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For almost 2 years, it has been a medical horror story that has captivated the nation--even the world. Nearly everyone who reads newspapers figured they knew the perpetrator: Florida dentist David Acer, who had apparently infected Kimberly Bergalis and four other patients with the AIDS virus, and one after another they were coming down with the disease. But, while there has been strong epidemiological evidence supporting that conclusion, proving it--either to the satisfaction of the scientific community or to a jury--has been extraordinarily difficult.
Now, scientists at the Centers for Disease Control (CDC) in Atlanta, where the case has been dissected, say the proof is there. Two papers, one in this issue of Science (p. 1165) and another that appeared last week in the Annals of Internal Medicine (15 May, p. 798) present a full accounting of the evidence that leads to the ineluctable conclusion that Acer infected Bergalis and the other four patients.
CDC researchers conducted a rigorous epidemiological study of the apparent transmission of the virus in Acer's dental practice and they employed the latest techniques of molecular analysis to nail down the proof. Along the way, the evidence was challenged in a law suit and became the focus of a bitter scientific dispute. And even now, some researchers are not entirely convinced that CDC has a watertight case. "We're not trying to say in any way that these guys' answer isn't correct," says physicist-turned-molecular biologist Temple Smith of Boston University, who along with mathematician Michael Waterman of the University of Southern California in Los Angeles has written a Perspective on the CDC paper in this issue of Science (see page 1155). "But probably correct is not the kind of statement that should end up in a courtroom."
Moreover, even as CDC closes the book on one aspect of the Acer case, another remains unresolved: How did Acer infect his patients? That mystery may never be solved. Yet, frightening as that may seem, the Acer case has, ironically, brought some reassurance about the risks of doctor-to-patient transmission of HIV. Since the case first broke, CDC has been conducting a major study of patients known to have been treated by HIV-infected health care workers. The results, published just last week in CDC's Morbidity and...