Wednesday, 18 September 2013

Cataloguing the paper of Dr Peter Piot: the archives of Projet SIDA (1983-1992)

Having finished repackaging the archives of Peter Piot for the past couple of weeks I have been cataloguing this collection. Cataloguing often requires a degree of familiarity with the contents in order to make accurate and informed descriptions and therefore it necessitates background reading of the subject or individual. Fortunately, for this collection I have the interesting and compelling account by the man himself in the form of his memoir, No Time to Lose (2012). The chapters that really stick out are his fieldwork in Africa on both the Ebola Virus and HIV/AIDS as they resonate the thrill and the horror of studying a new infectious disease in the middle of an epidemic. The archives mirrors the book with significant holdings on both diseases. In this post, I would like to concentrate on Projet SIDA, the Zairean-American-Belgium AIDS research project that ran from 1984 to 1992. 

Clinical definition of AIDS (c.1983)
In No Time To Lose, Peter Piot recalled how a number of the patients he attended at the Institute of Tropical Medicine, Antwerp exhibited AIDS-like symptom. The significance at the time was these patients were not the previously identified risk groups (the virus had only recently been named as acquired immunodeficiency syndrome was coined, the virus was previously known as the '4 H' virus after the confirmed communities affected: homosexuals, heroin users, hemophiliacs and Haitans) but all had ties or had spent time in Zaire. He knew he needed to go to the country to find out what was going on and was fortunate to encounter two US epidemiologists with the same assessment. Dr Tom Quinn and Dr Richard Krause, of the U.S National Institute of Health (NIH), they had both noticed the link with Zaire when investigating the AIDS outbreak in Haiti and in a cafe in Geneva, the three agreed to launch an investigation in the country. They were joined by Joseph McCormick, of the U.S. Centre for Disease Control (CDC) and arrived in Kinshasa, then Zaire in October 1983. 

When they arrived in Memo Yamba Hospital the epidemic was worse than they could imagine. Piot noted that the team saw fifty people alone on the first morning with AIDS symptoms which was a huge number for 1983 with only 2000 reported cases, many of them retrospectively. The team began to collect and examine blood samples from the patients and sent the samples to the team headed by Professor Luc Montagnier of the Pasteur Institute in Paris.The results of the tests confirmed the presence of AIDS with 97% positive results from the original sample. With this information the team and the other epidemiological and clinical information gathered the team produced an article that was published in the Lancet in 14th July 1984 confirming the first heterosexual HIV/AIDS cases in Africa. 

Manuscript note by Dr Piot relating to the LAV test results of Dr Montagnier for patients from the Memo Yamba Hospital

On the back of this preliminary investigation, it was decided that a major international project should be launched that would be known as Projet SIDA. The US health agencies, CDC and NIH provided the bulk of the funding with the third partner being the ITM, led by Piot. The project began in 1984 with it's first director being Dr Jonathan Mann, who would later become the Director of the World Health Organisation's Global Programme on AIDS, the precursor to UNAIDS. In it's time Projet SIDA employed over three hundred people, a number of them being Zairean doctors and hospital staff who former director, Dr Robin Ryder, described as the 'backbone' of the project. The project produced over 120 publications over the course of it's duration and was cited in thousand abstracts. It ended in 1992 as both the Belgium and US governments withdrew it's nationals in the face of the escalating nature of the Ugandan civil war. 

The archive of Projet SIDA provides a glimpse of the clinical work of the ITM during the breadth of the project. This includes material collected from the preliminary study in 1983 and later reports, blank medical questionnaires and project documentation along with numerous correspondence between Piot and project staff members and project partners, notably the former directors such as Jonathan Mann, Dr Robin Ryder and Dr William Heyward. 

To read more about the project there is an excellent article, by Joe Cohen, entitled, 'The Rise and Fall of Projet SIDA', published in Science is available online (and where a number of my references are from) at the following:

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