There Was No 'Patient Zero' for the AIDS Epidemic

There Was No 'Patient Zero' for the AIDS Epidemic

Subtype B genomes from Haiti were the most diverse of all, the researchers found, and are likely ancestors to U.S. strains. In that study, he was named patient "O" - meaning "Outside California" - which was later misread as a zero, hence his subsequent characterisation as the origin of HIV in the US.

Eight of the men - half in NY and half in Southern California - said they had sex with an unnamed flight attendant.

At the time, he was only known as Case 057, and his name came up several times as researchers conducted their interviews.

That was an unfortunate move.

The researchers also said the person identified as "Patient Zero", as having brought AIDS to North America, was wrongly identified.

The mistaken emphasis placed on Dugas that saw him placed as a key link between the spread of HIV/Aids between the east and west coasts of the USA in the 1984 study, he said, was likely down to Dugas's efforts to help researchers.

"Geographically there is an unmistakable signal that this lineage did diversify in the Caribbean before it moved into the U.S.", Worobey said in a conference call with journalists on Tuesday.

The U.S. Centers for Disease Control first labelled Mr. Dugas as Patient O (the letter), for he was a case "Out-of-California". But the phrase stuck thanks to publicity around Randy Shilts's 1987 bestseller And the Band Played On, and further coverage turned Dugas-who died in 1984-into a villainous stereotype in the popular narrative of the disease.

Dugas was placed near the center of this cluster, and identified as patient O for "Outside of California". "This individual was simply one of thousands infected before HIV/Aids was recognised".

The level of genetic diversity, they say, shows that the virus was circulating in the United States for a decade before what eventually became known as Aids was recognised.

Now, a new study exonerates Dugas once and for all.

"What we've done here is tried to get at the origins of the first cases of AIDS that were ever noticed", said Michael Worobey, the evolutionary biologist at the University of Arizona who led the study.

Geneticists believe HIV was first transmitted to a human from a chimpanzee in sub-Saharan Africa, sometime in the early 20th century. From there it spread around the world, and as it did so, its genes changed.

Researchers have figured out how HIV first spread to the United States after genetically sequencing blood samples from people infected by the virus - and found "Patient Zero" was wrongly blamed for the outbreak.

He estimates there were probably 20,000 cases of HIV in North America when reports of patients with a unusual new disease - soon to be called AIDS - first surfaced.

"Nobody should be blamed for the spread of a virus that nobody even knew about", Worobey said.

So Worobey started looking for older samples. With precise historic and genetic analysis, they have shown that the virus spread from the Caribbean to New York City before becoming widespread in the rest of the US.

These sequences bolstered his earlier conclusions, and added some new ones.

Scientists were able to track the evolution of the HIV virus in the U.S.by tallying the number of mutations in its genome.

An analysis of these genomes suggests that the epidemic was characterised from the beginning by important genetic diversity and that the origins of the strain circulating in the United States from the early 1970s could be traced back to Caribbean countries like Haiti. Over in Haiti, the virus could have easily spread due to unhygienic practices at a plasma bank, which transported clotting factors to NY to treat hemophiliacs.

His findings and those of a U.S. experts who genetically tested decades-old blood samples to map the early spread of HIV in America are published in the journal Nature. "When a tube shows up that has 1978 on it, that means something". So in their study, Worobey manages to finally sequence an HIV genome from Dugas - and "found no evidence that Patient 0 was the first person infected by this lineage", according to the paper. It wasn't the ancestor of the strains that ravaged America, and it wasn't any more closely related to the West Coast strains than those on the East.

For Dan Allman, acting director of the HIV Studies Unit at U of T's Dalla Lana School of Public Health, the story of Dugas also serves as a cautionary tale.

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