seem to spread it.
One researcher described it as torture. "With other diseases you die very fast. This is just horrible, a dwindling of the healthy body. I've worked with miserable diseases, but none as miserable as this."
As of March 9, 1,145 Americans had contracted AIDS; 428 of them are dead. Twenty percent of the cases appeared in the last two months. Half of the victims are under 35.
It may be one of the most lethal diseases of modern times, more deadly than smallpox once was. So far the overall death rate among AIDS victims stands at 40 percent....
- May 5, 1983 -
Doctors Use Interferon To Fight Rare Disease
BOSTON, May 4 (UPI)--Large doses of genetically engineered interferon, an infection-fighting protein, may be useful in fighting a rare skin cancer that afflicts homosexual men with a deadly immune system deficiency, doctors reported today.
Interferon was also effective in combating the breakdown of the body's disease-fighting system that is fatal to half the victims of acquired immune deficiency syndrome, or AIDS, researchers said in The New England Journal of Medicine.
Eight of 12 patients with Kaposi's sarcoma, nonlethal skin tumors that start in blood vessel walls, responded to interferon treatment, the researchers at the Memorial Sloan-Kettering Cancer Center in New York wrote. Kaposi's sarcoma is one of several diseases that strike people whose immune systems are weakened by AIDS.
- November 10, 1983 -
Some Step Up to Offer Help For Abandoned AIDS Baby
MIAMI, Nov. 9 (UPI)--Nearly 30 people have responded to a public plea and offered to take in a homeless 14-month-old girl suffering acquired immune deficiency syndrome, or AIDS, health officials said today. She has no more than three years to live.
The child, whose Haitian mother died three weeks ago of the syndrome, was abandoned by her father. She has no home except a hospital crib.
When her mother became seriously ill months ago, social workers began looking for a home for the child, whose name is being withheld. At first no one volunteered, many fearing they would catch the disease. But the authorities said that, after a public plea was made, almost 30 people have offered to help care for the baby.
"We've gotten calls from eight people, some of whom look like really sharp individuals who would make good foster parents," said Carol Barker, a social worker at Jackson Memorial Hospital.
Jay Kassack, district administrator in the Florida Department of Health and Rehabilitative Services, said his office has received about 20 calls from prospective foster parents....
AIDS is a deadly syndrome that robs the body of its immune system and makes it susceptible to other diseases. It is not highly infectious but can be transmitted to an infant before or during birth through an infected mother's blood.
Federal health officials have said that most AIDS victims are homosexuals, but Haitians are also thought to be at high risk. The infant is one of the fewer than 100 children nationwide who have contracted AIDS.
Because she is not seriously ill, officials at Jackson Memorial Hospital want to use her crib for a sicker child. State health officials who are paying for her care say the hospital bill, now nearly $60,000, is high enough.
When the search for a new home was begun three months ago, about 20 foster homes in Dade County rejected the child. Many people said they wanted to help but feared catching AIDS....
- November 10, 1983 -
Haitians Link to AIDS Doubted
BOSTON, Nov. 9, (AP)--Haitian immigrants, considered more likely than most other people to get AIDS, do not have any of the immune system abnormalities discovered in homosexual men, another group susceptible to the syndrome, a study shows.
Blood tests on healthy homosexual men show that many of them have irregularities in their disease defenses, even though they do not have AIDS.
Doctors at Mount Sinai School of Medicine in New York tested 17 healthy Haitian-Americans, then compared the results with those of healthy homosexual and heterosexual men.
"Although extensive immunologic abnormalities were found among the homosexual men, they were not seen in the Haitians," they wrote. "The results of studies in Haitians were much the same as those in the healthy New York heterosexual men."
The study, directed by Dr. P. Nicholas, was published in a letter in today's issue of The New England Journal of Medicine.
- December 9, 1985 -
A. M. A. to Debate AIDS Test
WASHINGTON, Dec. 8 (AP)--All couples should be tested for exposure to AIDS virus before being granted marriage licenses, according to a resolution to be considered this week by American Medical Association leaders.
The resolution, one of several concerning the syndrome, was included in a thick book of proposals distributed today to 361 members of the organization's House of Delegates, who will be voting on them Tuesday and Wednesday.
The resolution on AIDS says that "acquired immune deficiency syndrome has in the last few years become a hazard to our American society."
It also notes that most states already require some premarital tests for receipt of marriage licenses.
Thus, the resolution concludes, the A.M.A. should "recommend that each of our 50 states encourage introduction of legislation" to require tests to show whether or not a person has been exposed to the virus thought to cause the disease.
The resolution does not say what, if any, action should be taken if required tests prove positive. A person who has been exposed to the virus will not necessarily contract the disease itself.
The resolutions are to be considered separately so all, some or none may pass.