The news over the past 24 hours has exclaimed over and over:

HIV’s Patient Zero Exonerated

How scientists proved the wrong man was blamed for bringing HIV to the U.S.

Researchers Clear “Patient Zero” from AIDS Origin Story

H.I.V. Arrived in the U.S. Long Before ‘Patient Zero’

Gaetan Dugas: “patient zero” not source of HIV/AIDS outbreak, study confirms

HIV’s supposed “Patient Zero” in the U.S., Gaetan Dugas, is off the hook! He wasn’t responsible for our outbreak!

This is presented as new information.

gaetan_dugas

Gaetan Dugas, from Wikipedia.

It is not, and I think by focusing on the “exoneration” of Dugas, a young flight attendant and one of the earliest diagnosed cases of AIDS in the U.S., these articles (referencing a new Nature paper) are missing the true story in this publication–that Dugas was really a victim of Shilts and the media, and remains so, no matter how many times the science evidence has cleared his name.

First, the idea that Dugas served to 1) bring HIV to the U.S. and 2) spark the epidemic and infect enough people early on that most of the initial cases could be traced back to him is simply false. Yes, this was the hypothesis based on some of the very early cases of AIDS, and the narrative promoted in Randy Shilts’s best-selling 1987 book, “And the Band Played On.” But based on the epidemiology of first symptomatic AIDS cases, and later our understanding of the virus behind the syndrome, HIV, we quickly understood that one single person in the late 1970s could not have introduced the virus and spread it rapidly enough to lead to the level of infections we were seeing by the early 1980s. Later understanding of the virus’s African origin and its global spread made the idea of Dugas as the epidemic’s originator in America even more impossible.

When we think of Dugas’s role in the epidemiology of HIV, we could possibly classify him as, at worst, a “super-spreader“–and individual who is responsible for a disproportionate amount of disease transmission. Dugas acknowledged sexual contact with hundreds of individuals between 1979 and 1981–but his numbers were similar to other gay men interviewed, averaging 227 per year (range 10-1560). And while Shilts portrayed Dugas as a purposeful villain, actively and knowingly spreading HIV to his sexual partners, that does not jibe with both our scientific knowledge of HIV/AIDS or with the assistance Dugas provided to scientists studying the epidemic. Dugas worked with researchers to identify as many of his partners as he could (~10% of his estimated 750), as the scientific and medical community struggled to figure out whether AIDS stemmed from a sexually-transmitted infection, as several lines of evidence suggested. There’s no evidence Dugas was maliciously infecting others, though that was the reputation he received. Dugas passed away from complications of AIDS in March of 1984–weeks before the discovery of HIV was announced to the general public.

Furthermore, the information in the new publication is not entirely novel. Molecular analyses carried out in part by Michael Worobey, also an author on the new paper, showed almost a decade ago that Dugas could not have been the true “Patient Zero.” The 2007 paper, “The emergence of HIV/AIDS in the Americas and beyond,” had the same conclusions as the new paper: HIV entered the U.S. from the Caribbean, probably Haiti, and was circulating in the U.S. by the late 1960s–when Dugas was only about 16 years old, and long before his career as a flight attendant traveling internationally. So this 2007 molecular analysis should have been the nail in the coffin of the Dugas-as-Patient-Zero ideas.

But apparently we’ve forgotten that paper, or other work that has followed the evolution of HIV over the 20th century.

What is unique about the new publication is that it included a sample from Dugas himself, via a plasma contribution Dugas donated in 1983, and other samples banked since the late 1970s. The new paper demonstrated that Dugas’s sample is not in any way unique, nor is it a “basal” virus–one of the earliest in the country, from which others would diverge. Instead, it was representative of what was already circulating among others infected with HIV at that time. In supplemental information, the authors also demonstrated how notation for Dugas in scientific notes changed from Patient 057, then to Patient O (for “Outside California”) to Patient 0/”Zero” in the published manuscript–which Shilts then named as Dugas and ran with in his narrative.

patient-zero-graphic

Graphic of sexual network of early AIDS cases, from Auerbach et al., Am J Med 1984.

 

The media then extended Shilts’s ideas, further solidifying the assertion that Dugas was the origin of the U.S. epidemic, and in fact that he was outright evil. The supplemental material notes that Shilts didn’t want the focus of the media campaign initially to be about Dugas, but was convinced by his editor, who suggested the Dugas/Patient Zero narrative would result in more attention than the drier critiques of policy and inaction in response to the AIDS epidemic by the Reagan administration.

And the media certainly talked about it. A 1987 edition of U.S. News and World Report included a dubious quote attributed to Dugas: “‘I’ve got gay cancer,’ the man allegedly told bathhouse patrons after having sex with them. ‘I’m going to die, and so are you.’” NPR’s story adds “The New York Post ran a huge headline declaring “The Man Who Gave Us AIDS. Time magazine jumped in with a story called ‘The Appalling Saga Of Patient Zero.’ And 60 Minutes aired a feature on him. ‘Patient Zero. One of the first cases of AIDS. The first person identified as the major transmitter of the disease,’ host Harry Reasoner said.”

This is the real scandal and lingering tragedy of Dugas. His story was used to stoke fear of HIV-infected individuals, and especially gay men, as predators seeking to take others down with them. His story was used in part to justify criminalization of HIV transmission. So while science has exonerated him again and again, will the public–and the media–finally follow?

 

 

 

 

Comments

  1. #1 Don Monroe
    Massachusetts
    October 27, 2016

    Thanks for this clarification! I was really surprised by the widespread coverage in the past couple of days, since I thought we already knew he wasn’t responsible. Glad to know I wasn’t imagining it, although the coverage is a scary symptom of our collective short attention span. I wish this were the only example.

  2. #2 George Sims
    LSHTM
    October 28, 2016

    Thanks. True aeteology rules.

  3. #3 JustaTech
    October 28, 2016

    1) I’m really impressed that the researchers were able to to get so many sequences out of samples that old.
    2) Is Randy Shilts going to apologize about the whole “Patient Zero” thing, even though the man in question died so many years ago?

  4. #4 Tara C. Smith
    October 29, 2016

    Shilts died from complications of AIDS in 1994.

  5. #5 Ian
    October 30, 2016

    I remember reading, many years ago, possibly in the 1980’s an article that featured a retired MD. He had a patient in the late 1960’s, a young man, who exhibited a multitude of inexplicable symptoms and illnesses and who eventually succumbed to them. It was a case that stuck with the Doctor because it was so unusual and tragic. He had kept some tissue samples from his patient and when in retirement he was reading about HIV/AIDS and its symptoms, it leapt out at him because they where the same symptoms of this one patient of his. He had those tissues tested, and they were positive for HIV. So this current study demonstrating HIV was here a decade or more before it exploded in the early 80’s is a confirmation of what many already suspected.

  6. #6 JustaTech
    October 31, 2016

    Tara: Oh. I was not aware of that. I guess that just compounds the tragedy.

  7. #7 Tara C. Smith
    November 1, 2016

    Ian, yes. Not sure if it’s the same case you’re thinking of, but testing done of banked tissues from the DRC from the 1960s (also by the same author in the paper described above) showed the presence of HIV there, and extrapolated that HIV entered the human population somewhere around the turn of last century (see eg http://evolution.berkeley.edu/evolibrary/news/081101_hivorigins).

  8. #8 Richard Jefferys
    NYC
    November 10, 2016

    I think the case Ian is referring to is that of Robert Rayford who died in 1969. Stored tissues were reported to test positive for antibodies using Western Blot by Robert Garry from Tulane in 1988 (https://www.ncbi.nlm.nih.gov/pubmed/3418874). A lot of people still seem to believe Rayford is the earliest documented case of HIV infection in the USA (and a Wikipedia entry claims as much), but the documentation does not appear at all conclusive as far as I can tell.

    The only report of PCR testing for HIV appears to be a conference abstract from 1990 (https://web.archive.org/web/20070503080625/http://www.tulane.edu/~dmsander/Abstracts/rr99.html), claiming to have identified viral sequences very similar to the HIV IIIB isolate, which was the commonly used lab isolate at the time. That is obviously strongly suggestive of lab contamination, since this should have been an HIV from the 1960s and IIIB was the virus isolated in France in the early 80s (which turned out to be a late-stage disease, CXCR4-using isolate).

    The PCR study does not appear to have ever been published, and I can’t find any other references to efforts to identify HIV nucleic acids in the samples. According to a 2007 article in St. Louis Magazine (https://www.stlmag.com/The-Pre-Pandemic-Puzzle/), Garry now says the samples were lost due to Hurricane Katrina. The article also notes that the “Garry had difficulty persuading the scientific community of his results.” I don’t think Elvin-Lewis, the doctor quoted in the piece who says that the1990 PCR study “vindicated” their claims, realizes the limitations of that study. Given that Garry had until 2005 to conduct more advanced PCR analysis (or ask other independent researchers to do so), it seems reasonable to conclude that no compelling evidence of the presence of HIV genetic material in the samples ever emerged and that this likely was not a case of HIV infection.

    • #9 ian
      November 10, 2016

      Thanks for the info and clarification.

  9. #10 taylor
    June 12, 2017

    Very Interesting!! I didn’t know that they had actually tested samples from that long before the actual AIDS epidemic broke out!! Its horrible that he died before this clarification was brought about.