Robert Rayford

In early 1968, a 15 year-old teenager named Robert Rayford admitted himself to City Hospital in St. Louis, Missouri.^[5] His legs and genitals were covered in warts and sores. He also had severe swelling of the testicles and pelvic region, which later spread to his legs, causing a misdiagnosis of lymphedema. He had grown thin and pale and suffered from shortness of breath. Rayford told the doctors that he had experienced these symptoms since at least late 1966. Tests discovered a severe chlamydia infection which had, unusually, spread throughout his body. Rayford declined a rectal examination request from hospital personnel,^[3] and was described as uncommunicative and withdrawn.^[5] Doctors treating Rayford suspected that he was the victim of child molestation and was the recipient of receptive anal intercourse.^[3][7] Eventually, he was moved to Barnes-Jewish Hospital (then called Barnes Hospital).

In late 1968 Rayford's condition seemed to have stabilized, but by March 1969 his symptoms reappeared and had worsened. He had increased difficulty breathing, and his white blood cell count had plummeted. The doctors found that his immune system was dysfunctional. He developed a fever and died of pneumonia^[5] at 11:20 pm on May 15, 1969.

An autopsy of Rayford, led by Dr. William Drake, uncovered several abnormalities. Small purplish lesions were discovered on Rayford's left thigh and his soft tissue. Drake concluded that the lesions were Kaposi's sarcoma, a rare type of cancer that then mostly affected elderly men of Mediterranean or Ashkenazi Jewish ancestry,^[8] but almost unheard of among black teenagers.^[9] Kaposi's sarcoma was later designated an AIDS-defining illness.^[10]

These findings baffled the attending doctors, and a review of the case was published in the medical journal Lymphology in 1973.^[11]

TestsEdit

In 1984, HIV was first discovered (originally called "lymphadenopathy-associated virus", or LAV), and was spreading rapidly in the gay male communities of New York City and Los Angeles. Dr. Marlys Witte, one of the doctors who, like Elvin-Lewis, had cared for Rayford before death and also assisted in the autopsy, thawed and tested preserved tissue samples from Rayford's autopsy, which tested negative.^[3] Three years later, in June 1987, Witte decided to test the tissue samples again using Western blot, the most sensitive test then available. The Western blot test found that antibodies against all nine detectable HIV proteins were present in Rayford's blood. An antigen capture assay was also reported to have identified HIV antigens in tissue samples, but not serum.^[4] In a letter to the scientific journal Nature in 1990, Garry stated that efforts to directly detect HIV DNA were underway:^[12]

"Proviral DNA has recently been detected in his tissues by PCR in collaboration with J. Sninsky and S. Kwok (Cetus Corporation, Emeryville, California) but nucleotide sequence analysis is not yet complete."

A study reporting results of testing for HIV DNA was eventually presented nearly a decade later, as a conference abstract in 1999.^[13] The abstract reports the detection of HIV genes in Rayford's samples that were very similar to the HIV IIIB isolate that was discovered in France in the 1980s, and became widely used as a laboratory reference isolate (this study has never been published in a peer-reviewed scientific journal). Neither John Sninsky or Shirley Kwok were listed as authors on the abstract. The abstract argues that laboratory contamination by the HIV IIIB isolate was unlikely because the DNA testing was done on Rayford's samples without being cultured.^[13]

The last known tissue samples of Rayford were accidentally destroyed in a New Orleans lab during Hurricane Katrina in 2005, preventing further testing.^[9]

Impact on AIDS origin researchEdit

Rayford had never traveled outside the Midwestern United States and had told doctors he had never received a blood transfusion. If Rayford did have HIV infection, as one group of researchers claims, the mode of acquisition is assumed to have been through sexual contact. Since he had never left the country, the researchers claiming Rayford represented a case of HIV infection presume that AIDS may have been present in North America before Rayford began showing symptoms in 1966.^[2] Rayford never ventured into cosmopolitan cities such as New York, Los Angeles, or San Francisco, where the HIV-AIDS epidemic was first observed in the United States.^[14] The only notable international connection to St. Louis is that it was TWA's main airline hub. Doctors and others who subsequently investigated the case in the early 1980s speculated that Rayford may have been sexually abused and may have been a child-prostitute.^[3][7]

• Arvid Noe, the earliest known European AIDS case
• Index case
• History of HIV/AIDS
• Timeline of early AIDS cases
• Timeline of HIV/AIDS