Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California.
Accurate incidence and mortality rates in the US for Kaposi's sarcoma are not available, but the annual incidence has been estimated at 0.02-0.06/100,000. The disease has tended to affect primarily elder males. A departure from this pattern is the diagnosis in the past 30 months of Kaposi's sarcoma in 26 homosexual men in New York City and California whose mean age was 39 years (range 26-51 years). In contrast to the clinical course in elderly men, in whom the mean survival time is 8-13 years after diagnosis, 8 of the homosexual patients died within 2 years after diagnosis. A review of the New York University Coordinated Cancer Registry for Kaposi's sarcoma revealed no such cases in men under 50 years of age for the 1970-79 period. Presenting complaints in 20 of the homosexual men included skin lesions only (50%) and skin lesions plus lymphadenopathy (20%). After the initial physician visit, 6 patients developed pneumonia and 1 had necrotizing toxoplasmosis of the central nervous system. Serologic evidence of past or present cytomegalovirus infection was found in all 12 patients who were tested. Also of concern is the incidence of 15 cases of Pneumocystis in homosexual men in California since 1979. These findings indicate that physicians should be alert for Kaposi's sarcoma, Pneumocystis pneumonia, and other opportunistic infections associated with immunosuppression in homosexual men.