|Born||February 3, 1953|
St. Louis, Missouri, United States
|Died||May 15, 1969 (aged 16)|
St. Louis, Missouri, United States
|Known for||Alleged first known AIDS death in the United States|
Robert Rayford (February 3, 1953 – May 15 or 16, 1969), sometimes identified as Robert R. due to his age, was a teenager from Missouri who has been suggested to represent the earliest case of HIV/AIDS in North America based on evidence published in 1988 in which the authors claimed indicated he was "infected with a virus closely related or identical to human immunodeficiency virus type 1." Rayford died of pneumonia, but his other symptoms baffled the doctors who treated him. A study published in 1988 found the presence of antibodies against HIV. Results of testing for HIV genetic material have been reported; however, the data have never been published in a peer-reviewed medical or scientific journal.
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 Rayford declined a rectal examination request from hospital personnel, and was described as uncommunicative and withdrawn.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 the victim of child molestation and was the recipient of 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.
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, but almost unheard of among black teenagers. 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.
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. 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 study presented as a conference abstract in 1999 (but never published in a peer-reviewed journal) reported the presence in Rayford's samples of HIV genes that were very similar to the HIV IIIB isolate that was discovered in France in the 1980s, but claimed that contamination was unlikely given that DNA testing was done on Rayford's samples without being cultured. Critics[who?] 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. Given what is known about the rapidity of HIV evolution over time, both within individuals and populations, an HIV isolate from an individual in the US in 1968 would not be expected to be "closely related" to an HIV isolate from an individual in France in the early 1980s. In the absence of evidence of HIV genetic material in Rayford's samples, critics[who?] argue the case cannot be considered a confirmed instance of HIV infection.
The last known tissue samples of Rayford were accidentally destroyed in a New Orleans lab during Hurricane Katrina in 2005, preventing further testing. It is not clear why independent expert analysis of tissue samples to confirm or rule out the presence of HIV genetic material was not sought prior to 2005.
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. 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. 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. 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.
- Arvid Noe, the earliest known European AIDS case
- Index case
- History of HIV/AIDS
- Timeline of early AIDS cases
- Timeline of HIV/AIDS
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