As mentioned in the previous post [1], the Patient Zero meme instigated by the findings of Worebey et al cascaded through the general, medical, and scientific media alike.  An editorial published in Trends in Microbiology, Patient 0’ and the Origin of HIV/AIDS in America [2], praised the work of Worobey et al for dispelling the Patient Zero myth [3].  Worobey also concluded that HIV migrated to the USA from Africa via Haiti [3].

Haiti got all the press, but 5 years into the AIDS epidemic (1986), Bermuda that had the highest AIDS rate in the world, as seen in Table 1.

 

Table 1:          AIDS Prevalence in United States and Caribbean – September 1986

Country

Prevalence

(cases per 100,000)

Reported AIDS cases

Population

Bermuda

76.3

42

55,000

Bahamas

30.5

68

223,000

United States

10.3

24,169

234,249,000

Trinidad/Tobago

9.4

108

1,149,000

Haiti

8.8

501

5,690,000

 

Nevertheless,the Trends in Microbiology editorial supported the Africa-Haiti origin concept by listing three “plausible scenarios” for HIV transmission from Haiti to the USA.  My full response, below, describes the epidemiological winds that blow HIV from the United States towards the Caribbean (excluding Cuba because American travelers and tourists were embargoed).

 

__________________________________________________________________

 

Response to Gong et al – Patient 0’ and the Origin of HIV/AIDS in America

     Gong et al [2] commented on the Worobey findings [3] and listed three “plausible scenarios” for the migration of HIV from the Caribbean (i.e., Haiti) to the USA:

     (1) Caribbean immigrants;

     (2) American sex tourists; and

     (3) contaminated commercial blood products.

     In our view, these “plausible scenarios” should be treated more cautiously and the possibility that HIV migrated from the USA to Haiti should be treated more seriously.

     Early in the epidemic, HIV/AIDS was present only in locales frequented by American travelers and tourists, and absent in locales from which Americans were embargoed, i.e., the Soviet Bloc. By 1985, Poland, Yugoslavia, and Czechoslovakia had no confirmed AIDS cases [3, 5]. The USSR reported its first case in 1988 [6].

     By the September 1986, Cuba had only one AIDS case, and Haiti had 501 cumulative cases [7]. Three months later (December 1986), the USA had 28,980 cumulative cases [8]. The absence of HIV/AIDS from Cuba is particularly significant. Despite thousands of Cuban soldiers returning to Cuba from military interventions in sub-Saharan Africa during the 1970s and 1980s, Cuba remained free from HIV/AIDS. Possibly the American embargo of Cuba precluded tourist and business trade from the island; exclusively shielding Cuba from HIV infection. Table 1 lists HIV prevalence throughout the USA and Caribbean as of September 1986 [7].

 

Table 1:           AIDS Prevalence in United States and Caribbean – September 1986 [7]

Country

Prevalence

(cases per 100,000)

Reported AIDS cases

Population

Bermuda

76.3

42

55,000

Bahamas

30.5

68

223,000

United States

10.3

24,169

234,249,000

Trinidad/Tobago

9.4

108

1,149,000

Haiti

8.8

501

5,690,000

St. Lucia

8.4

10

119,000

Guadeloupe

3.5

11

315,000

Puerto Rico

2.5

81

3,179,000

St. Vincent

2.2

3

134,000

Martinique

1.9

6

308,000

Grenada

1.8

2

111,000

Barbados

1.6

4

251,000

Dominican Republic

1.0

62

6,248,000

Jamaica

0.2

5

2,200,000

Cuba

0.01

1

9,700,000

 

     By 1987, epidemiological investigators had failed to find any Haitian HIV/AIDS patients that had visited Africa, while 10 % – 24% of the initial HIV/AIDS patients had visited either the USA or Europe [9].

     Contrary to initial reports, the majority of Haitians HIV/AIDS patients were identified as men who have sex with men (MSM). By one account, 72% of AIDS patients in Haiti were MSM with at least one sexual encounter with visiting North-Americans or with Haitians residing in North America [10].

     In 2008, Worobey had theorized that a Haitian immigrant cohort had been infected before their 1975 arrival in the USA [11]; thereby discounting any consideration they might have contracted HIV in Miami, where the world’s first Haitian HIV/AIDS patients were discovered in April 1980 [12]. Three years early, the two plausible HIV/AIDS patients had presented in New York City (May and November 1977) [13].

(Contrary to popular belief, the HIV incubation period can be as short as 2 months. SeeHIV has a 10-Year Incubation Period – NOT)

     Retrospectively identified, the first HIV/AIDS within Haiti presented in June 1979. Extensive investigations sought to identify prior Haitian HIV infections, using Kaposi’s sarcoma (KS) as a marker for HIV infection. A survey of 21 practicing dermatologists and pathologists identified one case in 1972 (54-year old man). The following investigations failed to detect any other KS cases [14]:

  • cancer biopsies records; 1968 to May 1983; three private hospitals; Port-au-Prince (total 180 beds);
  • 1000 cancer biopsy records; Albert Schweitzer Hospital (Deschapelles); served rural population of 115,000 persons; and
  • autopsy records; 1978 to July 1982; Albert Schweitzer Hospital.

     According to Worobey (2016), a Haitian brought the H6 variant of HIV to the USA in 1981[3]. In the same year, the first Danish AIDS patient presented in Copenhagen [15]. In 1981 in Denmark, the greatest AIDS risk factor was homosexual exposure to US citizens during 1980 and 1981 [16]. One group of authors wrote: [The] high rate of travel of Danish homosexuals to the USA might explain the high rate of AIDS in Denmark which is at present the highest reported for citizens in a European country [17].”

     Throughout the world, early in the epidemic, the greatest risk factor for contracting AIDS was sexual contact with an American MSM.  A consistent finding among incipient AIDS populations throughout Denmark [15], United Kingdom [18], France [19], West Germany [20], South Africa [21], and the Caribbean [22]. Throughout these locations, a substantial portion of the first incipient cohorts were MSM who had sex with American MSM; such contact occurring inside or outside the USA.

     In Africa, the first cases presented in early 1982, two white MSM flight stewards in South Africa who frequented New York City [21], while the first black Africans (1983) were primarily residents of Belgium [23].  The physicians treating these patients in Belgium later wrote: “It is possible that AIDS has always been present but unrecognized in Africa. However, we are struck by the increasing number of patients who have come from Zaire or Rwanda to Belgium during the past 4 years to seek medical care. We believe that AIDS is a new disease that is spreading in Africa [24].”

     Ironically, the records demonstrate that American (not Haitian) blood products transmitted HIV infection to South Africa [25], France [26], West Germany [27], Scotland and Denmark [28].

     The theory that HIV migrated from Africa to the USA via Haiti has become the accepted theory by most HIV scientists and reporters. There is, however, compelling evidence suggesting the USA was the epicenter from which HIV migrated to the rest of the world. We invite the authors to consider whether HIV originated in the USA.

 

Keywords:      Phylogenetics, Haiti, Caribbean, HIV, AIDS, Migration

 

Related Blogs:

References:

[1]       Response to Worobey et al – 1970s and ‘Patient 0’ HIV-1 genomes illuminate early HIV/AIDS history in North America

[2]      Gong Z, Xu X, Han GZ. ‘Patient 0’ and the Origin of HIV/AIDS in America. Trends Microbiol. Jan 2017;25(1):3-4.       [PMID: 27866834]

[3]       Worobey M, Watts TD, McKay RA, et al. 1970s and ‘Patient 0’ HIV-1 genomes illuminate early HIV/AIDS history in North America. Nature. Oct 26 2016;539(7627):98-101.    [PMID: 27783600]

[4]       Brunet JB, Ancelle RA. The international occurrence of the acquired immunodeficiency syndrome. Ann Intern Med. Nov 1985;103(5):670-674.            [PMID: 2996398]

[5]       Rich V. AIDS: Poland’s minister for prophylaxis. Nature. September 12, 1985 1985;317(6033):100.        

[6]       Pokrovskii VI, Pokrovskii VV, Potekaev NS, Karetkina E, Astaf’eva NV. [The first case of acquired immunodeficiency syndrome in an USSR citizen]. Ter Arkh. 1988;60(7):10-14.            [PMID: 3212719]

[7]       Lange WR, Jaffe JH. AIDS in Haiti. N Engl J Med. May 28 1987;316(22):1409-1410. [PMID: 3574418]

[8]       CDC. Summary of notifiable diseases, United States, 1986. MMWR Morb Mortal Wkly Rep. 1986;35(55):1-57.           [PMID: 3118160]

[9]       Johnson WD, Jr., Pape JW. AIDS in Haiti. Immunol Ser. 1989;44:65-78. [PMID: 2489126]

[10]       Deschamps MD. AIDS in the Caribbean. Arch AIDS Res. 1988;2(1):51-56. [PMID: 12315930]

[11]     Worobey M, Pitchenik AE, Gilbert MT, Wlasiuk G, Rambaut A. Reply to Pape et al.: the phylogeography of HIV-1 group M subtype B. Proc Natl Acad Sci U S A. Mar 25 2008;105(12):E16. [PMID: 18337514]

[12]     CDC. Opportunistic infections and Kaposi’s sarcoma among Haitians in the United States. MMWR Morb Mortal Wkly Rep. Jul 9 1982;31(26):353-354, 360-361. [PMID: 6811853]

[13]     Biggar RJ, Nasca PC, Burnett WS. AIDS-related Kaposi’s sarcoma in New York City in 1977. N Engl J Med. Jan 28 1988;318(4):252. [PMID: 3336414]

[14]     Pape JW, Liautaud B, Thomas F, et al. Characteristics of the acquired immunodeficiency syndrome (AIDS) in Haiti. N Engl J Med. Oct 20 1983;309(16):945-950.           [PMID: 6621622]

[15]     Thomsen HK, Jacobsen M, Malchow-Moller A. Kaposi sarcoma among homosexual men in Europe. Lancet. Sep 26 1981;2(8248):688.            [PMID: 6116060]

[16]     Melbye M, Biggar RJ, Ebbesen P, et al. Seroepidemiology of HTLV-III antibody in Danish homosexual men: prevalence, transmission, and disease outcome. Br Med J (Clin Res Ed). Sep 8 1984;289(6445):573-575. [PMID: 6087972]

[17]     Gerstoft J, Nielsen JO, Dickmeiss E, Ronne T, Platz P, Mathiesen L. The acquired immunodeficiency syndrome (AIDS) in Denmark. A report from the Copenhagen study group of AIDS on the first 20 Danish patients. Acta Med Scand. 1985;217(2):213-224. [PMID: 3993435]

[18]     du Bois RM, Branthwaite MA, Mikhail JR, Batten JC. Primary Pneumocystis carinii and cytomegalovirus infections. Lancet. Dec 12 1981;2(8259):1339.    [PMID: 6118728]

[19]     Rozenbaum W, Coulaud JP, Saimot AG, Klatzmann D, Mayaud C, Carette MF. Multiple opportunistic infection in a male homosexual in France. Lancet. Mar 6 1982;1(8271):572-573.           [PMID: 6120427]

[20]     L’Age-Stehr J, Kunze R, Koch MA. AIDS in West Germany. Lancet. Dec 10 1983;2(8363):1370-1371.   [PMID: 6139707]

[21]     Ras GJ, Simson IW, Anderson R, Prozesky OW, Hamersma T. Acquired immunodeficiency syndrome. A report of 2 South African cases. S Afr Med J. Jul 23 1983;64(4):140-142.    [PMID: 6306851]

[22]     Farmer P. AIDS and accusation: Haiti and the geography of blame. Berkeley and Los Angeles, California: University of California Press; 1992.           

[23]     Clumeck N, Mascart-Lemone F, de Maubeuge J, Brenez D, Marcelis L. Acquired immune deficiency syndrome in Black Africans. Lancet. Mar 19 1983;1(8325):642. [PMID: 6131313]

[24]     Clumeck N, Sonnet J, Taelman H, et al. Acquired immunodeficiency syndrome in African patients. N Engl J Med. Feb 23 1984;310(8):492-497.            [PMID: 6229701]

[25]     Cohn RJ, MacPhail AP, Hartman E, Schwyzer R, Sher R. Transfusion-related human immunodeficiency virus in patients with haemophilia in Johannesburg. S Afr Med J. Dec 1 1990;78(11):653-656.     [PMID: 2123569]

[26]     Immunologic and virologic status of multitransfused patients: role of type and origin of blood products. By the AIDS-Hemophilia French Study Group. Blood. Oct 1985;66(4):896-901.        [PMID: 2994780]

[27]     Erfle V, Hehlmann R, Mellert W, et al. Prevalence of antibodies to human T-lymphotropic virus-III (HTLV-III) in hemophiliacs and other patients chronically substituted with blood products. Blut. Oct 1985;51(4):243-249.           [PMID: 2996664]

[28]     Melbye M, Froebel KS, Madhok R, et al. HTLV-III seropositivity in European haemophiliacs exposed to Factor VIII concentrate imported from the USA. Lancet. Dec 22 1984;2(8417-8418):1444-1446.     [PMID: 6151053]

 

Chris Jennings

Health Alert Communications

Cambridge, MA

 

Stuart Derbyshire, PhD

Associate Professor

Department of Psychology

Faculty of Arts and Social Sciences

National University of Singapore

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