Journal of Academy of Medical Sciences

LETTER TO EDITOR
Year
: 2012  |  Volume : 2  |  Issue : 4  |  Page : 137--138

Recitals of Kaposi sarcoma in human immunodeficiency virus disease: Wisdom from the past and current context in India


Amit Shankar Singh 
 Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Amit Shankar Singh
Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh
India




How to cite this article:
Singh AS. Recitals of Kaposi sarcoma in human immunodeficiency virus disease: Wisdom from the past and current context in India.J Acad Med Sci 2012;2:137-138


How to cite this URL:
Singh AS. Recitals of Kaposi sarcoma in human immunodeficiency virus disease: Wisdom from the past and current context in India. J Acad Med Sci [serial online] 2012 [cited 2021 Sep 25 ];2:137-138
Available from: http://www.e-jams.org/text.asp?2012/2/4/137/141136


Full Text

Sir,

In 1872, Moritz Kaposi a Hungarian dermatologist practicing at the University of Vienna described a blood vessel tumor (originally called idiopathisches multiples Pigmentsarkom der Haut "idiopathic multiple pigmented sarcoma of the skin") that has since been eponymously named Kaposi's sarcoma (KS). [1] In about 1892, after further study, Kaposi suggested another name for this disease, idiopathic multiple hemorrhagic sarcoma, which he felt best described it. He described 16 cases of this pigmented sarcoma in men and one boy. Kaposi removed a number of the sarcomatous lesions to study them microscopically. He described them as follows: "A round-cell sarcoma is seen," except that in a few places, the characteristic spindle-cell sarcoma is seen. A peculiarity of this type is the presence of capillary hemorrhages, which explain the later bluish-black pigmentation of the originally bluish-red nodules, as well as the excessive hardness of the diffuse infiltrations around the groups of nodules caused by deposits of fibrin. KS was thought to be an uncommon tumor of Jewish and Mediterranean populations until it was realized that it is actually quite common throughout sub-Saharan Africa. This led to the first suggestions in the 1950s that this tumor might be caused by a virus. With the onset of the acquired immune deficiency syndrome (AIDS) epidemic in the early 1980s, there was a sudden epidemic resurgence of KS affecting primarily gay and bisexual AIDS patients with up to 50% of reported AIDS patients having this tumor, an extraordinary rate of cancer predisposition. Careful analysis of epidemiologic data by Beral et al. led these investigators to propose that KS is caused by an unknown sexually transmitted virus that rarely causes tumors unless the host becomes immunosuppressed, as in AIDS. [2]

In the early 1980's, center for disease control in Atlanta USA observed a high frequency, 26 cases by July 1981, of KS occurring in young homosexual men. [3] Eight of these patients died within 24 months of diagnosis. Thus was ushered in "epidemic" KS that associated with the AIDS. In addition to KS many of these original patients also had opportunistic infections and in four a diagnosis of Pneumocystis carinii pneumonia (PCP) was made by open lung biopsy. At this very early stage in the evolution of the syndrome, AIDS, for all practical purposes, consisted entirely of KS and PCP. In 1982, Gallo who had spent many years researching retroviruses and cancer at the National Cancer Institute, proposed that the cause of AIDS was a retrovirus. [4] In 1983, Montagnier et al. at the Pasteur Institute detected a retrovirus, presently known as human immunodeficiency virus Type I (HIV-1), in the cultured T cells from a homosexual patient with lymphadenopathy. [5] With few exceptions, the hypothesis that the causative agent of AIDS is HIV has been universally accepted. However, as early as 1984 it became apparent that HIV does not exist in the cells from the lesions of KS and hence cannot cause KS directly. It was assumed then that in AIDS patients, HIV indirectly caused KS and opportunistic infections by its detrimental effects on the immune system. Alterations in T lymphocyte subsets (T4 and T8 cells) and a decrease in the T4/T8 ratio were believed to be the hallmark of AIDS and the immune deficit that defined this condition. [6] However, in heterosexuals, evidence existed that many diverse causes could be associated with the same (and additional) laboratory abnormalities of immunodeficiency that were manifest in AIDS patients. These causes included a number of infections, blood transfusion, the intake of many drugs including antibiotics and even solarium exposure. It is noteworthy that in none of these reports was there a single case of associated KS.

India second largest populated country has emergence of AIDS and its associated complications. Despite rapid growth in the prevalence of AIDS in India very little is known regarding the spectrum of neoplasm in patients with AIDS. KS is one of them and as medical practitioners we encounter such disease though rarely, but certainly indicate that this disease has no boundaries. First case in India detected in 1993 following, which different regions also detected cases. [7] Last case was found in Uttar Pradesh district of India and has been successfully treated by combined approach of anti-retroviral therapy and chemotherapy. [8] This development of approach from total anonymity of a disease to total cure in India was rapid and will pave a path in future to unite all analysts to combat this grievous illness tactfully and assuredly.

References

1Kaposi M. Idiopathic multiple pigmented sarcoma of the skin. Arch Dermatol Syphil 1872;4:265-73.
2Beral V, Peterman TA, Berkelman RL, Jaffe HW. Kaposi's sarcoma among persons with AIDS: A sexually transmitted infection? Lancet 1990;335:123-8.
3Centers for Disease Control (CDC). Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men - New York City and California. MMWR Morb Mortal Wkly Rep 1981;30:305-8.
4Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science 1983;220:868-71.
5Duesberg PH. Retroviruses as carcinogens and pathogens: Expectations and reality. Cancer Res 1987;47:1199-220.
6Gallo RC. The AIDS virus. Sci Am 1987;256:46-56.
7Shroff HJ, Dashatwar DR, Deshpande RP, Waigmann HR. AIDS-associated Kaposi's sarcoma in an Indian female. J Assoc Physicians India 1993;41:241-2.
8Singh AS, Atam V, Das L. Response of art and chemotherapy in AIDS associated Kaposi's sarcoma. J Case Rep 2012;2:125-9.