Epidemiologic Notes and Reports
Update on Kaposi's Sarcoma and Opportunistic Infections
in Previously Healthy Persons -- United States
Between June 1, 1981, and May 28, 1982, CDC received reports of
355 cases* of Kaposi's sarcoma (KS) and/or serious opportunistic
infections (OI), especially Pneumocystis carinii pneumonia (PCP),
occurring in previously healthy persons between 15 and 60 years of
age. Of the 355, 281 (79%) were homosexual (or bisexual) men, 41
(12%) were heterosexual men, 20 (6%) were men of unknown sexual
orientation, and 13 (4%) were heterosexual women. This proportion
of
heterosexuals (16%) is higher than previously described (1).
Five states--California, Florida, New Jersey, New York, and
Texas--accounted for 86% of the reported cases. The rest were
reported by 15 other states. New York was reported as the state of
residence for 51% of homosexual male patients, 49% of the
heterosexual
males, and 46% of the females. The median age at onset of symptoms
was 36.0 years for homosexual men, 31.5 years for heterosexual men,
and 29.0 years for women. The distribution of homosexual and
heterosexual KSOI cases by date of onset is shown in Figure 2.
Overall, 69% of all reported cases have had onset after January 1,
1981.
PCP accounted for a significantly higher proportion of the
diagnoses for both male (63%) and female (73%) heterosexual
patients
than for homosexual patients (42%) (p0.05). The ratio of
homosexual
to heterosexual males with PCP only, by year of onset of symptoms,
was
5:1 in 1980, 3:1 in 1981 and 4:1 thus far in 1982. Reported
case-fatality ratios for PCP cases with onset in 1980 and 1981 were
85% and 47%, respectively, for homosexual men and 67% and 41% for
heterosexual men. The distribution of PCP cases by diagnosis,
sexual
orientation, race, and overall case-fatality ratio is shown in
Table 1.
Both male and female heterosexual PCP patients were more likely
than homosexual patients to be black or Hispanic (p=0.0001). Of
patients with PCP for whom drug-use information was known, 14% of
homosexual men had used intravenous drugs at some time compared
with
63% of heterosexual men (p=0.001) and 57% of heterosexual women
(p=0.001)(Table 1).
Reported by Task Force on Kaposi's Sarcoma and Opportunistic
Infections, Field Svcs Div, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: Sexual orientation information was obtained from
patients by their physicians, and the accuracy of reporting cannot
be
determined; therefore, comparisons between KSOI cases made on the
basis of sexual orientation must be interpreted cautiously.
Similarities between homosexual and heterosexual cases in diagnoses
and geographic and temporal distribution suggest that all are part
of
the same epidemic. Masur et al (2) also reported that lymphocyte
dysfunction and lymphopenia were similar in heterosexual and
homosexual cases of PCP. However, differences in race, proportion
of
PCP cases, and intravenous drug use suggest that risk factors may
be
different for these groups. A laboratory and interview study of
heterosexual patients with diagnosed KS, PCP, or other OI is in
progress to determine whether their cellular immune function,
results
of virologic studies, medical history, sexual practices, drug use,
and
life-style are similar to those of homosexual patients.
References
CDC. Follow-up on Kaposi's sarcoma and Pneumocystis pneumonia.
MMWR 1981;30:409-10.
Masur H, Michelis M, Greene JB, et al. An outbreak of
community-acquired Pneumocystis carinii pneumonia: initial
manifestations of cellular immune dysfunction. N Engl J Med
1981;305:1431-8.
*A case is defined as illness in a person who 1) has either
biopsy-proven KS or biopsy- or culture-proven, life-threatening
opportunistic infection, 2) is under age 60, and 3) has no history
of
either immunosuppressive underlying illness or immunosuppressive
therapy.
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