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Special Communication
February 10, 2021

The Role of Dermatologists in the Early HIV/AIDS Epidemic: A Historical Review for the 40th Anniversary of HIV/AIDS

Author Affiliations
  • 1Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2021;157(3):326-329. doi:10.1001/jamadermatol.2020.5545
Abstract

In 1981, the HIV/AIDS epidemic was first recognized in young gay men presenting with opportunistic infections and Kaposi sarcoma. Over the past 40 years, there has been an unparalleled and hugely successful effort on the part of physicians, scientists, public health experts, community activists, and grassroots organizations to study, treat, and prevent HIV/AIDS. Yet the role of dermatologists in the investigation of HIV/AIDS and in the treatment of infected patients has largely been neglected in the historical literature. It is important to revisit dermatologists’ historic contributions and problematic biases during this epidemic and honor the legacy of the dermatologists who were instrumental in treating and advocating for patients affected by HIV/AIDS.

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    1 Comment for this article
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    Earlier Dermatology involvement in Kaposi's, AIDS/HIV
    Alan Dattner, AB, MD, FAAD | HolisticDermatology.com, Integrative Dermatology and Medicine
    To the Editor I appreciated the description of pioneers in the field in the article, The Role of Dermatologists in the Early HIV/AIDS Epidemic: A Historical Review for the 40th Anniversary of HIV/AIDS. As dermatologists, we should be proud that some of our inciteful and caring colleagues had an early role in the identification and treatment of Kaposi’s sarcoma and AIDS during and after its initial appearance in 1980-1981.
    I would like to point out dermatologist involvement even earlier in the Kaposi’s/ AIDS appearance. As a dermatology resident/clinical cancer fellow working with Dr Mark Hardy 1974, we had two
    renal transplant patients, one in a woman and another one in a man, who developed Kaposi’s Sarcoma. , . We initially ascribed their illnesses to lower T cell counts and to the immunosuppressive medications. We knew that it did not originate in the donor since both donors had negative autopsies. In the second patient we suspected an oncogenic virus may have been involved, and at that time could only find the patient to be positive for EBV. We focused our attention on the second patient since seeing this unusual tumor in two transplant patients within one year of each other was alarming. His azathioprine dose was discontinued to help with the immunosuppression related disease and his allograft continued to function. Bleomycin and Vincristine led to regression of recurrent lesions one year after initiation of chemo and discontinuation of azathioprine. Later, with a still working kidney allograft, he developed metastatic pulmonary Kaposi’s sarcoma, leading to his demise 3 years later, after our report was published. Only then did he admit to being homosexual, linking his Kaposi’s sarcoma to the newly emerging AIDS epidemic being seen in homosexual males. We also found out that one of the X-ray technicians taking care of the patients was gay as well, as a possible source of infection. The first patient received many blood transfusions which were most likely the cause of her disease.
    Only in retrospect could we suspect that HIV was the cause of Kaposi’s sarcoma in these patients.
    Milbar H, James WD. The Role of Dermatologists in the Early HIV/AIDS Epidemic: A Historical Review for the 40th Anniversary of HIV/AIDS. JAMA Dermatol. 2021 Mar 1;157(3):326-329. doi: 10.1001/jamadermatol.2020.5545. PMID: 33566057.

    Hardy MA, Goldfarb P, Levine S, Dattner A, Muggia FM, Levitt S, Weinstein E. De novo Kaposi's sarcoma in renal transplantation. Case report and brief review. Cancer. 1976 Jul;38(1):144-8. doi: 10.1002/1097-0142(197607)38:1<144::aid-cncr2820380123>3.0.co;2-7. PMID: 59624
    CONFLICT OF INTEREST: None Reported
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