Robert Rayford

Robert Rayford (c. 1953 – May 15^[1] or May 16,^[2] 1969), sometimes identified as Robert R. due to his age, was an American teenager from Missouri who had the earliest confirmed case of HIV/AIDS in North America. His death baffled doctors, who could not account for Rayford's symptoms. Not until 1987 was the cause of his death identified.

Illness

In early 1968 Rayford admitted himself to Barnes-Jewish Hospital (then called Barnes 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'd had these symptoms since at least late 1966. Tests discovered a severe chlamydia infection. Robert declined a rectal examination request from hospital personnel.^[2] Doctors treating Rayford suspected that he was homosexual and had engaged in passive anal intercourse.

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 at 11:20pm on May 15, 1969.

Autopsy

An autopsy, led by Dr. William Drake, Rayford 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.^[3] 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 eventually published in the medical journal Lymphology in 1973.^[4] 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.

Later investigations

Tests

In 1984, when HIV was first discovered (originally misidentified as HTLV-3), and was spreading rapidly in the homosexual male communities of New York City and Los Angeles, Dr. Marlys Witte, one of the doctors who, like Elvin-Lewis, had cared for Robert before death and also assisted in the autopsy, thawed and tested preserved tissue samples from Robert's autopsy, which tested negative.^[2] 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 Robert's blood. A second test found identical results.

Impact on AIDS origin research

Robert had never traveled outside the Midwestern United States, and had told doctors that he never received a blood transfusion. Since Rayford's AIDS infection was almost certainly through sexual contact and he had never left the country, researchers presume that AIDS may have been present in North America before Robert began showing symptoms in 1966.^[1] Moreover, Rayford also 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.^[5]

Doctors who subsequently investigated the case in the early 1980s speculated that Rayford may have been a male prostitute.^[2] This assumption was made when the medical community thought that the progression from initial infection to the diagnosis of AIDS took only two-and-a-half years.

See also

• Arvid Noe, the earliest known European AIDS case.
• Index case
• Origin of AIDS
• Timeline of early AIDS cases

References