Kaposi’s sarcoma is an opportunistic cancer that occurs in advanced AIDS patients; it’s not caused by poppers

Key takeaway

AIDS-related illnesses, like tuberculosis and Kaposi’s sarcoma, are the main causes of death among people living with HIV with inadequate access to HIV care. Early in the HIV epidemic, it was proposed that poppers were linked to cases of Kaposi’s sarcoma in people with AIDS. However, research has debunked this hypothesis, showing that Kaposi’s sarcoma develops in people who are HIV-positive irrespective of poppers use and heavy poppers use isn’t linked to an increased risk of developing Kaposi’s sarcoma. In reality, Kaposi’s sarcoma is an opportunistic cancer that appears in people with weakened immune systems, such as those with advanced AIDS.

Reviewed content

Verdict:

Inaccurate

Claim:

Poppers are the cause of Kaposi’s sarcoma

Verdict detail

Factually inaccurate: Kaposi’s sarcoma is an opportunistic cancer that appears in people with weakened immune systems, such as those with advanced AIDS. There is no evidence that this cancer is caused by poppers.
Incorrect: AIDS-related illnesses are the main cause of death among people living with HIV who progress to AIDS.

See our method of evaluation

Full Claim

“The AIDS Hoax”; “And how are these people dying of so-called AIDS? From the number two cause: drugs, both medical and street drugs. But one in particular that stood out and that has been linked by 24 scientific papers with Kaposi’s Sarcoma and that’s poppers or amyl nitrate. It’s very rare that you see a case of Kaposi Sarcoma in Africa because they don’t use poppers.”

In 2021, an estimated 650,000 people died of AIDS-related illnesses worldwide. When untreated, human immunodeficiency virus (HIV)-infections progress to a chronic condition known as Acquired Immunodeficiency Syndrome or AIDS.

AIDS is potentially life-threatening because it damages the immune system. This leaves people susceptible to opportunistic infections and cancers that normally don’t impact people with a strong immune system. AIDS-related illnesses are the main cause of death among people living with HIV without proper access to care, including access to HIV drugs and treatments for opportunistic illnesses. Examples of these include Kaposi’s sarcoma, a type of cancer primarily seen in people with advanced AIDS.

Despite it being well established that AIDS-related illnesses are the main cause of death for people living with HIV, disinformation about AIDS deaths abounds. In late March 2023, a short clip of Robert Willner, an HIV denialist physician who had his medical license revoked in Florida due to a number of infractions—including claiming he had cured AIDS with ozone therapy—was shared on Facebook, racking up hundreds of likes and shares. In the clip, Willner, who passed away in 1995, made a number of spurious claims about AIDS.

His main claim is that the real cause of AIDS deaths are “drugs, both medical and street drugs”. He went on to say that Kaposi’s sarcoma has “been linked by 24 scientific papers” to poppers. And he concluded by incorrectly claiming that “it’s very rare that you see a case of Kaposi’s sarcoma in Africa because they don’t use poppers”. Below, we’ll show why these claims are false.

Claims that medical drugs are the real cause of AIDS deaths are false. In reality, expanded access to HIV drugs, also known as antiretroviral therapy, has been critical in lowering the number of AIDS deaths from its estimated 3.1 million peak in 2004.

Health Feedback previously refuted two false claims about AIDS deaths and medical drugs. The first was an inaccurate claim that in the 80s and 90s, people with HIV were actually dying due to AZT (zidovudine), the first approved HIV drug in the US, instead of AIDS. As we explained in that fact-check, this false claim can be traced to a speculative quote made by an AIDS denialist in 1989. Moreover, though zidovudine presents higher toxicity compared to more recently developed antiretrovirals, it is still used today in HIV therapy.

The second claim was that experimental AIDS drugs were responsible for the deaths of children enrolled in a trial in New York City. As we explained in our review, an investigation into the claim found no evidence that deaths were caused by trial medication.

As an example for his claim that AIDS deaths are actually caused by drugs, Willner claimed that Kaposi’s sarcoma is due to poppers. Poppers, or amyl nitrate, are an inhaled party drug that’s associated with the club scene and the LGBTQ community.

While poppers can cause serious adverse reactions, such as sudden drops in blood pressure and irregular heart rhythms and tachycardia that may prove fatal, there is no connection between poppers and Kaposi’s sarcoma. Early in the AIDS epidemic, the possibility that poppers were the cause of Kaposi’s sarcoma was raised, but this was debunked by later studies.

One of these was a study published in The Lancet in 1993 that followed 715 men for a median of 8.6 years^[1]. During the follow-up period, there were 136 cases of AIDS. These cases occurred exclusively in men positive for HIV, and among these there were 34 cases of Kaposi’s sarcoma. The researchers also looked at risk behaviors, including the use of poppers, and found that while both HIV-negative and HIV-positive men reported using poppers, cases of AIDS-related illnesses like Kaposi’s sarcoma only occurred in HIV-positive men.

Furthermore, a 2017 scientific study looking at possible associations between heavy popper use and cancer risk in men who have sex with men (MSM) found that there was no statistically significant association between heavy popper use and increased risk of developing Kaposi’s sarcoma in HIV-infected MSM^[2]. The study, however, did find an association between an increased risk of Kaposi’s sarcoma and a weakened immune system.

Lastly, as evidence for his claim connecting poppers to Kaposi’s sarcoma, Willner said that “it’s very rare that you see a case of Kaposi’s sarcoma in Africa because they don’t use poppers”. This claim, however, is false.

A 2022 scientific study investigated the incidence of Kaposi’s sarcoma in Sub-Saharan Africa at different moments in the HIV epidemic^[3]. The researchers found that while cases of Kaposi’s sarcoma were rare before the HIV epidemic, case numbers increased rapidly as the epidemic progressed. Unfortunately, the authors of the study also noted that Kaposi’s sarcoma “continues to be a major public health problem in terms of morbidity and mortality” in Sub-Saharan Africa.

In short, Willner’s claims that HIV/AIDS deaths are actually caused by drugs and that Kaposi’s sarcoma is caused by poppers are both false. Kaposi’s sarcoma is an opportunistic cancer primarily seen in people with advanced AIDS and there’s no evidence it’s caused by poppers. The main cause of deaths among people living with HIV are AIDS-related diseases like tuberculosis and Kaposi’s sarcoma, particularly in those without access to proper care.

REFERENCES

• 1 – Schecter et al. (1993) HIV-1 and the aetiology of AIDS. The Lancet.
• 2 – Dutta et al. (2017) Long-term nitrate inhalant exposure and cancer risk in MSM. AIDS.
• 3 – Motlhale et al. (2022) Epidemiology of Kaposi’s sarcoma in Sub Saharan Africa. Cancer Epidemiology.