Robert Rayford

Illness

In early 1968, a 15-year-old black teenager named Robert Rayford admitted himself to City Hospital in St. Louis, Missouri. 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 Rayford declined a rectal examination request from hospital personnel, and was described as uncommunicative and withdrawn. Doctors treating Rayford suspected that he was homosexual or bisexual and had engaged in receptive anal intercourse. 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 at 11:20 pm on May 15, 1969.

Autopsy

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. Kaposi's sarcoma was later determined to be an AIDS-defining illness.

These findings baffled the attending doctors, and a review of the case was published in the medical journal Lymphology in 1973. After the autopsy, blood and tissue samples were kept in cold storage at the University of Arizona and at the laboratory of Dr. Memory Elvin-Lewis, who had assisted in Rayford's autopsy.

Tests

In 1984, HIV was first discovered (originally called HTLV-3), 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. 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. A second test found identical results. A conference abstract published in 1999 (but never apparently published in a peer-reviewed journal) reported the presence in Rayford's samples of HIV genes very similar to the HIV IIIB isolate that was discovered in France in the 1980s, and stating that contamination was unlikely given that DNA testing was done on Rayford's samples without being cultured. Critics argue that these efforts to confirm the presence of HIV using polymerase chain reaction (PCR) in Rayford's case do not appear to have produced conclusive results, and that similarities to the HIV IIIB isolate are perhaps a red flag that the result may have reflected laboratory contamination rather than the identification of HIV in Rayford's tissues. In the absence of evidence of HIV genetic material in Rayford's samples, critics argue the case cannot be considered a confirmed instance of HIV infection.

Impact on AIDS origin research

Rayford had never traveled outside the Midwestern United States and had told doctors he had never received a blood transfusion. Since Rayford's AIDS infection was almost certainly through sexual contact, and since he had never left the country, researchers presume that AIDS may have been present in North America before Rayford began showing symptoms in 1966. 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. 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.