Editor’s note: This guest opinion has been edited to correct the spelling of Kaposi sarcoma.
By Larry R. Erickson
Now, in June 2021, the COVID-19 pandemic is in decline, thanks to masks, social distancing, and the rapid development of effective vaccines. It has left in its wake more than 3.5 million deaths worldwide.
Perhaps it is now time to reflect back on another pandemic that was first identified in the summer of 1981. The identification of it was due in part by observations made by dermatologists. To date, an estimated 170,000 people have died from AIDS-related illnesses since its beginnings. I graduated from medical school in 1963. After serving eight years as a flight surgeon/dermatologist in the U.S. Air Force, I received my honorable discharge. It was then that I started a solo practice of dermatology in Lakewood, Colo.
Health historians and retired dermatologists like myself recall a slow response to this new health crisis. It was due in part to heated political and social stigma surrounding this new disease. In the 1970s a letter in the New England Journal of Medicine noted that many new patients — young, gay men — were seeking health care for hepatitis. By 1980, our dermatologic literature began reporting that gay young men were being diagnosed with Kaposi sarcoma. These cancerous skin lesions were being found in unusual locations, mainly the face. It progressed rapidly and usually resulted in death. For years this cancer had been seen mainly on elderly men, was slow to develop, rarely fatal and occurred primarily on the lower extremities.
The AIDS epidemic officially began on June 5, 1981, when the CDC’s morbidity and mortality weekly report (MMDR) identified unusual clusters of Pneumocystis pneumonia (PCP) in Los Angeles. Along with this, more dermatologists were reporting increasing numbers opportunistic skin lesions like molluscum contagiosum (common mainly in small children, was a concern by parents only for cosmetic reasons, responded quickly with simple treatments, was caused by a virus and as the name implied was very contagious). Again, these new patients were mainly in young gay men.
At that time, the cause of HIV still had not been identified. It was actually being called the “gay plague.” The CDC didn’t start using the term “AIDS” (Acquired Immune Deficiency Syndrome) until 1982. The probable cause and major transmission routes of AIDS, a retrovirus, were discovered in April 1984. In 1986, the NIAID director, Anthony Fauci, M.D. reported that 1 million Americans had already been infected. It was then that physicians like myself received precautions and rules from the federal government. For example, needles and sharps (scalpel blades) used when doing minor surgical procedures on AIDS patients, like skin biopsies and excisions of skin tumors, had to be placed in red bags and transported by approved companies to disposal sites for destruction. If the doctor or assistant accidently by a needle or scalpel were pricked or cut during the procedure, it was mandatory to report this and required that a blood test (CD4 count) be done to check for accidental exposure to HIV.
It wasn’t until June 1995 that the first antiretroviral therapy (protease inhibitors) became available. Simply by boosting the virus-caused damage to the immune system, dermatologists began to see resolutions of skin manifestations like Kaposi sarcoma. Since then, the development of highly active antiretroviral therapy (HAART) has revolutionized AIDS therapy. Unfortunately, after 40 years, unlike COVID-19, an effective vaccine for the HIV retrovirus has not been found.
Larry R. Erickson, M.D., is a Loveland resident.
