The Coming Plague

by Laurie Garrett

  163 T. C. Quinn, J. M. Mann, J. W. Curran, and P. Piot, “AIDS in Africa: An Epidemiologic Paradigm,” Science 234 (1986): 955–63.

  164 J. A. Levy, L. Z. Pan, E. Beth-Giraldo, et al., “Absence of Antibodies to the Human Immunodeficiency Virus in Sera from Africa Prior to 1975,” Proceedings of the National Academy of Sciences 83 (1986): 7935–37. R. Sher, S. Antunes, B. Reid, et al., “Seroepidemiology of Human Immunodeficiency Virus in Africa from 1970 to 1974,” New England Journal of Medicine 317 (1987): 450–51. E. Tabor, R. Gerety. J. Cairns, and A. C. Bayley, “Did HIV and HTLV Originate in Africa?” Journal of the American Medical Association 264 (1990): 691–92.

  165 M. Baldo and A. J. Cabral, “Low Intensity Wars and Social Determination of the HIV Transmission: The Search for a New Paradigm to Guide Research and Control the HIV/AIDS Pandemic,” in Z. Stein and A. Zwi, eds., Action on AIDS in Southern Africa: Maputo Conference on Health Transition in Southern Africa, April 1990 (New York: Committee for Health in Southern Africa).

  166 The most outstanding compilation of available information on this sad period in Uganda’s history and its impact on AIDS can be found in Barnett and Blaikie (1992), op. cit. Other excellent sources include R. Winter, “Uganda: Creating a Refugee Crisis,” United States Committee for Refugees Newsletter, 1983; and C. P. Dodge, “The West Nile Emergency,” in C. P. Dodge and P. D. Wiebe, eds., Crisis in Uganda: The Breakdown of Health Services (Oxford, Eng.: Pergamon Press, 1985).

  167 There are numerous sources of more detailed information on military and political activities in the region during the mid-1970s. See, for example, Western Massachusetts Association of Concerned African Scholars, U.S. Military Involvement in Southern Africa (Boston: South End Press, 1978).

  168 J. P. Getchell, D. R. Hicks, A. Svinivasan, et al., “Human Immunodeficiency Virus Isolated from a Serum Sample Collected in 1976 in Central Africa,” Journal of Infectious Diseases 156 (1987): 833–37.

  169 N. Nzilami, K. M. De Cock, D. N. Forthal, et al., “The Prevalence of Infection with Human Immunodeficiency Virus over a 10-Year Period in Rural Zaire,” New England Journal of Medicine 318 (1988): 276–79.

  170 K. M. De Cock and J. B. McCormick, “HIV Infection in Zaire,” New England Journal of Medicine 319 (1988): 309.

  171 A. J. Nahmias, J. Weiss, X. Yao, et al., “Evidence for Human Infection with an HTLV-III/ LAV-Like Virus in Central Africa, 1959,” Lancet I (1986): 1279–80.

  172 R. V. Henrickson, D. H. Maul, K. G. Osborn, et al., “Epidemic of Acquired Immunodeficiency in Rhesus Monkeys,” Lancet I (1983): 388–90.

  173 W. T. London, J. L. Sever, D. L. Madden, et al., “Experimental Transmission of Simian Acquired Immunodeficiency Syndrome (SAIDS) and Kaposi’s-Like Skin Lesions,” Lancet II (1983): 869–73.

  174 See letters to the editor in response to the California studies, in Lancet I (1983): 1097–98.

  175 “Thus, African green monkeys seem to possess antibodies to STLV-III [SIVagm], unlike African chimpanzees and baboons. These African green monkeys are apparently healthy, suggesting that STLV-III may be non-pathogenic in this species … ,” the Harvard team wrote. “We suggest that STLV-III [SIVagm] of African green monkeys may have been transmitted to man coincident with the recognition of AIDS in Central Africa. An HTLV-III [HIV] related virus has thus been found in two species of Old World Primates.” P. J. Kanki, R. Kurth, W. Becker, et al., “Antibodies to Simian T-Lymphotropic Retrovirus Type III in African Green Monkeys and Recognition of STLV-III Viral Proteins by AIDS and Related Sera,” Lancet I (1985): 1330–32.

  176 See D. Colburn, “Claiming Credit for HIV-2: A ‘Sordid Chapter’ in the Politics of Research,” Washington Post, October 27, 1987: Health 19; F. Clavel, K. Mansinho, S. Chamaret, et al., “Human Immunodeficiency Virus Type 2 Infection Associated with AIDS in West Africa,” New England Journal of Medicine 316 (1987): 1180–85; F. Clavel, F. Brun-Vézinet, D. Guétard, et al., “LAV Type II: A Second Retrovirus Associated with AIDS in West Africa,” Centre Recherche Académie Science Paris 302 (1986): 485–88; and M. Blanc, “L‘Autre Virus du SIDA,” La Recherche 17 (1986): 974–76.

  177 P. J. Kanki, F. Barin, S. M’Boup, et al., “New Human T-Lymphotropic Retrovirus (HTLV-IV) Related to Simian T-Lymphotropic Virus Type III (STLV-IIIagm),” Science 232 (1986): 238–43.

  178 P. J. Kanki, S. M‘Boup, D. Ricard, et al., “Human T-Lymphotropic Virus Type 4 and the Human Immunodeficiency Virus in West Africa,” Science 236 (1987): 827–31.

  179 J. L. Marx, “Probing the AIDS Virus and Its Relatives,” Science 235 (1987): 1523–25; and M. Essex and P. J. Kanki, Letter, Nature 331 (1988): 621–22.

  180 P. Kanki, S. M’Boup, R. Marlink, et al., “Prevalence and Risk Determinants of Human Immunodeficiency Virus Type 2 (HIV-2) and Human Immunodeficiency Virus Type 1 (HIV-1) in West African Female Prostitutes,” American Journal of Epidemiology 136 (1992): 895–907; and P. J. Kanki, “Biologic Features of HIV-2,” in P. Volberding and M. A. Jacobson, eds., AIDS Clinical Review 1991 (New York: Marcel Dekker, 1991); 19–32.

  181 See note 145.

  182 G. Franchini, R. C. Gallo, H. G. Guo, et al., “Sequence of Simian Immunodeficiency Virus and Its Relationship to the Human Immunodeficiency Viruses,” Nature 328 (1987): 539–43. The HIV-1 strain used in the study was HTLV-IIIb, the research strain that was virtually identical to Montagnier’s LAV strain, both of which underwent alteration due to multiple cell culture passages in the laboratories.

  183 L. Chakrabarti, M. Guyader, M. Alizon, et al., “Sequence of Simian Immunodeficiency Virus from Macaque and Its Relationship to Other Human Simian Retroviruses,” Nature 328 (1987): 543–47.

  184 Marx (1987), op. cit.

  Essex, working in collaboration with Gallo’s lab and researchers from Sweden’s Karolinska Institute and the Universite Pierre et Marie Curie in Paris, reached a similar conclusion about the viruses’ similarity. See S. K. Arya, B. Beaver, L. Jagodzinski, et al., “New Human and Simian HIV-related Retroviruses Possess Functional Transactivator (tat) Gene,” Nature 328 (1987): 548–50. But they stressed that it was possible that they were looking at an example of cross-species transmission of the same virus, from monkey to man.

  Harking back to disputes a decade earlier between Gallo and Japanese researchers over credit for discovery of HTLV-I, Yorio Hinuma of the Cancer Institute in Tokyo had isolated an SIV virus from wild-caught African green monkeys in 1985. His team, which had been instrumental in earlier HTLV-I efforts, now was credited with discovery of SIVagm, given evidence that Essex’s group was studying an SIVmac contaminant.

  185 Y. Ohta, T. Masuda, H. Tsujimoto, et al., “Isolation of Simian Immunodeficiency Virus from African Green Monkeys and Seroepidemiologic Survey of the Virus in Various Nonhuman Primates,” International Journal of Cancer 41 (1988): 115–22.

  186 Fukasawa, M. Miura, T. Hasegawa, A., et al. “Sequence of Simian Immunodeficiency Virus from African Green Monkey, A New Member of the HIV/SIV Group,” Nature 33 (1988): 457–461.

  187 For good reviews of these findings, see R. C. Desrosiers, “A Finger on the Missing Link,” Nature 345 (1990): 326; M. McClure, “AIDS and the Monkey Puzzle,” New Scientist, March 25, 1989; and M. McClure, “Where Did the AIDS Virus Come From?” New Scientist, June 30, 1990: 54–57.

  188 R. F. Khabbaz, W. Heneine, J. R. George, et al., “Brief Report: Infection of a Laboratory Worker with Simian Immunodeficiency Virus,” New England Journal of Medicine 330 (1994): 172–77.

  189 F. Gao, L. Yue, A. T. White, et al., “Human Infection by Genetically Diverse SIVsm-related HIV-2 i
n West Africa,” Nature 358 (1992): 495–99.

  190 R. Nowak, “HIV-2 and SIV May Be the Same Virus,” Journal of NIH Research 4 (1992): 38–40.

  191 C. Rouzioux, G. Jaeger, F. Brun-Vézinet, et al., “Absence of Antibody to LAV/HTLV-III and STLV-III (mac) in Pygmies,” II International Conference on AIDS, Paris, June 23–25, 1986.

  192 It would constitute a major breakthrough in AIDS research when University of Washington at Seattle scientists succeeded in infecting Macaca nemestrina monkeys with HIV-1, producing immune deficiency and lymphoma in the animals. From the earliest stages of the AIDS epidemic scientists had been infecting chimpanzees with HIV-1, but the animals never developed AIDS.

  193 U. Dietrich, M. Adamski, H. Kühnel, et al., “A Highly Divergent HIV-2 Related Strain, HIV-2alt, Defines an Alternative Subtype of the HIV-2/SIV mac/SIVsm Group of Primate Immunodeficiency Viruses,” IX International Conference on AIDS, Berlin, June 6–11, 1993.

  194 S. Giunta and G. Groppa, “The Primate Trade and the Origin of AIDS Viruses,” Nature 329 (1987): 22; and A. Karpas, “Origin and Spread of AIDS,” Nature 348 (1990): 578.

  195 T. Huet, R. Cheynier, A. Meyerhans, et al., “Genetic Organization of a Chimpanzee Lentivirus Related to HIV-1,” Nature 345 (1990): 356–58.

  The details were presented as follows:

  This showed that over two-thirds of the chimpanzee viral genes and HIV-1 were the same, versus far less commonality between SIVcpz and the other simian viruses or HIV-2.

  196 J. N. Nkengasong, M. Peeters, B. Willems, et al., “Phenotypic and Antigenic Properties of HIV-1 Isolates from Cameroon,” I International Conference on Human Retroviruses and Related Infections, Washington, D.C., December 12–16, 1993.

  197 G. Myers, K. Maclnnes, and L. Myers, “Phylogenetic Moments in the AIDS Epidemic,” Chapter 12 in S. S. Morse, ed., Emerging Viruses (Oxford, Eng.: Oxford University Press, 1993).

  198 There are about 9,700 nucleotides, or discrete bits of genetic information, inside an HIV virus. Nobel laureate Howard Temin (co-discoverer of reverse transcriptase and retroviruses) estimated that HIV-1 mutates at the rate of 2 × 10-2 substitutions per nucleotide per year. Put another way, if one could follow all the nucleotides in a population of HIV-1—assuming that the viruses were all identical at the outset—a year later there would be about fifty mutated nucleotides in any given virus one examined. And the whole population of viruses, which had been uniform at the outset, would have over the course of a year undergone thousands of generations of replication, becoming a heterogeneous swarm of dozens of quasispecies. An annual mutation rate of 2 × 10-2 was one of the highest seen in any viral species; but the cow virus responsible for foot-and-mouth disease mutated at a rate of 3 × 10-2 and the segment of the influenza virus responsible for its ability to infect human cells was an even more rapid mutator. See H. M. Temin, “Is HIV Unique or Merely Different?” Journal of Acquired Immune Deficiency Syndromes 2 (1989): 1–9.

  A study of the earliest HIV-1 strains found in people in 1983–85 similarly revealed a mutation rate of between 0.4 and 1.6 percent per year. The highest mutation rates occurred in viruses that were cultured repeatedly in the laboratory, undoubtedly subjected to selection pressures and contamination that wouldn’t occur naturally. Nevertheless, a median 1 percent annual metamorphosis rate seemed reasonable for wild HIV-1 viruses. See P. C. Sheng-Yung, B. H. Bowman, J. B. Weiss, et al., “The Origin of HIV-1 Isolate HTLV-IIIB,” Nature 363 (1993): 466–69.

  199 M. A. McClure, M. S. Johnson, D. F. Feng, and R. F. Doolittle, “Sequence Comparisons of Retroviral Proteins: Relative Rates of Change and General Phylogeny,” Proceedings of the National Academy of Sciences 85 (1988): 2469–73.

  200 There are several ways to picture these historical arguments. Paul Ewald, of Amherst College in Massachusetts, sees AIDS viral evolution as follows:

  Source: P. W. Ewald, “AIDS: Where Did It Come From and Where Is It Going?” in Evolution of Infectious Diseases (Oxford, Eng.: Oxford University Press, 1993), chapter 8.

  Gerald Myers pictured the evolution more like this:

  On a larger evolutionary scale, comparing HIV to other similar viruses, Doolittle saw this:

  201 The experience of Marburg disease, as described in earlier chapters, left many scientists wondering just how safe monkey-derived vaccines might be.

  202 See P. Brown, “US Rethinks Link Between Polio Vaccine and HIV,” New Scientist, April 4, 1992: 10; T. Curtis, “The Origin of AIDS,” Rolling Stone 625 (1992): 54–106; T. Curtis and P. Manson, “Do Cold, Hard AIDS Facts Lie in Freezer? Researchers Look for Clues in Old Vials of Polio Vaccine,” Houston Post, April 16, 1992: Al; C. H. Fox, “Possible Origins of AIDS,” Science 256 (1992): 1259–60; A. J. Garrett, A. Dunham, and D. J. Wood, “Retroviruses and Poliovaccines,” Lancet 342 (1993): 932–33; Giunta and Groppa (1987), op. cit.; “In the Beginning,” The Economist, March 14, 1992: 99–100; W. S. Kyle, “Simian Retroviruses, Poliovaccine and Origin of AIDS,” Lancet 339 (1992): 600–1; G. Lecatsas and J. J. Alexander, “Origins of HIV,” Lancet 339 (1992): 1427; A. McGregor, “Poliovaccine and AIDS Origin Link Very Unlikely,” Lancet 340 (1992): 1090–91; “Panel Nixes Congo Trials and AIDS Source,” Science 258 (1992): 304–5; and T. F. Schulz, “Origin of AIDS,” Lancet 339 (1992): 867. Rolling Stone later printed an apologia: “‘Origin of AIDS’ Update,” December 9, 1992: 40.

  203 N. Touchette, “Fact or Fiction? HIV and Polio Vaccines,” Journal of NIH Research 4 (1992): 40–41.

  204 See J. Rifkin, letter to Dr. James Mason, Director, CDC. undated, 1987; P. M. Boffey, “Cattle Virus Tied to AIDS,” New York Times, July 7, 1987: Al; J. Rifkin, letter to Dr. Frank Young, Commissioner, Food and Drug Administration, August 3, 1987; and J. B. Wyngaarden and B. W. Hawkins, letter to Mr. Jeremy Rifkin, Foundation on Economic Trends, September 23, 1987.

  205 J. Seale, “AIDS Virus Infection: Prognosis and Transmission,” Journal of the Royal Society of Medicine 78 (1985): 613–15.

  206 Using precisely the same reasoning, a right-wing organization based in Orange County, California, concluded that HIV was created by the KGB as part of a plot to take over the United States. The organization favored mandatory quarantine of HIV-positive Americans as the only available measure to stop communist encroachment. See The Freedom Fighter, published by the American Information Network of Orange, CA, January 1986. The publication also blamed AIDS on 1959 Nobel Prize recipient Bertrand Russell, saying, “These globalists are responsible for unleashing the AIDS virus upon the world’s population, they would be guilty of mass murder at levels heretofore not even conceived of in the most imaginative of monster movies.”

  207 U.S. Department of State, “The U.S.S.R.’s AIDS Disinformation Campaign,” Foreign Affairs Note, July 1987.

  208 Peter Duesberg’s views have been so widely published that it is difficult to narrow a list to key sources. For Duesberg’s perspective, see B. Guccione, Jr., Interview, September 1993: 95–108; P. H. Duesberg, “Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome: Correlation But Not Causation,” Proceedings of the National Academy of Sciences 86 (1989): 755–64; J. Miller, “AIDS Heresy,” Discover, June 1988: 63–68; P. Duesberg, “A Challenge to the AIDS Establishment,” Biotechnology 5 (1987): 3; and P. H. Duesberg, “Retroviruses As Carcinogens and Pathogens: Expectations and Reality,” Cancer Research 47 (1987): 1199–1220.

  209 For examples of counterarguments to Duesberg’s theories, see J. Cohen, “Keystone’s Blunt Message: ‘It’s the Virus, Stupid,’” Science 260 (1993): 292; P. Brown, “MPs Investigate AIDS Maverick,â
€ New Scientist, June 6, 1992: 9; D. Concar, “Patients Abandon AIDS Drug After TV Shows,” New Scientist, July 13, 1991: 13; J. E. Groopman, “A Dangerous Delusion About AIDS,” New York Times. September 10, 1992: A23; J. Weber, “AIDS and the ‘Guilty’ Virus,” New Scientist, May 5, 1988: 32–33; and A. G. Fettner, “Dealing with Duesberg,” Village Voice, February 2, 1988: 25–29.

  210 See S. B. Thomas and S. C. Quinn, “Understanding the Attitude of Black Americans,” in J. Stryker and M. D. Smith, eds., Dimensions of HIV Prevention: Needle Exchange (Menlo Park, CA: Henry J. Kaiser Family Foundation, 1993), 99–128.

  211 Estes (1991), op. cit., 489–558.

  212 A. J. Pinching, “AIDS and Africa: Lessons for Us All,” Journal of the Royal Society of Medicine 79 (1986): 501–3.

  213 Karpas (1990), op. cit.

  214 B. Evatt, D. P. Francis, and M. F. McLane, “Antibodies to Human T Cell Leukemia Virus-Associated Membrane Antigens in Haemophiliacs: Evidence for Infection Before 1980,” Lancet II (1983): 698–700.