Forty years ago this week researchers in Paris published the world’s first description of the virus that causes Aids. RFI looks back at a scientific milestone that paved the way for testing – and ultimately controlling – HIV.
In December 1982, 29 patients in France had been found with signs of the new disease that newspapers were calling “gay syndrome”.
First noticed in gay men in the United States a year and a half earlier, the disease had recently been given an official name: acquired immunodeficiency syndrome, or Aids.
But it was more commonly known as a mysterious form of cancer that seemed mainly to affect the “four Hs”: homosexuals, heroin users, haemophiliacs and Haitians.
The first three of these hinted that whatever provoked the symptoms – unusual forms of pneumonia, lesions and infections typically observed in people whose immune systems had been wiped out – could be transmitted through sexual contact and/or blood.
But the cause of Aids, and thus how to prevent or treat it, remained unknown.
Aids reaches France
While French newspapers were still referring to an American epidemic far across the Atlantic, a young doctor had begun noticing the tell-tale signs among his patients in Paris.
Willy Rozenbaum, an infectious disease specialist at the Claude-Bernard Hospital, read an account of the new illness in a US public health bulletin in June 1981.
“By chance, the same afternoon … I had a patient who came with his boyfriend and who had symptoms that were very close to what was described in the paper,” Rozenbaum recalls.
“It was the beginning of everything.”
He began asking around his colleagues and quickly identified several other possible cases in the Paris region alone.
By March 1982, Rozenbaum had gathered a working group of specialists from different domains who were all interested in studying the new disease – but they remained outliers.
“We were very few,” Rozenbaum told RFI.
“Prejudice was the first reaction of most people including physicians,” he says, recalling going back to the hospital at 2am to perform biopsies on patients because no one else was willing.
“I had to change hospitals several times because my colleagues didn’t want to see gay men or IV [intravenous] drug users coming to the hospital too much.”
Hunt for a virus
Early theories about what was decimating patients’ immune systems led to several dead ends.
Was it related to sexually transmitted viruses we already knew about, such as the human papillomavirus or herpes? Or could it all be the result of a toxic batch of poppers?
By mid-1982, researchers in the US had a more promising hypothesis: the origin of Aids might be a type of virus that had recently been shown to cause certain leukaemias.
Known as retroviruses, such viruses copy their genetic blueprint into the DNA of infected cells using a particular enzyme called reverse transcriptase.
The American researchers had not yet tracked down a retrovirus in the Aids patients they were studying.
But Rozenbaum and his colleagues had the idea to study people with the very earliest signs of the disease – such as a swollen lymph node, which seemed to be one of the first indicators.
They would need help from specialised virologists, so they approached the Pasteur Institute in Paris, renowned the world over for its pioneering work on infectious diseases such as tuberculosis and diphtheria.
A team led by virologist Luc Montagnier agreed to study a lymph node sample from one of Rozenbaum’s patients in the institute’s laboratory.
“There was some concern,” admits Professor Maxime Schwartz, who was a researcher at the institute at the time and would go on to become its director general.
“We saw that a virus that seemed to cause a serious illness had arrived at the Pasteur Institute, and we still didn’t really know how it was transmitted,” Schwartz told RFI.
“It’s in the tradition of the institute that when there’s an epidemic, our staff go out into the field and try to find the virus and so on … So we’re used to going out and trying to isolate microbes.
"But it was the first time that we saw the microbe arrive directly at the Pasteur Institute, and people were quite worried to see this dangerous virus entering the laboratory.”
The sample arrived at the lab in early January 1983, and from there things moved quickly.
By 27 January a virologist named Françoise Barré-Sinoussi had detected strong signs of reverse transcriptase activity.
And by 4 February, the microscopist Charles Daguet was shouting down the corridor to his colleagues: “I’ve got it, I’ve got it!”
He took the world’s first microscope images of the new retrovirus that afternoon.
A world first
Those photographs and the other findings were announced to the world in the journal Science on 20 May, 1983.
At the time the Pasteur team were calling the virus “lymphadenopathy associated virus” (LAV), in other words a virus that seemed to cause the lymph nodes to swell.
They remained cautious about saying it caused Aids, though they strongly suspected that was the case.
“You know, a discovery is not just one shot. It’s a chain of knowledge,” points out Rozenbaum.
“To affirm that the origin of Aids was really due to this virus, we needed additional studies … So a lot of work had to be done not only before the discovery of the virus but also after.”
So the work continued: studies to establish that sick people carried the virus and healthy people didn’t, as well as the first attempts to develop a test – which began at the Pasteur Institute within months of the discovery.
As early as August 1983, the institute was working on a test to identify not the virus itself but whether someone had antibodies to it, evidence that they had been infected.
“Basically, we take the virus and add the serum of the person we want to test, and if there are antibodies, they’ll stick to the virus. Then we can detect these antibodies,” explains Schwartz, who has co-written a book about the history of the discovery.
It was the first time doctors would have a way to detect who was infected, and it was only possible because of the isolation of the virus.
As Schwartz says: “You have to have the virus in order to develop the antibody test.”
The ‘HIV war’
Almost exactly a year later an announcement came from the US: “The probable cause of AIDS has been found.”
So said then US secretary of health Margaret Heckler in a press conference in April 1984 that credited American researcher Robert Gallo with the discovery.
A pioneer in the field of retroviruses, Gallo and his team had been the first to float the idea that Aids was linked to this type of virus.
But they had concluded the disease was caused by a relative of the same retrovirus they had identified in humans a few years earlier, which caused a type of leukaemia.
The announcement triggered what has since been dubbed the “HIV war”: a bitter dispute over whether the credit for finding the virus behind Aids should go to France or the US.
It wasn’t just a question of glory. Whoever claimed the patent on the first test for the virus, which the discovery had made possible, stood to earn huge royalties.
The Pasteur Institute pursued the case in the courts, and eventually obtained DNA proof that the virus identified in Paris and in Washington was one and the same.
In 1986 the virus – until then known as LAV in France and HTLV-III in the US – was given the name we still use today: human immunodeficiency virus, HIV.
The following year, after high-level mediation by the presidents of the two countries, the French and American teams agreed to call themselves “co-discoverers” and split the royalties.
From science to healthcare
That’s how they’re still credited in scientific papers today. But in 2008, medicine’s highest honour went to the French team alone.
That year’s Nobel prize for medicine was awarded to Montagnier and Barré-Sinoussi for their work to isolate the virus.
As they themselves emphasised, the discovery wasn’t made by just two people. Other researchers played a role – but so too did people who had Aids or were at risk of it, as Rozenbaum points out.
His working group included representatives of the communities concerned – intravenous drug users, gay men and others.
“They contributed to the discovery of the disease because when we had to carry out studies in the population, they helped us to recruit patients who were affected and people who were not,” Rozenbaum says.
“The work with the community was very important.” They were the ones, after all, who had the most to gain from the research – or to lose.
More than 40 million people would died from HIV and Aids over the next four decades, including most of Rozenbaum's first patients.
But the breakthrough led directly to diagnostic tests, which not only made it possible to identify people exposed to the virus sooner but also allowed doctors to screen donated blood, ending infections via transfusion.
It was also the first step towards developing the antiretroviral drugs that today allow millions of people to live with HIV.
“Now, as I’m probably retiring in some months, I’m telling my patients – some I’ve been treating for 40 years – that they don’t need me anymore,” says Rozenbaum.
“Because the treatment is very easy. They may have a life expectancy the same as everybody else. They may have sex like everybody else, because the treatment avoids the transmission of the virus.
“Discrimination against patients is still here, but physically the life of patients today – those who benefit from treatment – is normal.”
Like many of those who studied Aids in the early years of the epidemic, Rozenbaum has continued to fight the disease ever since.
But looking back, he doesn’t see his contribution as heroic. “It was not like a mission, it was just looking to understand,” he told RFI.
“I just wanted to understand more, not only for speculation but also because I thought it could be beneficial for the patients at the end.
“And it was. Finally. It takes time, but it was.”
