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Because we were going to be responsible for the laboratory, Skip went to Ken Sell and they bought all this equipment, loaded up some C131 Air Force jet or something, and we flew it over. It was a huge amount of equipment. Ken Sell was great that way. He thought big, and you needed something big to take on these investigations.
This was how it was set up. The NIH part was to do the laboratory work–diagnostics, the immunology. The CDC was to do the epidemiology: describe if the disease was heterosexual, if it was perinatal, how big a problem it was, and so forth. Colebunders was to describe what was this diarrhea wasting, what was this slims disease, what were the characteristics, the similarities and dissimilarities.
I would not say that they all got along very well, but I would say that in two years, that team generated all of the information that led to our understanding of the AIDS epidemic in Africa. It was those three gentlemen, with Peter, myself, and Jim Curran as their back-ups, their directors, their mentors instigating them, do this, do that. None of that would have been possible had it not been for the discovery of a virus that was causing AIDS. It would have been very difficult. We would have been stumbling along in the dark: who was infected, who was not, who has got what?
That brings back a funny political story as well. Here I was sitting on all this African sera from the first investigation [in Zaire], and I started getting tugged in two ways: should I give it to [Dr. Robert] Gallo to go test or give it to [Dr. Luc] Montagnier to go test. I did meet with Bob and we talked about it. But Peter was good friends with Luc Montagnier. And I was at NIAID, and it turned out that Martin...
Harden: [Dr. Malcolm] Mal Martin.
Quinn: Mal Martin was good friends with Montagnier. They said, “Send the sera to Montagnier.” He had that first paper out on LAV, and so we did that. And the ones we would have called AIDS were all positive, but a fairly high percent of the controls that we had picked were also positive. So we thought, “This test needs some work.” In retrospect, they probably were all infected but had not developed the disease yet, because we had picked relatives, and, in some cases, they were wives or husbands or spouses. But that was from the first investigation.
We published that in Science, by the way, and there was no problem getting it published. I was last author on that one, and one of the French investigators was first.
Hannaway: What date was that published in Science. Was that 1984 or 1985?
Quinn: Which year? I think that was 1985.
Quinn: Or it may be 1984. Again, let us find out.
Hannaway: Okay. It was 1984.
Quinn: It was 1984, at least that is what I have here. Brun Vesenet is the first author, Montagnier second, and Barré Sinoussi is on it. Then it is McCormick, Piot, Talman, and a number of other people, and then myself as last author. That was in Science, 1984. And I have here volume 226, pages 453-457. So that is the reference. If I am off, it could have been the end of 1984, but that is about where it was.
Harden: You have that gap. The virus publications were in 1984 too.
Quinn: Eighty-four as well, and this was his test, that Brun Vesenet was the one trying to make the serologic test. We sent the sera, picked up all the ones we called AIDS, but there were others that were still positive, so they were worried about specificity with that.
Then Abbott came out with their first test in Organon Technika, and I went to them before these commercial outfits were licensed, which were using the Gallo test. I actually got it sent to my laboratory. I did not have to send the sera to Gallo at that point because it had now gotten into the commercial outfits. I tested the same sera, again with almost identical results. But at that point, we realized, because of the papers that were starting to come out, that these people were infected but did not have full manifestations of the disease yet. The way we did that was their CD4 counts were much lower than in the people who were seronegative. We used the CD4 count as an aid to help the specificity. But once these tests were available and we had published our African experience, as the laboratory overseer in the project, I immediately said, “Let’s get these kits over to Africa.” We were the first one to get kits into Africa actually to do blood testing.
Jonathan Mann, who was a quick thinker and very aggressive in his epidemiologic approach, said, “Let’s go study this population, and this population, and this population. Let’s use those serologic tests and let’s find out what we have got going.” If you look, in terms of the publications, he was publishing like every three months. You may say, “How was that possible?” It was possible because in Projet SIDA, even though the individuals had some personality quirks with one another–you will hear plenty about that–they did good science and they worked hard together. Maybe they worked individually, but eventually they had to put the data together. And maybe it was the six of us that made that possible.
In other words, Piot and myself and Curran got along very well with each other, and we got along with our respective individuals. I can remember meetings when Jim would fly up here, Jon Mann and Skip, who were not talking to each other at the time, would fly here, and myself, and the four of us would negotiate how to get out of a particular wrinkle in an investigation. Whether it was political or science or whatever, we would work together and we would end the meeting with resolutions, and out would come a paper two weeks later.
So it worked. Sometimes opposite personalities can be complementary, whether they realize it or not, and be creative, thinking in different ways. Plus my laboratory then pitched in. I said, “If you’re not getting the work done, if Skip can’t get the work done quickly enough, I will start having my laboratory back you up,” and so forth. The phone calls were intermittent, but I was on the phone with Jonathan Mann or Skip almost weekly at that time.
The clinical studies were a little slower to get going. They took longer because you needed a lot more patients to say, “All right, we screened 200 patients,” with the disease, “and here are their characteristics.” I do not remember as much heated activity going on [in that part] as I did with the first part.
The project itself was called Projet SIDA. It was endorsed by the U.S. Embassy, and got its blessings. Jonathan was a very good politician, as you will hear later on. But he got the American Embassy to adopt this project under its wing, and give it lots of support. The NIH and the CDC split the money to get it going, and Peter got money out of the European Economic Community. So it was jointly funded by all three parties. I was very excited about it. It was a real highlight of my scientific career to be able to work with other institutions overseas and for us all to work together towards a common goal, which was to learn more about the spread of this disease.
For me, the crowning event in the early days of those first two years was the piece that I was then asked to write, and that was “The AIDS Epidemic in Africa: Epidemiologic Paradigm.”
Hannaway: That appeared in Science.
Quinn: Which was in Science.
Hannaway: In 1986.
Quinn: What I did was I sat down with Jonathan and Skip and Jim and Peter and I said, “Let’s pull all our data together. What are we saying here in all these individual little pieces?” Because what was happening was that Jonathan would do a little study and, boom, he would publish it, and then do another. I said, “Let’s put it together and let’s summarize it. Let’s make it a package and let’s put some new data in to make it even more exciting.” That was that Science piece, and I am very pleased that they all supported me in that effort. We got along very well, in terms of getting that done.
I know there was all this friction in discussions, the friction of one group versus another. Yes, the CDC and the NIH were a friction waiting to happen. If you take an individual from each of them and say, “I want you to represent our institution and go in there and do your thing, and you represent your institution,” they will have the same kind of frictions that were happening back here in the States. So I do not think it was unusual. Plus you get pretty isolated out there. The members of the team have actually remained friends, and I just saw them all in Vancouver. We happened all to be passing through at the same time, and we all stopped, and it was really exciting to see the whole project group back together. So that was the first two years of Projet SIDA.
Then Jonathan, who was clearly a rising star, got recognized by WHO [World Health Organization], and off he went. He was replaced by [Dr.] Robin Ryder. Robin was a different kind of person. He was a CDC person who also had diarrheal epidemiology training, but, again, his role in Projet SIDA was to oversee the epidemiologic aspects. He thought differently from Jonathan. Robin believed in bigger cohorts followed for a longer period of time resulting in a much more important finding, whereas Jonathan, at the time, was interested in who was affected and how quickly were they affected. He did not want to define the natural history. His aim was to say, who was getting it here, and why were they getting it? Whereas Robin said, “I want to know, once you are infected, who do you transmit it to eventually, and how long can you stay alive or how long does it take for you to die from that disease?” So he set up these huge cohorts and followed them. His most famous cohort was the pregnant women who were HIV-infected. He described–I think, probably the best paper was in the New England Journal of Medicine–the perinatal transmission of HIV in Africa, what the percent infection rate was, the clinical outcomes in the infants, and did they take to vaccines or not. There were a lot of spinoffs. So the real natural history of HIV in Africa–not its epidemiology, how it spread, but its natural history–was being dissected by Robin Ryder.
By that time, Skip had been in Zaire three or four years and it was time for him to come back. I put in another person named [Dr. Christopher] Chris Brown. Peter Piot had been publishing some papers from the project on the clinical aspects of Bob Colebunder’s work, and he left and was replaced with a man named [Dr.] Yost Perriens. All these people published their own papers. Perriens got into tuberculosis and HIV, which was very interesting.
Those investigations continued for a couple of years doing fine, with, again, the usual frictions. I would say those frictions between the individuals sometimes were due to personality, but were sometimes driven by institutions. We had our own needs, and sometimes those needs stepped on someone else’s needs and vice versa. Eventually I pick up the phone, call and talk to Peter or talk to Jim, and we would solve it. There was not usually a problem. They called us the “patrones,” French for the overseers, I guess. And we would go there once or twice a year, spend a week or two weeks, do a scientific review and so on. Then things started getting heated up politically in Zaire.
Hannaway: In the late 1980s?
Quinn: Now we are talking about the early 1990s. And the studies were still ongoing. It was getting more expensive because of those huge cohorts that Robin set up. I will never forgive Robin for that. I admired him for his scientific epidemiologic expertise, but, meanwhile, the project was going bankrupt because he had a lot of cohorts going on, and they are expensive. We went from a small project of maybe 25 Africans to having 300 Africans, Zairians, working in it. It was huge. We went from two cars to 12 cars and trucks. This became a big project with I do not know how many freezers, perhaps 25 freezers of specimens.
I should mention that the Armed Forces Institute of Pathology joined us midway through the tenure of Projet SIDA, and they did some pathologic investigations as well.
But then the politics of Zaire became unstable and there was rioting in the streets. We were worried about our people, and actually they were airlifted out and have not returned since.
Hannaway: This was in 1991?
Quinn: 1991. Although some of the Africans that we left stayed with the project and have persisted, Projet SIDA is not producing anywhere near what the original project was when it had all that support. It was publishing 10 papers a year in major journals and really writing the history of AIDS in Africa.
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