The Coming Plague (122 page)

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Authors: Laurie Garrett

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34
Centers for Disease Control, “Opportunistic Infections and Kaposi's Sarcoma Among Haitians in the United States,”
Morbidity and Mortality Weekly Report
31 (1982): 353–61.
35
For a detailed account of Haiti's AIDS epidemic and its political dimensions in the United States, see P. Farmer,
AIDS and Accusation: Haiti and the Geography of Blame
(Berkeley: University of California Press, 1992).
36
R. Altema and L. Bright, “Only Homosexual Haitians, Not All Haitians,”
Annals of Internal Medicine
99 (1983): 877.
37
Jaffe's rough pictograph of the epidemic appeared as follows:
Source: H. W. Jaffe, D. J. Bregman, and R. M. Selik, “Acquired Immune Deficiency Syndrome in the United States: The First 1,000 Cases,”
Journal of Infectious Diseases
148 (1983): 339–45.
38
Centers for Disease Control,
“Pneumocystis carinii
Pneumonia Among Persons with Hemophilia A,”
Morbidity and Mortality Weekly Report
31 (1982): 365–67.
39
Centers for Disease Control, “Possible Transfusion-Associated Acquired Immune Deficiency Syndrome (AIDS)—California,”
Morbidity and Mortality Weekly Report
31 (1982): 652–54.
40
Centers for Disease Control, “Unexplained Immunodeficiency and Opportunistic Infections in
Infants—New York, New Jersey, California,”
Morbidity and Mortality Weekly Report
31 (1982): 665–67.
41
B. D. Colen, “Epidemic Baffles U.S. Experts,”
Newsday,
September 12, 1982: 14, 27.
42
H. W. Jaffe, D. J. Bregman, and R. M. Selik, “Acquired Immune Deficiency Syndrome in the United States: The First 1,000 Cases,”
Journal of Infectious Diseases
148 (1983): 339–45.
43
In defense of the lassitude of government responses vis-à-vis the blood supplies of the United States, Canada, and Western European countries, it would later be argued that such surveys were impossible until the etiologic agent of AIDS was discovered. However, in the absence of a viral screening test, much could have been done to study those individuals listed as “hemophiliacs” or “unknown risk factor” cases on government AIDS rosters to identify contaminated units of blood. Requests for funding of such research in the United States were consistently denied until mid-1984.
44
T. Beardsley, “British AIDS: Whose Blood Can Now Be Safe?”
Nature
303 (1983): 102.
45
In 1983 blood was collected in the United States by 180 regional centers and 1,800 hospitals, all members of the American Association of Blood Banks. In addition, some 3,800 smaller hospitals not members of the AABB collected and transfused blood. See D. M. Surgenor, E. L. Wallace, S
.
H. S. Hao, and R. H. Chapman, “Collection and Transfusion of Blood in the United States, 1982— 1988,”
New England Journal of Medicine
322 (1990): 1646–51.
46
The series for which Gilbert Gaul won the Pulitzer Prize ran over several days in the
Philadelphia Inquirer
in September 1989.
47
In 1980, about 11,600 of the people with hemophilia had a genetic deficiency related to Factor VIII; about 3,000 had a Factor IX deficiency. Both products were available for treatment use.
48
It would later be shown that at least 10 percent of the injecting drug users of New Haven, Connecticut, were already infected with the AIDS virus by 1982. Since other areas have proven to have even greater numbers per capita of AIDS cases among drug users, it is assumed that far more than 10 percent of the users of East Brooklyn, Harlem, the South Bronx, and Newark were infected in 1982. See R. D‘Aquila, A. B. Williams, H. D. Kleber, and A. E. Williams, “Prevalence of HTLV-III Infection Among New Haven, Connecticut, Parenteral Drug Abusers in 1982–1983,”
New England Journal of Medicine
314 (1986): 117.
49
There were some laboratories that pooled plasma from over 30,000 donors to make a batch of Factor VIII. See P. H. Levine, “HIV Infection in Hemophilia,”
Journal of Clinical Apheresis
8 (1993): 120–25.
50
D. L. Aronson, “Infection of Hemophiliacs with HIV,”
Journal of Clinical Apheresis
8 (1993): 117–19.
51
These figures were calculated by the author based on 1980 STD data, plus hemophilia blooduse data found in L. M. Aledort, “Current Concepts in Diagnosis and Management of Hemophilia,”
Hospital Practice.
October 1982: 77–92; and National Institutes of Health, “Pilot Study of Hemophilia Treatment in the U.S.,” report to the Department of Health, Education, and Welfare, June 30, 1972.
52
In lawsuits against the blood bank industry in 1992–94, Francis so testified.
53
With the advantage of hindsight, there were other courses of action open to the FDA and the blood industry in 1983. Without knowing the cause of AIDS, they could have lowered the danger of the blood supply through:
• Closing all plasma and blood-for-money sites. This would only be done for blood years later in the United States, following rising pressure from the voluntary donor segment of the industry. It would never be done for plasma. By 1994, however, most European, Asian, and Latin American countries would still allow commercial blood banks to pay donors. In some countries (such as Brazil and India), most blood would be purchased, and rates of HIV and hepatitis contamination would, as a result, be very high.
• Shutting down mobile and permanent blood collection operations in neighborhoods known to have higher numbers of injecting drug users and gay men. Some blood banks—notably those in San Francisco—took such steps as early as mid-1983; most worldwide did not. See H. A. Perkins, “Safety of the Blood Supply,”
Journal of Clinical Apheresis
8 (1993): 110–16.
• Use only female-donated blood in pooled samples destined to be used for Factors VIII or IX. In 1983 over 90 percent of all AIDS cases in Europe and North America were male. and though that gender disparity would narrow over the years, the odds of infection among women were dramatically less than among men during the early 1980s.
• Verbally counsel all donors about the risks of contaminating the blood supply. Request that those who may be in a “risk group” for AIDS exclude themselves from donating blood.
• Actively lobby surgeons, with the aim of decreasing both unnecessary surgery and the amounts of blood used during necessary procedures.
• Heat the donated blood. Heat treatment of Factor products, already routine for albumin, would
be proven effective for Factor VIII by Jay Levy in mid-1984. Only Cutter Laboratories, which sponsored Levy's study, would then begin sterilization. Most products would not be so treated until mid-1985.
54
At that time HTLV-I was simply called HTLV, because the discovery of HTLV-II hadn't yet been announced. To avoid confusion, however, the author will refer to the various HTLVs in their numbered forms.
55
M. Essex, “Adult T-Cell Leukemia-Lymphoma: Role of a Human Retrovirus,”
Journal of the National Cancer Institute
69 (1982): 981–85.
56
J. J. Goedert, W. C. Wallen, D. L. Mann, et al., “Amyl Nitrite May Alter T Lymphocytes in Homosexual Men.”
Lancet
I (1982): 412–15. See also, for speculation on “poppers,” I. Gorin, O. Picard, L. LaRoche, et al., “Kaposi's Sarcoma Without the U.S. or ‘Popper' Connection,”
Lancet
I (1982): 908; G. R. Seage, K. H. Mayer, C. R. Horsburgh, et al., “The Relation Between Nitrite Inhalants, Unprotected Receptive Anal Intercourse, and the Risk of Human Immunodeficiency Virus Infection,”
American Journal of Epidemiology
135 (1992): 1–11; Letters to the Editor (several authors), “Re: An Autopsy of Epidemiologic Methods: The Case of ‘Poppers' in the Early Epidemic of the Acquired Immunodeficiency Syndrome (AIDS),”
American Journal of Epidemiology
131 (1990): 195–200; K. A. Jørgensen, “Amyl Nitrite and Kaposi's Sarcoma in Homosexual Men,
” Lancet
307 (1982): 893–94; and R. O. Brennan and D. T. Durack, “Gay Compromise Syndrome,”
Lancet
II (1981): 1338–39.
57
“‘Highly Abnormal' B-Cell Function Found in AIDS,” Hospital Practice, October 1983: 32–40; and H. C. Lane, H. Masur, A. H. Rook, et al., “Abnormalities of B Lymphocyte Activation and Immunoregulation in Patients with the Acquired Immunodeficiency Syndrome,”
New England Journal of Medicine
309 (1983): 453.
58
Letter to the Honorable Margaret Heckler, May 19, 1983, signed by Donald Abrams, Jay Levy, W. J. W. Morrow, Conrad Casavant, Andrew Moss, Marcus Conant, William Drew, Daniel Stites, Paul Volberding, John Ziegler, and John Greenspan, all of the University of California at San Francisco.
59
Robert S. Walker (Pennsylvania), Frank Horton (New York), John N. Ehlenborn (Illinois), Lyle Williams (Ohio), William F. Clinger, Jr. (Pennsylvania), Judd Gregg (New Hampshire), Dan Burton (Indiana), Alfred A. McCandless (California), Larry Craig (Idaho), and Dan Schaefer (Colorado).
60
Groupe de Travail Français sur le SIDA, “Le Syndrome d‘Immuno-déficit Acquis,”
La Presse Médicale
12 (1983): 2453–56.
61
Centers for Disease Control, “Experimental Infection of Chimpanzees with Lymphadenopathy-Associated Virus,”
Morbidity and Mortality Weekly Report
33 (1984): 442–44. By the time the CDC finally mustered the resources for animal research, the Pasteur Institute's research team had already identified the presence of a retrovirus in AIDS patients, which they dubbed lymphadenopathy-associated virus, or LAV. Therefore, the CDC actually injected viral inoculum into the test animals. The virus did enter the animals' cells, and reproduced, but no symptomatic disease had been produced by August 1984.
62
J. Gerstoft, A. Malchow-Møller, I. Bygbjerg, et al., “Severe Acquired Immunodeficiency in European Homosexual Men,”
British Medical Journal
235 (1982): 17–19.
63
Gorin, Picard, LaRoche, et al. (1982), op. cit.
64
Groupe de Travail Francais sur le SIDA. “Sarcome de Kaposi et Infections Opportunistes chez des Subjets Jeunes sans Antecedent Susceptible d'Entrainer une Immuno-dépression,”
La Presse Médicale
12 (1983): 2431–34. Other cases with which Liebowitch was familiar are described in J. B. Brunet, E. Bouvet. J. Liebowitch, et al., “Acquired Immunodeficiency Syndrome in France,”
Lancet
I (1983): 700–01.
65
N. Clumeck, F. Mascaret-Lemone, J. deMaubeuge, et al., “Acquired Immune Deficiency Syndrome in Black Africans,”
Lancet
I (1983): 642.
66
R. M. DuBois, J. R. Mikhail, and J. C. Batten, “Primary
Pneumocystis carinii
and Cytomegalovirus Infections,”
Lancet
II (1981): 1339; J. L‘Age-Stehr, R. Kunze, and M. A. Koch, “AIDS in West Germany,”
Lancet
II (1983): 1370–71; G. Rezza, G. Ippolito, G. Marasca, and D. Greco, “AIDS in Italy,”
Lancet
II (1984): 642; W. Rozenbaum, D. Klatzmann, C. Mayaud, et al., “Syndrome d'Immunodépression Acquire chez 4 Homosexuals,”
La Presse Médicale
12 (1983): 1149–54; O. Tello, “AIDS in Spain,”
Lancet
II (1984): 1472; and H. K. Thomsen, M. Jacobsen. and A. Malchow-Møller, “Kaposi Sarcoma Among Homosexual Men in Europe,”
Lancet
II (1981): 688.

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