Opportunistic Diseases

Medicine

A puzzling new syndrome afflicts homosexual men

Kaposi's sarcoma is a rare cancer that appears as violet patches on the skin and infiltrates the digestive and lymph systems. In the past, its victims have been mainly children in equatorial Africa and elderly people of Jewish or Mediterranean extraction. But now the disease is taking an alarming toll on another distinct group, American homosexual males. In the past six months, the disease that usually afflicts fewer than two people out of 3 million Americans has stricken 95 individuals, more than 90% of them homosexual men, most of whom are in their 30s. The death rate so far exceeds 20%.

This cancer is only one of a variety of ailments that have been suddenly turning up in young homosexual men, according to last week's New England Journal of Medicine. Known to doctors as "opportunistic diseases," they strike when the body's natural immunological defenses are down. Previously they were seen mainly in organ-transplant and cancer patients. Among such medical opportunists are pneumocystic pneumonia, a parasitic lung infection that has killed 60% of its victims, and herpes simplex and cytomegalovirus (CMV), two commonplace microorganisms that are generally brushed off by healthy people..

Severe immunological vulnerability poses some tricky medical problems. "Specific infections can be treated," says Internist Henry Masur of New York Hospital-Cornell Medical Center, "but the person will usually just come down with another infection two months later." Masur has seen homosexual patients be sieged by bacteria, fungi and offbeat viruses, all in quick succession. "Why this group has something suddenly wrong with its immunity is a mystery."

At the Centers for Disease Control in Atlanta, a team of researchers is trying to piece together the clues from more than 180 cases of Kaposi's sarcoma and pneumocystis. Nearly all the victims come from big cities with large homosexual communities: New York, Los Angeles and San Francisco. A number of them report a high level of sexual activity with numerous partners. Though this kind of activity increases the suspicion that the disease or some factor in it is sexually transmitted, researchers have been unable to trace the syndrome from sexual partner to partner as they often can with venereal diseases. In addition, they are puzzled by the fact that another group that usually suffers the same venereal ills as active homosexual men is not affected: female prostitutes.

One possible culprit in the syndrome is cytomegalovirus, which is known to weaken immune defenses and can be transmitted in semen more than a year after infection. In a recent study, traces of CMV were found in 94% of homosexual men, as opposed to 54% of heterosexual men. U.C.L.A.'s Dr. Michael Gottlieb believes that CMV does contribute to the immune deficiency, but, he points out, both the virus and homosexuality "have been around for thousands of years." Thus, he concludes, "there is a piece of the puzzle missing."

The missing link could be "poppers," drugs like amyl nitrate and butyl nitrate, which are said to enhance orgasm. More than 85% of the CDC patients admitted to inhaling them. Another possible explanation is the so-called immunologic overload theory, says San Francisco's Dr. Robert Bolan. Homosexuals with many sexual partners often contract numerous venereal diseases, intestinal disruptions (gay bowel syndrome), mononucleosis and other infections, explains Bolan. "This constant, chronic stimulation to their immune system may eventually cause the system to collapse."

Whatever the cause, doctors, are advising potential victims to be wary of severe infections or any prolonged illness characterized by fatigue and weight loss. They are also warning homosexuals to limit their sexual contacts. "Promiscuous behavior is an old-fashioned term that nobody likes to use," observes New York Internist Daniel William, who treats many homosexuals, "but it increases the risk."

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