Chicago Tribune (CT) - Sunday October 25, 1987
John Crewdson, Chicago Tribune

On the other side of the Atlantic, an anonymous resident of Kinshasa, Zaire, was having his AIDS-infected blood drawn for posterity, while in the industrial city of Manchester, England an ailing British sailor was presenting himself to doctors at the Royal Infirmary.

For nearly two years, the young sailor said, he had suffered from a variety of puzzling symptoms, including strange purplish lesions on his back and shoulders. Then, just before Christmas of 1958, his condition had taken a turn for the worse.

The slightest exertion left him breathless, and he had come down with a bad case of "night sweats." He began losing weight at an alarming rate, experienced unremitting fatigue and developed a spiking fever.

The sailor grew steadily weaker until, in August of 1959, he died. An autopsy found evidence of pneumocystis carinii pneumonia (PCP), an infection of the lung that was then almost unheard of in adults.

Every one of the dozen or so cases of adult PCP then on record around the world had occurred only after a drug or disease had dealt some obvious blow to the patient's immune system. But the sailor's doctors could find no apparent immune deficiency.

In a letter published 25 years later in the British medical journal Lancet, they noted their bewilderment.

"We could not explain this patient's decreased resistance to infection," they wrote. "Could he have had AIDS? He had previously been well. While in the navy (1955-57) he had traveled abroad. He was not married and we know nothing of his sexual orientation."

A second case recorded in 1959 was closer to home, but no less mysterious. This time the subject was a 48-year-old shipping clerk for a Manhattan garment manufacturer who had come to New York City from his native Haiti three decades before.

Shortly after falling ill, the clerk developed many of the same symptoms as the sailor: shortness of breath, loss of weight, headache, sore throat and malaise, continuous fatigue and profuse night sweats.

Finally he died. Once again, PCP proved to be the cause of death-and no underlying disease or immune deficiency could be found.

Asked whether he believed, in retrospect, that the clerk might have had AIDS, Dr. Gordon R. Hennigar, the pathologist who performed the man's autopsy, replied "You bet."

"It was so unusual at the time," Hennigar said. "Lord knows how many cases of AIDS have been autopsied that we didn't even know had AIDS. I think it's such a strong possibility that I've often thought about getting them to send me the tissue samples."

Dr. Hennigar and his colleagues in Manchester are not alone. A number of other physicians interviewed by the Tribune in recent weeks said they, too, had come to the conclusion that AIDS may have been responsible for otherwise inexplicable deaths going back 30 years or more.

Among the suspect victims are a number of children. Dr. Senih Fikrig, director of pediatric immunology at the State University of New York's Health Sciences Center in Brooklyn, recalled seeing a previously healthy seven-month- old black infant with PCP in 1975.

"If we had seen the same child today, our first thought would have been AIDS," he said. Dr. Madu Rao, a colleague who consulted on the case, agreed.

"It's certainly possible," he said. "I have wondered many a time if some of the children we saw in the 1970's with various other infectuous diseases might really have had AIDS."

The AIDS epidemic may be less than a decade old, but most virologists agree that there is no such thing as a truly new disease-only diseases that have been newly discovered. The AIDS virus, they say, surely did not spring to life full blown in this decade or even this century, and probably not in this millenium.

"Nothing new has been made for 2,000 years, maybe not for two million years," says Peter Duesberg, a professor of microbiology at the University of California. "Remember that part of the Bible called Genesis?"

Though they have surely been present for generations, the viruses that cause Lassa fever and ebola disease went unnoticed until the African epidemics of the 1970s, and the same is true for other "modern" microbes.

"Anybody that keeps a freezer full of serum can tell you that when the thing was defined, people went back into their collections and said, 'Hey, I wonder if any of those cases of pneumonia were Legionnaire's Disease,' " said Dr. Memory Elvin-Lewis of Washington University in St. Louis.

"And low and behold, they were. It's just that it was never recognized as what it was. I guess what we're trying to say is that AIDS has been around for a long time but just wasn't recognized."

To the question of when AIDS was first recognized there are differing answers.

Blood samples taken from homosexual men in San Francisco and New York in 1977 and 1978 and kept frozen since then show that some of those men had already been exposed to Human Immunodeficiency Virus (HIV), the virus that has been most often linked to AIDS.

But HIV wasn't identified until 1983, and those samples weren't tested until two years ago. Moreover, none of the men in the study became ill until several years after their blood had been drawn.

The first case of what public health officials now officially recognize as AIDS was seen in a black security guard, a homosexual, who checked into a New York hospital in April of 1979 and died of PCP a year later.

That case was followed by a score of similar ones over the next 18 months in New York, San Francisco and Los Angeles, most of them white men, all of them homosexuals or heroin addicts or both, all of them victims of PCP or a malignant tumor called Kaposi's sarcoma (KS).

Each case of PCP was accompanied by a request to the federal Centers for Disease Control for a special drug called pentamadine, then and now the recommended treatment for pneumocystis carinii. It was the accumulation of these requests that, in April of 1981, finally alerted the public health establishment to the beginnings of the AIDS epidemic.

If HIV was around long before 1981, how it could have been missed for so many years? One answer is that no one actually dies of AIDS.

AIDS, after all, is not a disease. It is a syndrome-Acquired Immunodeficiency Syndrome-that occurs when something, possibly HIV, attacks and kills a vital component of the human body's defense against invading diseases.

As the patient's resistance diminishes, he becomes a target for "opportunistic" diseases that do not present a threat to most individuals because they are not virulent enough to break through the immune defenses of a healthy person.

PCP is the most common opportunistic disease recorded among those with AIDS, so far afflicting about two-thirds of all AIDS patients. Next most common is Kaposi's sarcoma, a variety of cancer that has shown up in about one AIDS patient in eight.

Until AIDS, however, both KS and PCP were thought by American physicians to be exotic and quite rare.

The first case of PCP was recorded in this country in 1953, in a seven- week-old baby in Milwaukee. Of 13,700 cancers recorded at the University of Chicago's tumor registry between 1946 and 1960, only eight were identified as KS.

Even with the most modern health-care facilities at hand, relatively isolated cases of any disease can be overlooked or misconstrued. When doctors at Seattle's Swedish Hospital Medical Center reviewed more than 300 autopsies for evidence of PCP, they found that it had gone undetected in at least 14 cases.

Kaposi's sarcoma is harder to miss. But the lesions that characterize it are not always visible, and even those that are can be mistaken for another variety of sarcoma.

For those who are beyond the reach of the health-care system, the chances of misdiagnosis are greater still. It may not be a coincidence that, with the exception of the British sailor, nearly all of the suspected AIDS patients recorded before 1979 are black.

CAPTION:

CHART: Early AIDS cases chronology.

- 1959: A serum sample is taken in Kinshasa, Zaire, that later tests positive for the antibody to Human Immunodeficiency Virus (HIV).

- 1959: A previously healthy British seaman dies in Manchester, England, of Pneumocystis carinii pneumonia (PCP). His doctors could not explain his decreased resistance to infection.

- 1959: A 48-year-old Haitian man dies in New York City of PCP; there is no evidence of any other cause.

- 1966: A 50-year-old black woman dies in Miami after three-months of chills, fever, weakness, weightloss. Autopsy finds extensive Kaposi's sarcoma (KS), but no apparent immune deficiency.

- 1966: A black man, 54, is admitted to St. Anthony Hospital, Columbus, Ohio, with KS.

- February, 1967: Robert R., a young black man, first becomes sick in St. Louis.

- November, 1968: Robert R. is admitted to a St. Louis hospital.

- May, 1969: Robert R. dies. Blood samples taken at autopsy later test positive for HIV.

- 1975: PCP is diagnosed in a previously healthy seven-month-old black infant at Kings County Hospital, Brooklyn, New York.

- 1979: A white male homosexual, 44, is diagnosed with KS in New York City. Patient is believed to be the first victim of what will come to be known as Acquired Immunodeficiency Syndrome.

Chicago Tribune Graphic; Source: Chicago Tribune news reports.

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