A New Patient Zero

A New Patient Zero
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A New Patient Zero

By Drs. David Niesel and Norbert Herzog

New viruses are becoming part of the human experience more often. Who can forget the rise of HIV around the world in the early 1980's? In the 1987 book, "And the Band Played On," the author identified flight attendant Gaëtan Dugas as "Patient Zero," the person who introduced HIV into the US. However, a recent genetic analysis reveals that this was wrong.

In June of 1981, the Centers for Disease Control published a report of five previously healthy gay young men in Los Angeles with a rare lung infection with Pneumocystis carnii or PCP. This infection is indicative of a weakened immune system. Little did we know that this was the start of the US AIDS epidemic. In addition, doctors also reported cases of a rare, aggressive form of skin cancer called Kaposi's sarcoma in some gay men. On June 8th, the CDC began to look for risk factors and to create case definitions for this new disease. By the end of 1981, 270 gay men were diagnosed with severe immune deficiency and 121 of them had died. On September 24, 1982, the CDC coined the term AIDS, Acquired Immune Deficiency Syndrome.

In the 1987 book, the original carrier of HIV who brought AIDS into the US was named as Gaëtan Dugas, a Canadian flight attendant. Mr. Gugas died of Kaposi's sarcoma in 1984 at age 31. It was claimed that he was Patient Zero who spread HIV to the gay bath houses in San Francisco and Los Angeles, sparking the AIDS epidemic. Evolutionary biologist Michael Worobey at the University of Arizona has compiled evidence proving that Dugas was not Patient Zero. After the AIDS virus was identified, scientists tested for HIV in stored blood samples taken from gay and bisexual men in the late 1970's in San Francisco and New York. Worobey determined the sequences of the genomes of those HIV viruses.

When HIV replicates its genome, errors are made producing mutations. Using these sequences, it was determined how these HIV's are related. Results indicated that the epidemic most likely started in New York City around 1970. The US HIV resembles older HIV isolates from Caribbean countries and that HIV reached San Francisco in 1975. Although Dugas did visit Haiti in 1977, he does not appear to be the key person in starting the US epidemic. In fact, the virus he carried fell in the middle of the family tree, not at the beginning.

So Dugas was wrongly vilified in the book, "And The Band Played On" and in the press. Two of his doctors are quoted accusing Dugas of being a "sociopath" for his large number of sexual partners.. However, it was not until 1983 that there was consensus that AIDS was transmitted sexually and in contaminated blood. So Dugas was not aware he was passing on AIDS as the result of his sexual activity until the year before his death. Now we also know that he is unlikely to have been the man who brought HIV to the US. Unfortunately, his lifestyle likely led to him infect many partners contributing to the scale of the epidemic.

Medical Discovery News
is hosted by professors Norbert Herzog at Quinnipiac University, and David Niesel of the University of Texas Medical Branch. Learn more at www.medicaldiscoverynews.com.

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