Sailors and star-bursts, and the arrival of HIV

doi:10.1136/bmj.315.7123.1689

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Edward Hooper, writer and medical researchera

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Introduction

Tracking the origins and early history of a newly recognised disease is more than just an academic exercise. To appreciate how a disease began can help medical science to combat it. The classic example is John Snow's investigation of the cholera epidemic in Golden Square, London, in 1854: his removal of the handle of the Broad Street pump contained the outbreak.1 An appreciation of causation may also help to prevent similar events occurring in the future. The recent evidence, for example, about the origins of new variant Creutzfeldt-Jakob disease2 3 will, hopefully, sensitise those research scientists who are transplanting baboon livers in humans to the potentially catastrophic impact of zoonoses—human diseases acquired from animals.4

Three outbreaks of AIDS…

In the case of AIDS, three related but distinct causes have been recognised in the past 16 years—namely the three human immunodeficiency viruses (HIV-2 and HIV-1 groups M and O). It is now widely accepted that HIV-2 is the result of a zoonotic transfer of a simian immunodeficiency virus from the sooty mangabey (a species of African monkey). HIV-1 groups M (for “main”) and O (“outlier”) seem to result from two separate zoonotic transfers of different variants of simian immunodeficiency virus in chimpanzees.

Summary points

Learning about the origins of a disease may help us to control it and also to prevent similar diseases arising in the future

The earliest confirmed case of AIDS in the world was in a young Norwegian sailor who was infected with HIV-1 group O—probably in Cameroon in 1961-2

The earliest evidence of HIV-1 group M is from 1959 and of HIV-2 from 1965. It seems, therefore, that all three HIVs may have emerged around the same time

Phylogenetic evidence shows that HIV-1 groups M and O show a “star-burst” phylogeny, with different subtypes suddenly emerging around 1959

Opinion is …