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Curran: There was a lot of friction between Gallo and Don Francis and many of the people at the CDC, and it involved a lot of issues. We were doing everything we could to discover the virus. And we were interested in retroviruses. At NIAID at the time, although [Dr. Malcolm] Mal Martin was interested in retroviruses, the leaders of NIAID were [Dr. Richard] Dick Krause and Dr. Kenneth] Ken Sell, and they were more interested in other viruses.
Harden: Why were they not interested in retroviruses? Was it because that was the Cancer Institute's investigation?
Curran: That is speculation. I think that NIAID figured that these were not their strengths, except for Mal Martin. We would go to meetings–I remember [Dr.] Albert Sabin chaired a meeting in 1983 on the search for the cause of AIDS, and the CDC and the NCI representatives were the only people who believed AIDS was caused by a retrovirus. NIAID was presenting other ideas as potential causes of AIDS that made much less sense to us than a retrovirus did.
Hannaway: Well, I was just wondering about...
Curran: Oh, the CDC and Gallo. A lot of things happened that were tough. Don Francis came from Phoenix to coordinate our laboratory efforts. We did not have any retrovirus experts in Atlanta. He had done a doctorate with [Dr.] Max Essex at the Harvard School of Public Health on feline leukemia virus and was a strong believer that a retrovirus was causing AIDS. He himself was not strictly a laboratory scientist, but he was trying to pull together laboratory activities. The CDC did not have a lot of horses, and Don was very aggressive, but CDC people had never worked on retroviruses in the laboratory.
Gallo was the dominant American scientist in the field. Then the French discovered the virus. I mean, they published it in 1983 in Science, but the original paper was not convincing to everybody. We now know that it was HIV. Don was working with the French, too, so we had connections at the Pasteur Institute. Don was going over there, and we were getting specimens from them. Meanwhile, Gallo's principal protein chemist was a man named V. S. Kalyanaraman. He was having career-change thoughts, for whatever reason; and Don Francis hired him away from Gallo. Now, Kalyanaraman wanted a change at that time. So somebody would have hired him. But Don did, of course, which did not make Gallo happy, because he needed him. Kalyanaraman came to CDC with a couple of other people whom Don had also hired who were trying to beat Gallo to the punch. Meanwhile, we were getting specimens from France, as did Gallo...
Hannaway: Mal Martin did too.
Curran: Mal Martin did. That is right. We were all getting specimens. We took some of our viral specimens and we injected them into chimpanzees. And we developed protein probes. But we could not get the virus to grow. Gallo's group got the virus to grow, which was a major contribution. Then he accumulated convincing evidence that the virus caused AIDS.
Curran: Then United States politics took over. Now, how much of that is Gallo, how much of that is the NIH, how much of that is HHS [Health and Human Services], to what extent that is American nationalism, is speculative.
Hannaway: Or all of the above.
Curran: I was the one trying to work together with the NIH. I was just being pragmatic. We needed reagents from NCI to do our studies. This was not a personality contest; we had a lot of things we needed to do. We needed to protect the blood supply; we needed to find out if the blood test we were going to be using at the blood banks worked; we needed to do a lot of things. So we needed reagents to do it.
[Dr.] Peter Fischinger and I were always negotiating with each other to get things done, while Don Francis was fighting with Gallo on the phone in the middle of the night. But also, the U.S. government was saying, “Okay, we are going to call this virus HTLV-3.” We could not do that because we had been doing studies with LAV, and we could not refer to the results of those studies as HTLV-3. For example, we inoculated chimps with LAV before Gallo published his series of papers. So until LAV and HTLV-3 were proven to be the same virus, there were difficulties in comparing results. From our work with both Dr. Gallo and the French scientists, we knew that these viruses were the same (not necessarily identical).
Then, there was a scientific meeting in Park City, Utah, that Gallo and [Dr. Jacques] Chermann and many others attended. Dr. Gallo briefly discussed some isolates he had. He called me shortly thereafter and asked for a blinded panel of sera from CDC to do serologic tests. Subsequently, he and I met in a restaurant called La Miche in Bethesda, and went over and broke the code and looked at the results. I was quite convinced that what he had was the cause of AIDS. I told him that his results were nearly identical or superior to those of the French.
Hannaway: But this was before he had published. He told you this in La Miche?
Curran: Well, he showed me the results.
Harden: But you are talking about a meeting before the papers in Science came out in 1984, is that correct?
Curran: Yes. But it did not mean that his virus was exactly identical to that of the French.
Hannaway: He amassed the data that demonstrated what the French had not been able to demonstrate.
Curran: The thing is that they were all publishing in peer-reviewed journals; they can come back and reconstruct the history. I mean, the way it stands now is that the credit is viewed to be somewhat shared.
Hannaway: Yes, as far as the credit goes. I would like to ask if you would talk about the international scene. First of all, there was an investigation in Haiti in which Dr. Richard Krause and Dr. Clifford Lane were involved. This was in the very early period. We were under the impression that someone from the CDC went with them. I wonder if you recall this.
Curran: Some people who went to Haiti ?
Curran: I do
not remember whether they went with Krause and Lane or not. When did Cliff
Lane start work on this problem?
Hannaway: He was Tony Fauci's postdoc, so in 1982, when the first AIDS patient showed up, the first one that they treated, he was the primary care physician for that patient. He and Fauci had worked on the patient to study AIDS pathogenesis.
Curran: So he was with Fauci from the very beginning?
Harden: Yes, from the very beginning. He has a wonderful story about going to Haiti and telling a cab driver that he needed to find some brothels to do a scientific study. And the cab driver said, “Sure, doc.” It was a charming story.
Curran: He is a charming guy.
Hannaway: It was a gay brothel he wanted.
Harden: Yes, he needed a gay brothel, the cab driver thought. And that was mostly because he looked like a choirboy.
Curran: For us, the Haiti story has a lot of different dimensions to it. There were cases of Kaposi's sarcoma diagnosed by a man named [Dr.] Bernard Liautaud, who was a dermatologist from Haiti, and they were diagnosed in the late 1970s and early 1980s. So it was suspicious that something was going on there preceding the discoveries in the United States.
The second thing is that among the gay men that we interviewed and met in the first year, there were about a dozen or so who had been to Haiti. We knew also that there were gay windjammer cruises to Haiti. We knew that there were gay brothels in Haiti. Haiti stuck out for that reason, in part because there was clearly an epidemic of very similar conditions in people from Haiti who lived in Florida. This created a huge political problem among Haitians at a crucial time.
Curran: AIDS was first diagnosed among Haitians migrants by pathologists in Florida in the form of CNS [central nervous system] toxoplasmosis. Two-thirds of the cases of AIDS in Florida in 1982 were among Haitians who were recent Haitian migrants, illegal migrants who came in the boatlift following the Duvalier debacle. As a matter of fact, there were a half a million or more Haitian-Americans who had been migrating into the country legally since the 1960s, at the rate of about 8,000 to 10,000 per year. Most of them lived in the Northeast, the New York and New Jersey area. Almost all the Haitians were in that area. Very few were in Florida, actually. And there were no cases of AIDS in those Haitians who had legally migrated. So, whatever it was, this was something that was a recent problem in Haiti. It was a problem noted only in those who had recently migrated. And it looked very much like AIDS. It was occurring in the sex ratio that one would predict from the sex ratio of the migrants, of about maybe 3/4 men and 1/4 women. So it looked to us like some type of heterosexual transmission issue, although we could not prove that.
First of all, for some, the politically correct view would be to say that this really was not AIDS at all. The Haitian physicians abroad, the Haitian tourist industry, did not want it to be AIDS. This was at a time when Haitian migrants were very unpopular in Florida. Baby Doc [Jean-Claude Duvalier] was a tyrant in Haiti and the political unrest was already damaging a country very dependent on tourism. From that point of view, it was a horrible thing to implicate the Haitian migrants as having AIDS. But the truth was, they had AIDS, we did not know the cause yet, and we had no choice.
Harden: Were you not hearing anything from Africa, if I might ask?
Curran: Not quite yet. That was coming soon, and, of course, it would fit together. This was in 1982. And that was when the cases in hemophiliacs also appeared.
Hannaway: Yes, right.
Curran: So Haitians were reported with AIDS. In our studies of Haitians, we learned they were heterosexual. They had toxoplasmosis, which is a different opportunistic infection, but that was predictable based upon their exposures. They also had Pneumocystis and other things, Kaposi's sarcoma. So it looked very much like we had Haitians with AIDS. Then, the story in Africa came along.
Hannaway: Yes, we would like to know about that.
Curran: One of the men, who was on our staff at the CDC, was a guy named [Dr. Joseph] Joe McCormick, who was a hemorrhagic fever virus expert, and who is now at the Pasteur Institute. He had worked extensively in Africa. As a matter of fact, when he got out of college, he entered the Peace Corps as a high school teacher in Zaire. That experience was in the late 1960s, before he went to medical school. When the Belgians were removed from power in Zaire, there were very few educated Zairians. They brought in many expatriates, including Haitians, to teach in Zaire. When Joe was over there teaching in the Peace Corps, he was teaching with many Haitians, many of whom, like Joe, subsequently returned to their own country.
Now, in Haiti, unlike Africa, unlike Zaire, the cases were present in Port-au-Prince way before they were present in the rural areas, which would go along with the migration back of people from Africa, and be compatible with the hypothesis that the virus moved from Zaire to Haiti. In Zaire, on the other hand, there were cases in the rural areas in the 1960s and 1970s, which would go along with the thesis that urban migration subsequently facilitated the transmission in that country.
Joe, coming back and thinking the way he thinks, believed that the most plausible idea was that this problem comes from Central Africa, is transmitted to Haiti, and then gets transmitted to the North American continent somehow through a combination of factors. Now that kind of speculation back in the 1980s would be enough to get you severely criticized, but it was the most plausible hypothesis. Then Americans transmitted it through sexual contact to injecting drug users.
But the pattern in Haiti looked very much like the pattern in Central Africa. Ultimately, we were able, after the virus was discovered, to call it that way, that this was simply a heterosexual transmission pattern. And it became epidemiologically less relevant. But, initially, the cases in Haitians were a new phenomenon and it was a fairly prominent part of the emerging United States epidemic. But also the uniqueness of the pattern among Haitians resulted in a lot of concern and discrimination in a population that was already discriminated against because they were migrants.
Hannaway: Can you tell us a little more about the cooperative projects between the CDC, the NIH, and the Institute of Tropical Medicine (ITM) of Antwerp in Projet SIDA in Zaire, because I know that [Dr. Thomas] Tom Quinn told us that you and he were both coordinators.
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