Book: The River: A Journey Back to the Source of HIV and AIDS
Authors: Sebastian Lucas
Journal: BMJ (2000)

Edward Hooper


Penguin Press, £25, pp 1070 




ISBN 0 713 99335 0

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Rating: ★★★

Does it really matter how AIDS started? Not long after AIDS was described in the United States, Europe, and Haiti, it became evident that several countries in sub-Saharan Africa had far greater proportions of people already affected. The belief emerged that the human immunodeficiency viruses arose in Africa. Thanks to molecular technology, the HIV-2 virus, mainly limited to west Africa, was found to be identical in genome organisation to a simian virus (SIV) in the local sooty mangabey. Evidence accumulated about the close relation between the now pandemic HIV-1 and chimpanzee SIVs in central Africa.

How did the viruses transmit from monkeys and apes to humans, to cause the most important zoonosis yet known? And when? The earliest identified isolate of HIV-1 comes from an unknown male in Kinshasa, Congo, in 1959. The first identified patient with HIV infection and AIDS was a Scandinavian man in the 1960s, who had visited west-central Africa. Then came sporadic cases among gay men in the United States and among Haitians in the 1970s, leading to the global explosion in the '80s and '90s and the literal decimation of peoples in several tropical countries. Did the transmissions of SIV across species—and there were two or more some time earlier last century—come about through close contact between human hunters and their primate prey (dissecting or eating), or might the pandemic have arisen from a medical accident?

The hypothesis of this book is that the drive to conquer another scourge, polio, is the crux. The preparation of live attenuated oral polio vaccine originally used cultures of monkey kidney cells; there were monkey laboratories in Africa devoted to testing these vaccines and providing kidneys for the vaccine factories; the kidney cells (or associated lymphocytes) could have been infected by SIVs that could adapt to humans and cause disease (which they do not in their natural hosts); then administration of oral polio vaccine infected adults and children with SIV during the mass trials in the late 1950s.

The idea is not new, having been proposed in 1992 (and rubbished or deflected by the scientific community). What Hooper has done is to show a striking geographical and temporal correlation between the earliest known and probable cases of AIDS and the sites of administration of polio vaccine in central Africa. He presses for a major review of the vaccine hypothesis and the testing of any remaining stocks of those vaccines for infection with HIV or SIV.

Whether the proposition is true will become clear as more primate SIVs are genetically sequenced and correlated with HIVs over time and place. My personal feeling is against the hypothesis on the grounds that it is too simple an account of the evolutionary complexities of these lentiviruses, and the fact of more than one introduction of SIV or HIV into humans. However, it is possible in principle, and finding out the truth is important because of the implicit threat to vaccine programmes in the future.

This magnum opus from a non-medical investigative journalist should stand for other reasons. It is the best yet historical description of AIDS. It is a detailed examination of a great episode of medical endeavour (the polio vaccine), and also shows how we can cut corners when it suits and fail to document much methodological information (it is not certain whether cultures of chimpanzee kidney cells were used in the final stages of vaccine production).

Yes, it does matter how AIDS started, and this book is a contribution to the debate.