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Fighting AIDS

The day before we talked, Dr. Alvin E. Friedman-Kien and his colleagues had diagnosed New York University Medical Center's 1,000th case of AIDS-associated Kaposi's sarcoma. He was among the first to report this cancer's association with the AIDS virus.

Dr. Friedman-Kien, 52, is a professor of microbiology and dermatology at the medical center. His brown eyes are piercing and he talks fast, trying to pass on as much information as quickly as he can.

"In February 1981, I saw a young man who was perfectly healthy except for a number of spots on his skin. He was an actor in his late thirties, and he came to me only because he was having trouble covering the spot on his nose with makeup," Dr. Friedman-Kien told me. "I'd never seen anything like it, so I did a biopsy. Under the microscope, the cell structure was clear. It was' Kaposi's sarcoma [KS].

"A week later, another physician sent me another patient, also a gay man in his late thirties, also with disseminated KS," he says, explaining that each spot is a separate tumor.

"Until then, as a dermatologist at the largest skin clinic in the United States, I'd seen fifteen cases of KS in 24 years, mostly in elderly men from a Mediterranean or Eastern European background." The disease was relatively benign and could be treated with radiation or chemotherapy. Usually, elderly patients lived with it for many years and died of something else.

Then he discovered that a colleague, Dr. Linda Laubenstein, had also seen young homosexual men with KS. Soon, he had seen 26 young gay men with KS. Their lesions were so unusual that Dr. Friedman-Kien is now editing a color atlas to show physicians new manifestations of this old disease:

"Often, you'd hardly notice the spots. You had to look to see them. They were faint lavender or pink, like a mosquito bite, but not itchy. Primary-care physicians sometimes told patients they were birthmarks. Other lesions were dark purplish brown and lumpy. I've never seen a skin tumor vary so much," he says. The spots were all over the body, not limited to the lower legs, as they are in the elderly.

"No patient of mine has asked that his life be ended. However bad, living's better than the alternative."—Alvin E. Friedman-Kien

Why was this disease behaving differently? Why was it attacking young homosexual men? As a researcher, he knew that KS was one of the most common cancers in Africa and that it also sometimes appeared in kidney-transplant patients who were taking immunosuppressive drugs to prevent rejection. When the drugs were stopped, the KS went away.

Many of the new KS patients had had many sexually transmitted diseases—hepatitis, syphilis—and they used recreational drugs such as amyl and butyl nitrite. Maybe the diseases and drugs had depressed their immune systems, allowing the KS to appear.

The new KS patients often developed lymphomas and other cancers, unrelenting herpes simplex infections, CMV infections that sometimes affected the eyes, and meningitis. "It's a sadistic disease that destroys the immune system. The immune system protects us against malignant cells that probably develop all the time and against many organisms that don't cause disease in people who have a healthy immune system," Dr. Friedman-Kien points out.

AIDS patients with KS have a better prognosis than those whose first sign of the disease is Pneumocystis carinii pneumonia. "I have one patient who's still alive and functioning six years after diagnosis of KS," Dr. Friedman-Kien says. The NYU team has investigated AZT and ribavirin, both of which, Dr. Friedman-Kien notes, have an effect on a key enzyme in the AIDS virus. A study of AZT in KS patients is starting at NYU, one of fourteen national AIDS Treatment Evaluation Units.

"AZT is a beginning. It keeps patients with PCP alive a bit longer, until a vaccine can be developed. I see hope in my patients' eyes," he says.

"Dermatologists' patients don't usually die, and with AIDS you see a young person destroyed. It's devastating," he says. "But none of my patients has ever asked that his life be terminated. Living is so important that, however bad it is, it's more acceptable than the alternative.

"Working with these patients has given me great appreciation for being alive and healthy. I'm closer to family and friends. Art helps. I used to paint; now I collect paintings. Sometimes I want to get away, but not for long, because I feel guilty that I'm not there when somebody needs me. You can never do enough."

Call the child Tim. He's eight now. In 1979, HE was referred to Dr. Arye Rubinstein's immune-deficiency clinic at the Albert Einstein College of Medicine in the Bronx because he had recurrent infections, a common sign of immune problems. Dr. Rubinstein, 50, an Israeli-born immunologist who previously worked in Switzerland and at Harvard, is an expert in allergy and immunology.


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