The Chimp and the River: How AIDS Emerged from an African Forest (16 page)

This happened to hundreds of paid plasma donors in Mexico during the mid-1980s. It happened to a quarter million luckless donors in China. Jacques Pepin thinks it happened in Haiti too.

He found reports of a plasmapheresis center in Port-au-Prince, a private business known as Hemo Caribbean, that operated profitably during 1971 and 1972. It was owned by an American investor, a man named Joseph B. Gorinstein, based in Miami, with links to the Haitian Minister of the Interior. Donors received three dollars per liter. Their vitals were checked before they could sell plasma, but of course nobody screened them for HIV—which didn’t yet exist as an acronym, or an infamous global scourge, only as a quiet little virus that lived in blood. According to an article that ran in
The New York Times
on January 28, 1972, Hemo Caribbean was then exporting between five and six thousand liters of frozen blood plasma to the United States each month. The wholesale customers were American companies, which marketed the product for use in transfusions,
tetanus shots, and other medical applications. Mr. Gorinstein wasn’t available for comment.

Papa Doc had meanwhile died, in 1971, and been succeeded by his son Jean-Claude (Baby Doc) Duvalier. Annoyed by the
Times
publicity, Baby Doc ordered that Gorinstein’s plasmapheresis center be closed. The Haitian Catholic Church condemned the blood trade as exploitation. Beyond that, the story of Hemo Caribbean drew little notice at the time. No one yet realized how devastating blood-product contamination could be. Nor did the CDC’s
Morbidity and Mortality Weekly Report
mention it, a decade later, when breaking the news that Haitians seemed especially at risk for the mysterious new immune-deficiency syndrome. Randy Shilts didn’t mention it in
And the Band Played On
. The only allusion to Haitian blood plasma that I recall, from the years before Jacques Pepin’s book, came during my conversation with Michael Worobey in Tucson.

Shortly before publishing on DRC60 and ZR59, Worobey coauthored another notable paper, dating the emergence of HIV in the Americas. The first author was a postdoc named Tom Gilbert, in Worobey’s lab, and in the anchor position was Worobey himself. This was the work, based on analyses of viral fragments from archived blood cells, that placed the arrival of HIV in Haiti to about 1966. It appeared in the
Proceedings of the National Academy of Sciences
. Soon afterward, Worobey got a peculiar e-mail from a stranger. Not a scientist, just someone who had caught wind of the subject. A reader of newspaper coverage, a listener to radio. “I think he was from Miami,” Worobey told me. “He said he worked in an airport that dealt with the blood trade.” The man had certain memories. Maybe they haunted him. He wanted to share them. He wanted to tell Worobey about cargo planes arriving full of blood.

25

T
he
next leap of the virus was small in distance and large in consequence. Port-au-Prince is just seven hundred miles from Miami. A ninety-minute flight. Part of the project that Tom Gilbert undertook, in Worobey’s lab, was to date when HIV had arrived in the United States. To do that he needed samples of old blood. Whether the blood had reached America in bottles, in bags, or in immigrant Haitians didn’t much matter for this purpose.

Worobey, serving as Gilbert’s adviser, remembered a study of immunodeficient Haitian immigrants, published twenty years earlier. (I alluded to the same study at the beginning of this book, quoting its observation of something that seemed “strikingly similar” to the new syndrome of immunodeficiency among American homosexuals.) That study had been led by a physician named Arthur E. Pitchenik, working at Jackson Memorial Hospital in Miami. Pitchenik was an expert on tuberculosis, and beginning in 1980 he noticed an unusual incidence of that disease, as well as
Pneumocystis
pneumonia, among Haitian patients. He had sounded the first alarm about Haitians as a risk group for the new immune-deficiency syndrome, alerting the CDC. In the course of clinical work and research, Pitchenik and his colleagues drew blood from patients and centrifuged it, separating serum from cells, so they could look at certain types of lymphocyte. They also froze some samples, on the assumption those might be useful to other researchers later. They were right. But for a long time no one seemed interested. Then, after two decades, Arthur Pitchenik got a call from Michael Worobey in Tucson. Yes, Pitchenik said, he would be glad to send some material.

Worobey’s
lab received six tubes of frozen blood cells, and Tom Gilbert managed to amplify viral fragments from five. Those fragments, after genetic sequencing, could be placed into context as limbs on another family tree—just as Worobey himself would later do with DRC60 and ZR59, and as Beatrice Hahn’s group was doing with SIV
_cpz
. It was molecular phylogenetics at work. In this case, the tree represented the diversified lineage of HIV-1 group M subtype B. Its major limbs represented the virus as known from Haiti. One of those limbs encompassed a branch from which grew too many small twigs to portray. So in the figure as eventually published, that branch and its twigs were blurred—depicted simply as a solid cone of brown, like a sepia shadow, within which appeared a list of names. The names told where subtype B had gone, after passing through Haiti: the United States, Canada, Argentina, Colombia, Brazil, Ecuador, the Netherlands, France, the United Kingdom, Germany, Estonia, South Korea, Japan, Thailand, and Australia. It had also bounced back to Africa. It was HIV globalized.

This study by Gilbert and Worobey and their colleagues delivered one other piquant finding. Their data and analysis indicated that just a single migration of the virus—one infected person or one container of plasma—accounted for bringing AIDS to America. That sorry advent had occurred in 1969, plus or minus about three years.

So it lurked here for more than a decade before anyone noticed. For more than a decade, it infiltrated networks of contact and exposure. In particular, it followed certain paths of chance and opportunity into certain subcategories of the American populace. It was no longer a chimpanzee virus. It had found a new host and adapted, succeeding brilliantly, passing far beyond the horizons of its old existence within
Pan troglodytes
. It reached hemophiliacs through the blood supply. It reached drug addicts
through shared needles. It reached gay men—reached deeply and devastatingly into their circles of love and acquaintance—by sexual transmission, possibly from an initial contact between two males, an American and a Haitian.

For a dozen years it traveled quietly from person to person. Symptoms were slow to arise. Death lagged some distance behind. No one knew. This virus was patient, unlike such hasty, peremptory bugs as Ebola and Marburg and the one that causes SARS. More patient even than rabies, but equally lethal. Somebody gave it to Gaëtan Dugas. Somebody gave it to Randy Shilts. Somebody gave it to a thirty-three-year-old Los Angeles man, who eventually fell ill with pneumonia and a weird oral fungus and, in March 1981, walked into the office of Dr. Michael Gottlieb.

NOTES

A number of the principals who feature in this account gave me their generous cooperation by way of sitting for interviews or responding to questions by e-mail or phone: Robert Gallo, Jane Goodall, Beatrice Hahn, Jean-Marie Kabongo, Phyllis Kanki, Brandon Keele, Elizabeth Lonsdorf, Martin Muller, J. J. Muyembe, Martine Peeters, Jane Raphael, Dirk Teuwen, Karen Terio, and Michael Worobey. Direct sourcing from those conversations, and from my field reporting, is clear from context. These notes refer to printed sources.

18.
Gottlieb’s barebones text
: Gottlieb et al. (1981), 250.

19.
Morbidity and Mortality Weekly Report
carried Friedman-Kien’s communication
: Friedman-Kien. (1981), 305–306.

19.
saw a “syndrome” that seemed “strikingly similar”
: Pitchenik et al. (1983), 353–354.

19.
who became notorious as “Patient Zero”
: Shilts (1987), 23. But see also Auerbach et al. (1984), 489.

19.
as the man who “carried the virus out of Africa”
: e.g., http://en.wikipedia.org/wiki/Gaëtan_Dugas.

20.
even “gorgeous”
in some eyes
: Shilts (1987), 21, 47.

20.
Dugas himself reckoned
: Shilts (1987), 83.

20.
and say
:
“I’ve got gay cancer”
: Shilts (1987), 165.

20.
“Although the cause of AIDS is unknown”
: Auerbach et al. (1984), 490.

21.
Randy Shilts later transformed
: Shilts (1987), 23.

21.
HIV had already arrived in North America when
: Gilbert et al. (2007), 18566, 18568.

22.
A Danish doctor named Grethe Rask
: Shilts (1987), 4–7; Bygbjerg (1983), 925.

22.
“I’d better go home to die.”
: Shilts (1987), 6. Shilts seems to have interviewed Bygbjerg (but not Rask herself), as well as drawing from Bygbjerg (1983).

22.
Nine years later, a sample of Rask’s blood serum
: Hooper (1999), 95, 879.

23.
GRID was one, standing for
: Shilts (1987), 121; Engel (2006), 6.

23.
Some doctors preferred ACIDS
: Shilts (1987), 138.

23.
“Kaposi’s sarcoma and opportunistic infections”
:
Morbidity and Mortality Weekly Report,
June 11, 1982, 294.

23.
By September 1982,
MMWR
had switched
:
Morbidity and Mortality Weekly Report,
September 24, 1982, 507.

24.
Montagnier’s research focused mainly
: Montagnier (2000), 27–30, 38, 47.

25.
“AIDS could not be caused by a conventional bacterium”
: Montagnier (2000), 42.

25.
The only known human retrovirus as of early 1981
: Gallo (1991)
,
91–93, 99.

25.
A related retrovirus, feline leukemia virus
: Barré-Sinoussi (2003a), 844.

25.
Montagnier’s group in Paris, screening cells
: Barré-Sinoussi et al. (1983), 868; Montagnier (2000), 57. Barré-Sinoussi and Montagnier didn’t name it LAV in the original 1983 paper, but slightly later.

26.
Gallo’s group came up with
: Gallo et al. (1983), 865–866; Gallo (1991)
,
92–93, 99, 117. Gallo uses Arabic numerals (e.g., HTLV-1, HTLV-2) in his book;
but in the scientific papers, he and others use Roman numerals.

26.
He called this newest bug HTLV-III
: Gallo et al. (1984), 500, 502; Popovic et al. (1984), 497.

26.
An editorial in the same issue of
Science: Marx (1983), 806.

26.
Then again, neither was Gallo’s
: Gallo and Montagnier (1988), 44; Gallo (1991), 186; Crewdson (2002), 163–166.

26.
Montagnier had personally delivered
: Montagnier (2000), 60–62, 68–69.

27.
Meanwhile the third team of researchers:
Crewdson (2002), 143, 158.

27.
“more than 4000 individuals in the world”
: Levy et al. (1984), 840.

27.
“Our data cannot reflect a contamination”
: Levy et al. (1984), 842.

28.
A distinguished committee of retrovirologists
: Crewdson (2002), 179–180, 236.

29.
There she saw a weird problem:
Essex and Kanki (1988), 67; Letvin et al. (1983), 2718–2719.

29.
they did find a new retrovirus
: Daniel et al. (1985); Kanki et al. (1985b).

29.
for what soon would be renamed HIV
: i.e., they referred to the AIDS virus as HTLV-III and called their macaque virus STLV-III.

29.
This discovery, they wrote
: Daniel et al. (1985) and Kanki et al. (1985b), last paragraph of each.

29.
Only a single sentence at the end
: Kanki et al. (1985b), 1201.

30.
Kanki and Essex looked at other Asian macaques
: Essex and Kanki (1988), 67–68.

30.
“In 1985, the highest rates”
: Essex and Kanki (1988), 68.

30.
Kanki grew isolates of live virus
: Kanki et al. (1985b), 952–953.

31.
“must have evolved mechanisms”
: Essex and Kanki (1988), 68.

31.
The samples arrived with coded labeling
: Essex and Kanki (1988), 69; Kanki et al. (1986), 238.

31.
Despite one possible misstep
: Kanki et al. (1986), 238; regarding contamination and confusion, cf. Montagnier (2000), 80–81; Hooper (1999)
,
108; Kestler et al. (1988), 619, and Essex and Kanki’s reply to Kestler, same issue, 621–622; Barin et al. (1985), 1387.

32.
It more closely resembled SIV strains
: Barin et al. (1985), 1387.

32.
Montagnier and his colleagues screened the blood
: Montagnier (2000), 79–81; Clavel et al. (1986), 343–344.

32.
This man showed symptoms of AIDS
: Clavel et al. (1986), 343–344; Montagnier (2000), 79–80.

32.
Eventually, when all parties embraced the label
: Clavel (1986), 346; Montagnier (2000), 81.

33.
Possibly it was already with us
: See Fukasawa et al. (1988), 460; Mulder (1988), 396.

33.
when a group of Japanese researchers
: Fukasawa et al. (1988), 457.

33.
The nucleotide sequence of its retrovirus
: Fukasawa et al. (1988), 457, 459; Mulder (1988), 396.

34.
A commentary in the journal
Nature: Mulder (1988), 396.

35.
had noticed a leprosy-like infection
: Gormus et al. (2004), 216.

35.
not known to be transmissible from people
: Wolf et al. (1985), 529.

35.
The animal in question, a sooty mangabey
: Gormus (2004), 216. The story unfolds from Gormus (in retrospect) to Wolf et al. (1985) to Murphey-Corb et al. (1986).