AIDSTruth.org

How to spot an AIDS denialist

Eduard Grebe — Fri, 13 Nov 2009 13:00:00 +0000

by Seth Kalichman (Originally published in the New Humanist)

Imagine that you or someone you love just received an HIV positive test result. The news is devastating. After a short time you begin to face the diagnosis. You turn to the Internet for answers. Searching the words “AIDS diagnosis” brings up thousands of websites. A whirlwind of information spins your mind. One credible-looking website, Aids.org, reads: “There is no cure for AIDS. There are drugs that can slow down the HIV virus and slow down the damage to your immune system. There is no way to ‘clear’ HIV from the body. Other drugs can prevent or treat opportunistic infections (OIs). In most cases, these drugs work very well. The newer, stronger ARVs have also helped reduce the rates of most OIs. A few OIs, however, are still very difficult to treat.”

With a click of the mouse, an equally credible-looking site, Aliveandwell.org, asks: “Did you know … Many experts contend that AIDS is not a fatal, incurable condition caused by HIV? That most of the AIDS information we receive is based on unsubstantiated assumptions, unfounded estimates and improbable predictions? That the symptoms associated with AIDS are treatable using non-toxic, immune-enhancing therapies that have restored the health of people diagnosed with AIDS and that have enabled those truly at risk to remain well?”

Which do you trust? Which do you believe? Which would you want to believe? Would you choose to believe there may be hope offered by medical treatments or would you prefer to believe that HIV is harmless? This simple example illustrates the lure of AIDS denialism.

AIDS denialism tells us what anyone would want to hear – that HIV does not cause AIDS and that if you live a “healthy lifestyle” (whatever that is) you won’t get AIDS. None of which is true. In fact, there are an estimated 33 million people in the world living with HIV infection. In 2007 there were nearly three million new HIV infections and two million people died of AIDS. People are living longer and healthier lives with HIV infection as a result of earlier detection through HIV antibody testing and the remarkable success of HIV treatments. Indeed, countries that launched aggressive testing and treatment programs, such as Brazil and Botswana, have reduced suffering and prolonged life. In contrast, South Africa delayed testing and treatment programs as a result of former President Thabo Mbeki’s AIDS denialism, policies that resulted in over 300,000 unnecessary deaths and over 35,000 infants senselessly infected with HIV. There is no rational basis for disputing these established facts, and yet rejecting the reality of AIDS is the mission of AIDS denialists.

AIDS denialism is one of several incarnations of denialism. All denialism is defined by rhetorical tactics designed to give the impression of a legitimate debate among experts when in fact there is none. Holocaust deniers claim that historians disagree about the evidence for Nazi mass gassings and systematic murder of Jews. Global warming denialists say that climatologists are torn by the evidence about climate change. 9/11 “Truth Seekers”, as clever a piece of branding as “pro-life”, say the collapse of the Twin Towers resulted from controlled demolition. Vaccine hysterics tell us that the science is split on whether vaccinations cause autism. And AIDS denialists say that scientists are in disagreement about whether HIV causes AIDS.

It is easy to be fooled by AIDS denialists. Not only do they tell us what we want to hear, they use methods of persuasion to create the illusion of debate. Just as HIV attacks our immune defences that would otherwise destroy it, AIDS denialists appeal to our sense of scepticism. Indeed, AIDS denialists refer to themselves as dissident scientists and sceptics. Denialists misuse science and rely on pseudoscience to call established fact into question. Denialists also exploit what is not known about how HIV causes AIDS to suggest that HIV may not cause AIDS at all. The more sophisticated efforts of AIDS denialism, like the “documentary” House of Numbers, are most disturbing because they use every trick in the denialist playbook to juxtapose pseudoscience with established science. The best way to recognise AIDS denialism is to know their common tricks of persuasion.

There are two sides to every debate. But just asserting there is a debate does not mean there is one. AIDS denialists rely on a small band of fake experts, mostly retired academics who proclaim that HIV does not cause AIDS. There is not a single instance of an “expert” offered by AIDS denialism that has ever actually done research on AIDS. In rare examples, denialist experts have a history of credible science only to have later gone off the deep end. The most credentialled AIDS denialists are Nobel Laureate Kari Mullis, who developed the PCR technology for sequencing the genetic code, and Peter Duesberg, Professor of Biochemistry and Molecular Biology at the University of California-Berkeley and member of the National Academy of Science. Although credentialled, neither is credible. Aside from saying HIV cannot cause AIDS, though he has done no research on AIDS, Mullis has shared his experiences on LSD and encounters with an alien fluorescent raccoon, and Duesberg, who did important work on cancer in his early career, now claims that there is no genetic basis for any cancer. Both have demonstrated an outright disregard for scientific evidence.

But beyond these two high-profile mavericks most of the “experts” in AIDS denialism are out-and-out pseudoscientists. My favourite is Henry Bauer, Emeritus Professor of Chemistry and Science Studies at Virginia Tech University, who claims to have proven that HIV cannot cause AIDS. Professor Bauer is also a self-proclaimed international expert on the existence of the Loch Ness Monster. Detecting fake experts requires looking beyond college degrees and achievements from decades gone by. Do not confuse credentials with credibility. Saying that there is no genetic basis for any cancer, describing extraterrestrial experiences, and searching for big green monsters in Scottish waters should matter when examining the credibility of someone making important claims about the causes of a devastating disease.

In the 1980s legitimate scientists disagreed about AIDS. For AIDS deniers, everything old is new again. AIDS denialists rely on selected research findings from the days when not much was known about AIDS. The first tests for HIV antibodies were less reliable than current testing technologies. There were early debates about what caused AIDS and good ideas that turned out to be dead ends. The drug AZT was prescribed in massive and often toxic doses. But none of this is true any more. Though there remain many debates in medical science about how HIV causes AIDS, there is no longer a debate about whether HIV causes AIDS. Unfortunately, outdated scientific literature is not purged when new knowledge emerges. AIDS deniers use this information to create the illusion of a live debate. Denialists select old findings that support their flawed logic because they have no evidence of their own. Cherrypicking is another favourite rhetorical technique of denialists. This involves selecting a lone scientific finding, presenting the results out of context, and deploying it as evidence for their own conclusions.

Another popular denialist manoeuvre is to call for a definitive single study, analogous to the creationist demand for a definitive transitional fossil to prove evolution. Peter Duesberg for example, asserts that “There is not a single controlled epidemiological study to confirm the postulated viral etiology of AIDS.” He is right about this. No one scientific study ever “proves” anything. Scientists are cautious to draw conclusions from even a series of experiments. To establish that HIV causes AIDS required countless laboratory, clinical, and epidemiological studies, all converging to a definitive conclusion. There is no single scientific paper proving that HIV causes AIDS, just as there is also no single physics experiment proving that a man could land on the moon, no single study that proves excessive exposure to the sun causes skin cancer or one study that proves smoking causes lung cancer. Rather there are tens of thousands of studies containing a wide range of evidence that, taken together, make an overwhelming case.

AIDS denialists will also demand even more specific evidence, only to change the demand once the evidence is produced. One example of this “pushing back the goalpost” technique was the former Sunday Times journalist and prominent AIDS denier Neville Hodgkinson’s claim that HIV tests are invalid because HIV has never been isolated. When scientists provided evidence that HIV has been isolated, the demand changed; Hodgkinson argued that the isolated virus was “impure”. Denialists now demand that the virus be isolated in “pure form”, that is uncontaminated by proteins. The demand for a pure virus devoid of cellular proteins is impossible to meet as it defies the biological nature of viruses. Such shifting of the grounds of debate allows denialists to claim that they are the ones following the evidence, and it is the AIDS establishment – an alliance of careerist researchers and greedy drugs companies – who are propagating pseudoscience.

All denialism is entrenched in conspiracy thinking. A spectrum of such thinking motivates AIDS denialism, covering everything from a government conspiracy to invent HIV for genocide against Africans and gays to a pharmaceutical industry conspiracy to sell toxic drugs. One of my favourites is the flamboyant conspiracy thinking of vitamin entrepreneur Matthias Rath, who said “The people and the governments of the world have to decide whether they are ready to stop being manipulated by the pharmaceutical industry and embrace instead the scientific knowledge that is now available to fight the global HIV/AIDS epidemic with effective, safe and affordable natural means.” The “natural means” Rath is referring to, of course, are the useless vitamins that he peddles to the poor. Though Rath has now been prevented from marketing his phony cure in Africa, and famously lost his libel suit against Ben Goldacre when he exposed his fraudulent practices, great damage was done and he continues to agitate for AIDS denialism through his spurious Health Foundation.

But while some denialists are clearly charlatans out to make a quick buck out of other people’s misery, many are perfectly genuine, which is what makes them especially dangerous. They can be persuasive because they actually believe what they say. Evidence means nothing to them. Their thought process resembles what psychiatrists call an “encapsulated delusion”, where despite what appears to be otherwise rational thinking there is an intractable maladaptive belief system that is impermeable to contrary evidence. Many of these people have themselves been diagnosed with HIV, and cling to the hope that this is not a death sentence. This adds a particular poignancy to their claims. A potent irony also hangs over denialism; year on year AIDS deniers who have tested positive for HIV succumb to AIDS-related illnesses. The most visible of such cases was Christine Maggiore, the founder of the Alive and Well movement that claims there is no causal link between HIV and AIDS. Maggiore believed that HIV does not cause AIDS even after the AIDS-related death of her three-year-old daughter and right up until her own death of AIDS in 2008. AIDS denialists are therefore a mixed bag of rogue scientists, pseudoscientists, conspiracy theorists, and snake-oil salesmen. There are also vocal AIDS denialist activists, primarily HIV positive people who are in deep denial of their diagnosis and seek the insulating bubble offered by AIDS denialism.

So, what can we do about AIDS denialism? There will always be crazy people who say crazy things. AIDS denialists only do harm when people listen to them. The best defence against AIDS denialism is improved public understanding of science and medicine. We all need to know how to recognise cranks and crackpots and their sinister rhetorical devices. When searching for reliable information make sure it does not rely on old, most likely outdated, sources. Find credible sources of current information and trust them, but keep pressing them with questions. Familiarise yourself with the basic facts of HIV and AIDS and be sceptical of far-fetched conspiracies. Be informed and think critically, but don’t fall for global conspiracy hysteria or accept pseudoscience because that is what you want to hear. We know that drugs companies make huge profits, and that scientists rely on research grants and can be fallible. This does not mean there is a global conspiracy to misrepresent the science. AIDS researchers and the pharmaceutical industry, believe it or not, are in it to save lives.

And finally, hard as it might be for believers in free speech and open debate, if you encounter AIDS denialism, do not enter into a debate. AIDS denialists want to create the impression that there is a debate regarding HIV causing AIDS and debating feeds the illusion. This debate was exhausted years ago. Now it merely serves as a distraction from the ongoing struggle to explain how and why HIV causes AIDS and trying to prevent it. In the words of The Who, and the title of Richard Wilson’s excellent book on scepticism, “Don’t Get Fooled Again”.

To see the AIDS Denialist Hall of Fame, visit the article at New Humanist.

Seth Kalichman's book Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy is published by Springer/Copernicus - all royalties from the book are donated to buy HIV treatments in Africa.

Warning about pseudo-scientific review of alternative AIDS medicines

Eduard Grebe — Thu, 12 Nov 2009 17:10:44 +0000

A website that is advertised via Google ads, is promoting alternative, unproven and untested medicines for the treatment of HIV. The website is http://www.hivsecrets.com. Upon registering with it, a report titled HIV Alternative Therapies Report is made freely available for download. This report is written by a Ms Shirley Wyand. Ms Wyand has no known expertise in the science of HIV/AIDS.

The report is replete with misconceptions. For example, it states, "Since Western medical science offers no cure and few treatments for AIDS, people living with HIV are open to other options, and a tradition of gathering and sharing treatment information already exists." On the contrary, antiretroviral treatment is a very effective chronic treatment for HIV. There are also many effective medicines that treat AIDS-related opportunistic infections. There are no alternative treatments for HIV that have been shown to be effective. Indeed, once a medicine is shown to be effective it is no longer an alternative one.

Another example of the report's misconceptions is that it promotes an untested product called Revivo tea. This products advertisements touting its efficacy for the treatment of HIV have recently been banned in South Africa by that country's Advertising Standards Authority.

We urge people with HIV to be extremely cautious about following any of Ms Wyand's advice.

HIV/AIDS is leading cause of death of women of reproductive age: UN report

Eduard Grebe — Thu, 12 Nov 2009 16:48:14 +0000

The World Health Organization's report Women and health: today's evidence, tomorrow's agenda identifies HIV/AIDS as the leading cause of death among women of reproductive age: "Globally, the leading cause of death among women of reproductive age is HIV/ AIDS. Girls and women are particularly vulnerable to HIV infection due to a combination of biological factors and gender-based inequalities, particularly in cultures that limit women’s knowledge about HIV and their ability to protect themselves and negotiate safer sex."

Here is an extract from the report:

This section is copied without footnotes or graphs. To download the full report, see below.

Women and HIV/AIDS

Globally, HIV is the leading cause of death and disease in women of reproductive age. Of the 30.8 million adults living with HIV in 2007,a 15.5 million were women. The prevalence of HIV infection in women has increased since the early 1990s and is most marked in sub-Saharan Africa.

Total number of people living with HIV/AIDS in 2007 was 33 million, including two million children younger than 15 years.

Southern Africa is most affected; in 2005–2006, median HIV prevalence among pregnant women attending antenatal care was above 15% in eight Southern African countries. Infection was acquired primarily through heterosexual transmission.

In all regions, HIV disproportionately affects female sex workers and injecting drug users, as well as the female partners of infected males.

Women’s particular vulnerability to HIV infection stems from a combination of biological factors and gender inequality. Some studies show that women are more likely than men to acquire HIV from an infected partner during unprotected heterosexual intercourse. The risk posed by this biological difference is compounded in cultures that limit women’s knowledge about HIV and their ability to negotiate safer sex. Stigma, violence by intimate partners, and sexual violence further increase women’s vulnerability. Fewer young women than young men know that condoms can protect against HIV. Furthermore, while women generally report increased condom use during high-risk sex, they are generally less likely to protect themselves than men are.

The youngest women are the most vulnerable. They not only face barriers to information about HIV – and in particular how they can protect themselves from infection – but in many settings they often engage in sexual activity with older men who are more sexually experienced and more likely to be infected.

Female drug users and sex workers are particularly vulnerable; stigma, discrimination and punitive policies only increase their vulnerability. The rate of HIV infection among female sex workers is high in many parts of the world, and a large proportion of women who use drugs also engage in sex work. In prisons, the proportion of drug users among females is higher than among males. The use of contaminated injection equipment is particularly prevalent among women, resulting in higher rates of HIV infection.

Economic vulnerability is another key factor driving HIV infection among women. Economic vulnerability is sometimes associated with migration, which increases high-risk behaviours among women who may be driven into sex work by economic necessity. On a more positive note, in recent years women have benefited from increased access to HIV prevention, treatment and care. Data from 90 low- and middle-income countries suggest that, overall, women are slightly advantaged in terms of access to antiretroviral therapy: at the end of 2008, 45% of women in need and only 37% of men in need received antiretroviral therapy. In 2008, 45% of pregnant women living with HIV received antiretrovirals to prevent mother-to-child transmission of HIV, up from 10% in 2004. Nonetheless, challenges remain: only 21% of pregnant women received HIV testing and counselling, and only one third of those identified as HIV-positive during antenatal care were subsequently assessed for their eligibility to receive antiretroviral therapy for their own health.

To download the full report or executive summary, visit this page: http://www.who.int/gender/documents/9789241563857/en/index.html

South African health minister reveals "shocking" AIDS figures; blames Mbeki denialism for worsening the crisis

Eduard Grebe — Wed, 11 Nov 2009 12:58:05 +0000

South Africa's Mail & Guardian newspaper reports:

"In 11 years -- from 1997 to 2008 -- the rate of death has doubled in South Africa. That is obviously something that cannot but worry a person," Health Minister Aaron Motsoaledi told reporters at Parliament in Cape Town.

He said that in 1997 the total number of deaths stood about 300 000. Last year the figure was 756 000.

Motsoaledi said the figures called for a "massive change in behaviour and attitude" toward Aids among South Africans.

"On the figures, it's shocking. As to whether it has been affected by what we did in the past 10 years, to me that's obvious," he said, according to the South African Press Association.

Read the full article.

Anthony Mbewu is made director of GFHR: Is this an appropriate appointment?

Eduard Grebe — Wed, 04 Nov 2009 12:55:35 +0000

Anthony Mbewu with Matthias RathAnthony Mbewu, the current President of the Medical Research Council of South Africa (MRC), has been appointed the Executive Director of the Swiss-based Global Forum for Health Research (GFHR).

The South African government under former President Mbeki and former Health Minister, Manto Tshabalala-Msimang, pursued an AIDS denialist ideology that was responsible for at least 300,000 premature deaths and tens of thousands of preventable HIV infections. [1-2] Mbeki and Tshabalala-Msimang were the main protagonists in this crime against humanity. But there were several politicians and civil servants whose actions and inactions helped extensively. Anthony Mbewu was one of them. An appointment to a top position in Geneva hardly seems appropriate for someone with his questionable track record. This included misrepresenting the relative importance of HIV as a cause of death, supporting the vitamin salesman Matthias Rath, playing down the known benefits of antiretroviral treatment, promoting absurd conspiratorialist thinking and over-promoting multi-vitamins and traditional medicine as potential responses to AIDS.

Matthias Rath, with the support of Tshabalala-Msimang, conducted unauthorised experiments on people with HIV, imported and distributed his products unlawfully and claimed multivitamins alone reversed the course of AIDS, in contrast to antiretrovirals which he claimed were toxic. Anthony Mbewu helped establish Rath's presence in South Africa.

Rath at the MRCIn 2004, Mbewu had a series of meetings with Rath that led to Rath giving a workshop and committing to pay R200,000 to the MRC, of which over R60,000 was eventually paid. The minutes of the meetings with Rath are illuminating. They include plans to run a clinical trial using multivitamins to treat cancer. At one point the minutes record Mbewu stating, “NAPWA (National Association of People with Aids) [is a] good group. TAC [Treatment Action Campaign] is paid by pharma cartel. NAPWA has an open mind and will be an great advocacy tool as a counter-balance to attack.” NAPWA was a corrupt organisation that served Manto Tshabalala-Msimang's interests by opposing antiretroviral treatment. TAC, the organisation that led the campaign for antiretrovirals, never received money from pharmaceutical companies and eventually won an interdict against Rath for propagating this claim.

The minutes are replete with pseudoscientific assertions and evince an AIDS denialist agenda. There is additional questionable behaviour: In one meeting Mbewu introduced Rath to Denova, a marketing company of which Mbewu's wife, Priscilla Reddy (also an MRC employee) was a director. [3] (This reference has links to meeting minutes, commitments to pay and photos of Rath and Mbewu.)

Mbewu presented on HIV to the Parliamentary Health Portfolio Committee on 16 March 2005 and stated:

The importance of nutrition in mitigating the impact of HIV and AIDS cannot be understated. The Tanzanian/Harvard University clinical trial by Fawzi et al published recently in the New England Journal of Medicine is a case in point. This blinded, randomised controlled clinical trial showed that amongst over 1000 HIV positive women; those assigned to receive daily multivitamin over the subsequent 5 years showed a 30% reduction in death and progression to AIDS compared to those who did not receive multivitamin. This implies that multivitamins can reduce the socioeconomic impact of HIV and AIDS by both reducing the annual death rate, as well as reducing the rate at which patients deteriorate to the point of needing active medical care. In addition, the widespread use of traditional medicines in AIDS could have direct benefit, if efficacious in reducing mortality; as well as indirect benefit in stimulating the industry of producing and distributing natural medicines.

He then stated:

Little is known about the length of survival of patients on antiretroviral therapy in resource poor settings. Data from ACTG studies in the USA, using regimens similar to those we use in South Africa suggest that median survival once started on ARVs is likely to be of the order of several years but this is very tentative.

As the TAC has explained, “these statements are misleading. He has contrasted multivitamins with antiretrovirals and in effect argued that there is more reliable evidence of the usefulness of multivitamins than antiretrovirals. This is false. The opposite is actually the case. Little is known of the effect of multivitamins on people with HIV. While Mbewu correctly identifies that a Tanzanian study found them to be beneficial, he fails to point out that these benefits were small relative to antiretrovirals. He claims little 'is known about the length of survival of patients on antiretroviral therapy in resource poor settings', while actually little is known about the survival benefits of multivitamins and a lot is known about the survival benefits of antiretrovirals in resource poor settings.” [4]

Mbewu and Rath enjoying dinnerMbewu also cast doubt on the size of the AIDS epidemic at a point when denialist scepticism was crucial to President Mbeki's resistance to introducing ARVs. He has been quoted stating, “The nation is in poor health, with just as many if not more deaths from heart disease and strokes than AIDS ... AIDS is a major problem, but heart disease and strokes are much bigger.” [5] Yet the claim that “heart disease and strokes are” a much bigger problem than AIDS had been shown to be false by a report published by the MRC. [6] (See also Professor Solly Benatar's criticisms of Mbewu's statements about AIDS mortality. [7])

The GFHR press release announcing Mbewu's appointment describes one of his achievements: “In 2003 he chaired the Task team that developed South Africa’s Comprehensive Care, Management and Treatment for HIV and AIDS programme that has enrolled 871 914 patients on antiretroviral therapy.” [8]

The statement is either cynical or callous. It shows a poor knowledge of the history of AIDS denialism in South Africa and appears designed to whitewash Mbewu's discreditable role in fostering it. This task team was appointed after a massive campaign by civil society led by the Treatment Action Campaign (TAC) to get the South African government to develop a treatment plan. It included several large marches as well as civil disobedience in which activists were beaten up, arrested and sprayed with water cannons. Finally the Cabinet relented and while Mbeki was out of the country, it ordered Tshabalala-Msimang to produce a treatment plan. Mbewu was appointed to head the task team by Tshabalala-Msimang because he was a politically reliable ally, the commissar whose job it was to ensure that the people doing the committee's real work were watched and controlled (thankfully not very successfully). To imply that Mbewu was responsible for South Africa's antiretroviral programme is a grave insult to the people who actually made the programme happen. The mealy-mouthed language and nutritional pseudoscience that made it into the report were Mbewu's doing.

GFHR describes itself as “an independent, international organization committed to demonstrating the essential role of research and innovation for health and health equity, benefiting poor and marginalized populations.” We question whether the appointment of Anthony Mbewu is consistent with that mission and call on GFHR to require Mbewu to account for his questionable and discreditable history.

References

1. Nattrass, N. 2008. AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa. African Affairs 2008 107(427):157-176. http://afraf.oxfordjournals.org/cgi/content/abstract/107/427/157 ^back^

2. Chigwedere, P. et al. 2008. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes. 49(4):410-415, December 1, 2008. http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2008&issue=1... ^back^

3. TAC. 2006. Release of Documents showing collusion between some government officials, including MRC Head Anthony Mbewu, and Matthias Rath. http://www.tac.org.za/community/node/2203 ^back^

4. TAC. 2006. Submission to African Peer Review Mechanism. http://www.tac.org.za/Documents/AfricanPeerReviewMechanismReportFinal-20... ^back^

5. Pretoria News, 17/2/2005. Quoted in TAC Submission to African Peer Review Mechanism. ^back^

6. Dorrington et al. 2001. The impact of HIV/AIDS on adult mortality in South Africa. http://www.hst.org.za/publications/452 ^back^

7. SAPA. 2005. MRC Man's statement supports AIDS denial. http://70.84.171.10/~etools/newsbrief/2005/news0211.txt ^back^

8. Global Forum for Health Research. 2009. Appointment of new Executive Director: Prominent South African researcher to head Global Forum for Health Research http://www.globalforumhealth.org/Media-Publications/Archive-news/Appoint... ^back^

"House of Numbers" Lies about Research Findings on T Cells Destruction and AIDS

Eduard Grebe — Mon, 02 Nov 2009 12:39:48 +0000

by Jeanne Bergman

The lynchpin of Brent Leung’s argument in “House of Numbers” that HIV does not cause AIDS is the headline of a 2007 article on ScienceDaily.com that read, “Sudden Loss Of T Cells Is Not Trigger For AIDS, New Study Suggests.” [1] The screen shows the article’s headline and first paragraphs for 12 seconds (a very long time in “House of Numbers”), while Leung, in a voice-over, intones, “In late 2007, ScienceDaily reported that three prominent research teams had published papers in the Journal of Immunology, challenging the theory that the sudden loss of T-cells triggers disease and AIDS.” Since T cell destruction is understood to be the primary mechanism by which HIV destroys the immune system, this seems to seriously challenge the HIV/AIDS paradigm.

The film then cuts to a clip of researcher John P. Moore saying, “The details of HIV pathogenesis, how HIV kills people, are still being worked out.” The placement of this interview fragment implies that Moore would agree that T cell destruction does not lead to AIDS and death (though, of course, he does not agree: JPM – personal communication). Next, Leung is shown in a lab, theorizing that, “If the sudden loss of T-cells in HIV positive individuals can’t explain why people get disease, then there must be co-factors that cause people to get sick and die. Or, factors that have absolutely nothing to do with HIV.” And the film goes on to propose other causes for AIDS—poverty, poppers, AZT.

But the research Leung cites to claim that T cell loss does not cause AIDS does not say what Leung says it did. On the contrary, it affirms that in humans T cell destruction leads to AIDS and death. The document on the screen was indeed from ScienceDaily, a popular science news website. However, the headline and first paragraph of that article, which was itself based on a press release from Tulane University, did not accurately represent the research: notably, it failed to mention that the research was done with non-human primates. Leung and his crew disregarded the rest of the ScienceDaily article, which clearly recorded that non-human primates were used and stated that the particular strain of SIV infecting these particular simian species behaves differently from HIV in humans. (Some other strains of SIV do cause AIDS in other simian species, notably in macaques) In the simian species used in this particular study, the animals rebound from the T cell destruction caused by the infecting virus, whereas humans generally don’t when they are infected with HIV. Leung also ignored the actual Journal of Immunology articles that ScienceDaily linked to—which is remarkable since his entire case against HIV’s causality rests on them. [2]

The articles misrepresented by Leung said that three teams of researchers studied SIV-infected sooty mangabeys, rhesus macaques, and African green monkeys, respectively, and found that soory mangabeys and African greens have non-pathogenic infections: they can recover from T cell depletion, which is why they do not get AIDS. (Rhesus do progress rapidly to AIDS.) The researchers explicitly contrasted non-human primate T cell recovery with the disease progress in HIV-infected human beings, who cannot recover from T cell depletion without treatment, and who therefore progress to AIDS and death. The three research teams suggest that while some non-human primates have evolved to adapt to the virus over many centuries, it is still new in humans: we have not yet evolved to recover from T cell destruction. The researchers see their findings as suggestive for therapies to control immune system activation and promote recovery from HIV-related T cell destruction.

We contacted ScienceDaily and they have corrected the misleading headline and paragraph. The headline now reads, “Progression Of SIV Infection In Monkeys Points To Differences Between Human And Simian Forms Of AIDS.” [3] The summary of the research clarifies the distinction between the virus in humans and simians:

Another major question raised by the study is why monkeys with SIV, unlike HIV-positive humans, are generally resistant to progression to AIDS after infection with the virus.

The answer, the authors propose, is that thousands of years of host/virus co- adaptation has enabled monkeys, the natural hosts of SIV, to effectively limit T cell immune activation and apoptosis, a mechanism that leads to progression of the disease. By contrast, humans, who were introduced to the virus fairly recently, have not had the opportunity to develop such protective adaptations.

ScienceDaily has also added an Editor's Note:

This story has been modified from its original version, which can be accessed here:http://web.archive.org/web/*/http://www.sciencedaily.com/releases/2007/09/070923193631.htm (via the Internet Archive's Wayback Machine). This version clarifies that the research described in the story examined the differences in how the simian and human forms of AIDS progress. The purpose of the story was NOT meant to suggest that the sudden loss of T cells is not the trigger of AIDS in humans, nor was there any intent to support the erroneous belief that HIV somehow does not cause AIDS. We regret any confusion that this may have caused. Links to the abstracts of the journal papers referred to above are provided below.

There is very little actual research cited in “House of Numbers.” It is shocking that Leung so radically misrepresented the only legitimate “evidence” for his HIV denialist theory, and that his source in fact affirms that HIV destroys T cells in humans, causing AIDS.

November 1, 2009

Notes

1. Tulane University (2007, September 26). Sudden Loss Of T Cells Is Not Trigger For AIDS, New Study Suggests. ScienceDaily. ^back^

2. Ivona V. Pandrea, Rajeev Gautam, Ruy M. Ribeiro, Jason M. Brenchley, Isolde F. Butler, Melissa Pattison, Terri Rasmussen, Preston A. Marx, Guido Silvestri, Andrew A. Lackner, Alan S. Perelson, Daniel C. Douek, Ronald S. Veazey, and Cristian Apetrei. Acute Loss of Intestinal CD4+ T Cells Is Not Predictive of Simian Immunodeficiency Virus Virulence. Journal of Immunology, 2007; 179: 3035-3046.

Shari N. Gordon, Nichole R. Klatt, Steven E. Bosinger, Jason M. Brenchley, Jeffrey M. Milush, Jessica C. Engram, Richard M. Dunham, Mirko Paiardini, Sara Klucking, Ali Danesh, Elizabeth A. Strobert, Cristian Apetrei, Ivona V. Pandrea, David Kelvin, Daniel C. Douek, Silvija I. Staprans, Donald L. Sodora, and Guido Silvestri. Severe Depletion of Mucosal CD4+ T Cells in AIDS-Free Simian Immunodeficiency Virus-Infected Sooty Mangabeys. Journal of Immunology, 2007; 179: 3026-3034.

Jeffrey M. Milush, Jacqueline D. Reeves, Shari N. Gordon, Dejiang Zhou, Alagar Muthukumar, David A. Kosub, Elizabeth Chacko, Luis D. Giavedoni, Chris C. Ibegbu, Kelly S. Cole, John L. Miamidian, Mirko Paiardini, Ashley P. Barry, Silvija I. Staprans, Guido Silvestri, and Donald L. Sodora. Virally Induced CD4+ T Cell Depletion Is Not Sufficient to Induce AIDS in a Natural Host. Journal of Immunology, 2007; 179: 3047-3056. ^back^

3. Tulane University (2007, September 26). Progression Of SIV Infection In Monkeys Points To Differences Between Human And Simian Forms Of AIDS. ScienceDaily. ^back^

Maggiore's labs

Eduard Grebe — Sun, 01 Nov 2009 07:00:00 +0000

"House of Numbers" offers new information about the late Christine Maggiore's experience with HIV testing. In the movie, her oral narrative and the dated lab reports on screen simply don't line up. What the film clearly shows by including the lab work is that Maggiore was HIV infected, and the reports suggest that her immune system controlled the virus well for some time. Commentary are placed in the blocks.

Christine Maggiore: “In 1992, I was encouraged by a doctor to take what’s called an HIV test as a mater of social responsibility, and I was shocked and devastated and horrified when the results came back positive. It was one of those moments that everyone fears their whole life. A week later, I take the same test to an AIDS specialist. He looks and says, this isn’t a positive test. I don’t know what this test means.”

The screen shows a lab report from Patricia O’Connell, NP, for Christine Maggiore, dated 02/24/92. Resolution is not good, but it looks like two bands—P24 and P120/160—of a Western Blot were reactive, the rest non-reactive. This VERY clearly is a positive test. The test interpretation instructions are below and she has a positive WB according to this test’s criteria (p24 and gp120).

Maggiore: “So I take the test again, and this time my results come back from the lab marked “’indeterminate.”

The screen shows part of a lab report in, with “Western blot” and “indeterminate” highlighted in yellow—bands from only 2 (GAG, ENV) of 3 groups positive. But it appears to have been a pretty thorough set of tests, include T-4 count etc. Interesting how shot is edited: column headings missing, no date, etc. NB: The second WB has different criteria – the same two bands are present but without a POL band this test will not be listed as positive. CD4 count (1040) and CD4/CD8 ratio (1.28) are comparable to an uninfected person and typical of someone who is controlling the virus very well immunologically. No date though.

Some denialists claim Maggiore refused treatment at this time, but with this CD4 count it would never have been offered. Indeed, Maggiore herself characterized the advice of her doctor at the time as 'wait 'til you get sick, and then we'll give you AZT.' This quote also contradicts another denialist myth, that asymptomatic people with HIV were routinely offered antiretroviral treatment.

Maggiore: “I’m faced with a decision: do I want to wait six weeks to test again, or do it right away? I opted for right away. My results that time come back positive.”

The screen shows another lab report, dated 9/23/93—nineteen months later. This is hardly “right away.” It is REACTIVE on every line—8 of 8 bands positive.

Maggiore: “Took it again, came back negative.”

The screen shows a lab report dated 08/09/93-six weeks BEFORE the test shown above. So the sequence of events she is narrating is not supported by the paperwork shown. The name on this report is Christina Maggiore, not Christine. Only a fragment is visible. NB: can’t tell if this one is an ELISA screen or a WB. It looks like an ELISA.

Maggiore: “I took it again—positive”

On screen, another lab report dated Sept. 29, 1993. This seems to be the one she took “right away”—six days after the solidly positive test. Sept 29, 93: HIV-1 EcG Confirmation [can’t read] Positive HIV-1 Ab 3g (?0 EIA 9.9 ]

Maggiore: "I’m very much opposed to the concept of mandatory testing of any population, because the tests are scientifically shown to be unreliable and inaccurate."

Landmark speech by South African President Jacob Zuma

Eduard Grebe — Fri, 30 Oct 2009 12:09:20 +0000

The Treatment Action Campaign's statement on the South African president's unequivocal repudiation of AIDS denialism in a speech to the upper house of the country's parliament:

Yesterday, President Jacob Zuma made one of the most important speeches in the history of AIDS in South Africa. In front of the National Council of Provinces (NCOP), he unequivocally acknowledged the devastation of AIDS on our country. With this speech state-supported AIDS denialism has been banished. The Treatment Action Campaign welcomes the ushering in of this new era, almost exactly ten years since former President Mbeki made a speech that began the era of state-supported denial in front of the NCOP.

President Zuma acknowledged that government’s efforts so far have been insufficient to curb the devastation of the epidemic. The reality of this has been declining health outcomes and increasing mortality. We have a crippled health system and a ballooning epidemic from the years of AIDS denialism and inaction by former President Thabo Mbeki and former Health Minister Manto Tshablala-Msimang. However, today’s speech puts that behind us and provides hope that President Zuma will urgently tackle the epidemic with renewed commitment to meet the treatment and prevention targets of the HIV & AIDS and STIs National Strategic Plan 2007-2011 (NSP).

In his speech, President Zuma acknowledged that the fear and shame that have surrounded the epidemic must be overcome. The spread of the epidemic is intimately connected to government’s ability to safeguard our human rights. All South Africans must feel secure to know their status and access and adhere to treatment without fear of discrimination.

President Zuma emphasized the need for behaviour change to reduce new infections by 50% from 2007 to 2011, the NSP prevention target. Changing behaviour must be facilitated by increased access to prevention services and by reducing the vulnerabilities to HIV infection in our society. Converting knowledge to behaviour change will be directly linked to these interventions.

A theme of the speech was that to turn the tide of the epidemic political will is needed not only by government but also by the citizens of South Africa. TAC and other civil societies have developed an active cadre of HIV activists in South Africa but this commitment to tackling the epidemic needs to be adopted throughout our society. As South African citizens we must actively engage with our own health and the health of each other. As active citizens we can overcome the stigma and discrimination that have driven the epidemic.

Key challenges remain to meeting the ambitious targets of the National Strategic Plan (2007 - 2011) for the treatment and prevention of HIV. But with the renewed political will demonstrated by President Zuma demonstrated by President Zuma and the leadership of Minister of Health, Aaron Motsoaledi, we believe these targets are achievable.

Joseph Sonnabend: House of Numbers is an AIDS denialist film

Eduard Grebe — Fri, 30 Oct 2009 11:52:58 +0000

Joe Sonnabend writes in his POZ blog:

House of Numbers is the title of a documentary film which according to its promotional material will "rock the foundations on which all conventional wisdom on HIV/AIDS is based"

I have seen the film. It is completely unable to achieve this grandiose objective. It is in fact an AIDS denialist film, despite the contention to the contrary by Brent Leung who made it.

The denialists are a disparate group who remarkably continue to believe that HIV cannot be the causative agent of AIDS either because it is harmless or because it does not exist. There are even those who believe that AIDS itself does not exist as a distinct disease entity. Of course there is no shortage of people with strange views that fly in the face of solid evidence. We can mostly just ignore them. But sometimes these views can be dangerous, and then we really do have to confront and challenge fallacious assertions that can lead to harm.

The Spectator is a weekly UK publication that had arranged a showing of the House of Numbers to be followed by a panel discussion of the film with audience participation. I had agreed to be one of the four panel members together with the filmmaker. Several people asked me not to participate in this event, probably with the thought that it was wrong to associate in any capacity with individuals who hold such outrageous views. There was also much activity on UK blogs, generally denouncing the Spectator event. It seems that a lot of people just did not want it to happen.

Two of the panel members withdrew so the event has now been cancelled. This is a pity. The film is as I said, dangerous. It is dangerous specifically because it presents antiviral treatments as only toxic with no mention of their benefits. Therefore it is justified to be very concerned that some people who need treatment may be dissuaded from receiving it after seeing the film.

I do accept that it is right to not prohibit individuals from expressing their views, no matter how distasteful. But when these views carry danger it is particularly important that they be challenged with valid information. It is absolutely wrong to ignore the film and allow it a free hand in spreading misinformation. As I have experienced when I was a member of President Mbeki's panel in S. Africa, it is impossible to argue with those who hold such denialist views. They are impervious to reason. It is therefore pointless to engage them in discussion. However, when their position is presented to the public, then it is right to try to expose the fallacy of their views to those who might be influenced by them and thus may come to harm as noted above regarding HIV infected people in need of treatment.

I should explain why this is definitely a denialist film despite the protestations of its director that it is not.

In providing a more or less equal, uncritical and essentially neutral platform to those holding denialist views together with those who do not, the filmmaker, presenting himself as an unbiased observer merely asking questions, puts forward the impression that the issue of HIV's role in causation remains unsettled. Although the film does not explicitly reject HIV as playing a causative role in AIDS, it most certainly leaves one with the impression that this, and even the existence of the virus, is merely conjecture. This is a misleading presentation of the well established causative link between HIV and AIDS as something that is just a theory, on a par with the theories of Dr Duesberg or of those who claim that HIV does not exist.

This is absurd and as I explained, also dangerous.

Read the full post.

South Africa needs an HIV/AIDS truth commission

Eduard Grebe — Tue, 27 Oct 2009 22:44:17 +0000

Salim Abdool Karim with his wife and collaborator Quarraisha Abdool Karim
Photo credit: CAPRISAIn this article prominent South African AIDS researcher, Prof Salim S. Abdool Karim, calls for a truth commission to account for South Africa's past HIV/AIDS denialist policies and rebuild trust:

The HIV/AIDS epidemic is one of the greatest challenges facing post-democracy South Africa. In 2007, the country, which is home to less than one per cent of the world's population, carried 17 per cent of the global burden of HIV infection — and the virus continues to spread relentlessly.

The government's response to the epidemic during the last decade has contributed to this disproportionate burden. It not only questioned the reliability of HIV testing, the safety and efficacy of antiretroviral drugs and the accuracy of statistics on AIDS-related morbidity and mortality, but also the very premise that HIV causes AIDS.

Deliberate attempts were made to undermine scientific evidence as the basis for action and to place politics at odds with science. President Thabo Mbeki's AIDS Advisory Panel, set up in 2000, marked a low point in the government's relationship with scientists when he asked AIDS scientists to engage AIDS 'denialists' in a debate for political adjudication.

Preventable deaths

The impact of these policies was very damaging. The government delayed the implementation of nevirapine — an antiretroviral drug proven to prevent mother-to-child transmission of HIV — which resulted in hundreds of thousands of newborns becoming infected unnecessarily. Researchers at Harvard University estimate that between 2000 and 2005, 330,000 lives were lost to HIV/AIDS and 35,000 babies were born with the virus because of government inaction and failure to provide lifesaving drugs.

AIDS activists have repeatedly had to challenge health service providers, government and pharmaceutical companies. Through petitions, marches, mobilising communities and legal action they have sought to bring more treatment to poor people.

But the change in government leadership last year has created new hope that the country will rise to the challenges posed by HIV/AIDS. President Jacob Zuma's 2009 State of the Nation Address boldly stated: "We must work together to improve the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS so as to reduce the rate of new HIV infections by 50 per cent by the year 2011. We want to reach 80 per cent of those in need of ARV [antiretroviral] treatment also by 2011."

Yet, while these statements are welcome, should we simply forget the past and accept that it was unfortunate — but there is nothing we can do about it now? To simply ignore the actions that led to hundreds of thousands of avoidable deaths would be to condone them and lay South Africa open to history repeating itself.

Call for a commission

South Africa needs an HIV/AIDS truth commission as a vital step towards establishing what happened and why, including detailed estimates of how many people died.

It is particularly important to hear directly from the decision-makers and to gather personal testimonies from all parties involved on how the damaging policies took hold in a democracy, where government should be accountable to the public for its actions.

The commission would also help us understand how to prevent the situation from happening again and would give the many people who lost loved ones to AIDS an explanation for why they died unnecessarily.

It is also needed to rebuild trust among people working against HIV/AIDS in South Africa, including those in research, government, health and local communities.

Simply establishing the truth is an important step. But for real reconciliation, the truth must also be made public and open to scrutiny before we can move on.

As South Africa starts building a new era in its response to the HIV/AIDS epidemic, we must work together — government, scientists, civil society and community organisations. It will take all our efforts — unimpaired by any ill-feeling or hurt from the past — to build a constructive foundation for tackling this devastating enemy.

Salim S. Abdool Karim is director of the Centre for the AIDS Programme of Research in South Africa at the University of KwaZulu-Natal. He was a member of Thabo Mbeki's AIDS Advisory Panel.

This article originally appeared on SciDev.net. It is republished in accordance with the Creative Commons Attribution 2.0 licence.

Death by denial: Symposium explores HIV denial, conspiracy theories

Eduard Grebe — Tue, 27 Oct 2009 22:08:19 +0000

AIDSTruth contributor Nicoli Nattrass and Seth Kalichmann, author of Denying AIDS were among the scientists and activists who participated in Harvard University's symposium on AIDS Denial. The Harvard Gazette reports:

People who deny that the HIV virus causes AIDS continue to persist in their beliefs despite overwhelming scientific evidence to the contrary, nurtured by the broad reach of the Internet and cherry-picked scientific claims, AIDS authorities said Monday (Oct. 19).

Researchers from Harvard, elsewhere in the United States, and South Africa convened at the Carpenter Center for the Visual Arts to decry HIV “denialism,” saying that the continued questioning of HIV’s role in AIDS harms those infected with the virus by discouraging both testing and treatment.

According to the speakers, denialism takes two major forms. Some skeptics deny that HIV plays a role in AIDS, or that it even exists, while others believe in AIDS conspiracies, acknowledging that HIV causes AIDS but questioning HIV’s origins, saying it results from a government conspiracy, is intended as a genocide campaign against blacks, that it was created in CIA labs, or is of other sinister origin or purpose.

The event, sponsored by the Harvard University Center for AIDS Research, was presented in conjunction with the Carpenter Center’s exhibit “ACT UP New York: Activism, Art, and the AIDS Crisis, 1987-1993.” The exhibit contains posters, T-shirts, fliers, and pamphlets from ACT UP’s AIDS activism campaigns which, through sometimes graphic and jarring messages, pushed government action against AIDS. The campaign argued that the government dragged its feet because of homophobia and racism aimed at two groups prone to the ailment: gay men and intravenous drug users, who are often minorities.

Read the full article.

The Spectator dabbles in denialism

Eduard Grebe — Sat, 24 Oct 2009 21:53:00 +0000

The Spectator's editor, who has in the past questioned climate change, has now started "Questioning the AIDS consensus", inspired by the denialist film House of Numbers.

Update: Now Neville Hodgkinson writes in The Spectator "on a new film that challenges the tenets of the Aids religion and exposes the dangerous confusion at the heart of the industry".

New Statesman's Mehdi Hassan writes:

I have blogged before on the new Spectator editor Fraser Nelson's crude denialism of climate change and his failure to engage with the peer-reviewed scientific literature. I see he has now turned his attention to questioning the link between HIV and Aids, in his Coffee House blog post "Questioning the Aids consensus". Here is how he puts it:

Is it legitimate to discuss the strength of the link between HIV and Aids? It's one of these hugely emotive subjects, with a fairly strong and vociferous lobby saying that any open discussion is deplorable and tantamount to Aids denialism. Whenever any debate hits this level, I get deeply suspicious.

Which is why the below clip -- from a documentary which the Spectator Events division is screening next week, called House of Numbers -- aroused my interest. The film picked up awards at various American film festivals, but has since been denounced as backing Aids denialism. Yet the footage shows Luc Montagnier -- who won a Nobel prize last year for his work on Aids -- saying that many HIV infections can be shrugged off by a healthy immune system.

If Nelson had done his research, he would know that 18 angry doctors and scientists interviewed in the film have since issued a public statement claiming that the film-maker Brent Leung "acted deceitfully and unethically" when recruiting them and that House of Numbers "perpetuates pseudoscience and myths".

Read Mehdi's full post.

HIV and Aids: debate or denial?

Eduard Grebe — Sat, 24 Oct 2009 19:26:11 +0000

Ben Goldacre writes in The Guardian:

A lot of strange stuff can fly in under the claim that you are "simply starting a debate". You may remember the Aids denialist documentary House of Numbers from three weeks ago. Since then, it has received many glowing outings. The London Raindance film festival explained that they were proud to show it, and a senior programmer appeared on YouTube saying they had gone through the film at 15-second intervals, finding no inaccuracies at all.

This is pretty good for a film which suggests that HIV doesn't cause Aids, but antiretroviral drugs, or poverty, or drug use do, or HIV probably doesn't exist, diagnostic tools don't work, and Aids is simply a spurious basket diagnosis invented to sell antiretroviral medication for a wide range of unrelated problems, and the treatments don't work either.

But now the film has received an even more prominent platform. Here is Fraser Nelson, political editor of the Spectator, promoting the Spectator event next Wednesday at which they will be screening this film: "Is it legitimate to discuss the strength of the link between HIV and Aids? It's one of these hugely emotive subjects, with a fairly strong and vociferous lobby saying that any open discussion is deplorable and tantamount to Aids denialism. Whenever any debate hits this level, I get deeply suspicious."

Of course people will have some concerns. Despite international outcry, from 2000 to 2005 South Africa implemented policies based on the belief that HIV does not cause Aids, and declined to roll out adequate antiretroviral therapy. It has been estimated in two separate studies that around 350,000 people died unnecessarily in South African during this period.

Read the full article.

Reviled, Yes. Genius? Not So Much.

Eduard Grebe — Mon, 19 Oct 2009 15:06:58 +0000

Newsweek Exposes Duesberg’s Psychopathology

by Jeanne Bergman for AIDStruth.org

Peter Duesberg:
Photo by Seth Kalichman

"The whole dissident idea attracts a lot of crazies. And then all of a sudden, without realizing it, you've become one of them."

—Peter Duesberg

Newsweek this week published a strange and very revealing profile of the HIV über-denialist Peter Duesberg by Jeneen Interlandi (“The World’s Most Reviled Genius: Can the Scientist Who Denies the Cause of AIDS Be Trusted to Cure Cancer?” Oct. 19, 2009, pp. 44-48). The article asks if Duesberg’s aneuploidy theory of cancer may have some real promise that is being ignored because he has completely destroyed any scientific credibility he ever had by refusing to acknowledge that he was wrong about HIV and AIDS. (The short answer to this question is simply: no. Aneuploidy isn’t being ignored, much better scientists than Duesberg are working on it, and it is unlikely to be the key to the cause or cure of cancers. [1]) More significantly, the piece reveals a lot about the character and pathology of the man behind the denialist movement.

Interlandi describes how Duesberg has “toiled in scientific purgatory” at Berkeley. An embarrassment to the University, he has been relegated to a crummy little lab in a shabby building, with no grant funding, no promising graduate students, and no respect from anyone—including other cancer researchers working on aneuploidy. He is no longer allowed to teach. Duesberg clearly understands that this follows from his failed theory that HIV is harmless. Interlandi identifies in him a core conflict between two equally disturbing character traits: “he craves a return to respectability, [and] he refuses to cede any ground to his adversaries.” (See AIDStruth’s article about his malignant narcissism.) But Duesberg seems unable to grasp that the contempt is the result of his refusal to accept the conclusive scientific evidence that HIV is the cause of AIDS, and of his persistent proselytizing of his disproven claims about HIV, AIDS and antiretrovirals, which has caused hundreds of thousands of unnecessary deaths, particularly in South Africa.

The Newsweek profile touches on the formative impact of Nazism on Duesberg, who grew up a privileged Catholic in fascist Germany, and the resulting attitudes he holds toward people who aren’t heterosexual white men. He degrades women and developmentally disabled people (both lack “all the IQ genes,” he told Interlandi, “half joking”). He calls black people Schwartzes (the German N-word) and gays “homos,” and describes both as evolutionary failures. [2] His assistant calls these “gaffes,” and says of Duesberg: “He’s just from a different era, when people actually talked like that.” Actually, only Nazis and other racists, homophobes and eugenicists talked like that. Decent people of any age didn’t, and don’t.

In an extraordinary instance of projective inversion, Duesberg likens himself to the victims of Nazism rather than to the perpetrators of the Holocaust. Paraphrasing his reflection on his professional marginalization, Interlandi writes that for Duesberg “Being cast out of the mainstream… is like being herded onto a train by the Gestapo, never to be seen again.” Duesberg said this while relaxing at Caffe Strada, across the street from the great university that has tolerated both his professional failures and his hate speech. It’s appalling that the University of California allows this bigot to occupy space and draw a salary at the taxpayers’ expense.

Duesberg illustrated both his delusional feeling of victimization and his lack of ethics and judgment with a story about conducting secret tumor experiments on mice that he and his assistant bought in local pet shops. The article notes that this violated University policy concerning the pre-approval, housing, and treatment of lab animals. It might have also mentioned how stupid it is: results from those experiments would never be meaningful or publishable since they came from a small number of out-bred mice. U.C. learned of the project and, Interlandi writes, “Despite Duesberg's pleas to let them finish up, the mice were confiscated and killed. The data were lost. ‘We are the pauper scientists,’ he says, recalling the incident. ‘Always begging on our knees. Ever since HIV.’" Again, Duesberg can only see his imagined persecution, and not his abject failure as a scientist.

Newsweek did its best to find legitimate defenders of Duesberg. Interlandi writes: “Even some scientists who don't agree with Duesberg say that he has been treated unfairly,” and she quotes Lancet editor Richard Horton: "The ideological assassinations that he has undergone will remain an embarrassing testament to the reactionary tendencies of modern science.” But Horton wrote this in 1996, thirteen years ago, when antiretroviral drugs were just coming on the market. With their success, and in light of the unnecessary infections and deaths for which Duesberg is responsible, any illusions that criticism of Duesberg is based on ideology rather that evidence can no longer be sustained.

Peter Duesberg is shunned by his fellow scientists not because he is stubborn or obnoxious. He is shunned because he has been the driving force behind the AIDS denialist movement. He influenced the South African government, under former President Thabo Mbeki, to adopt an AIDS denialist position and delay the implementation of antiretroviral treatment access. This resulted in over 350,000 avoidable deaths. There is no possibility of professional reprieve for a  scientist so consciously involved in such a grotesque outcome.

Endnotes

1. Is there any validity to the notion that Duesberg’s infamy has hindered exploration of a promising domain of cancer research? Not according to cancer research George Klein:

In some of the comments around the Newsweek article, and in similar Duesberg-contexts previously, I have noticed a slight hesitation by the virologists about the cancer-aneuploidy story, leaving open the possibility that this was a real contribution by Duesberg. It is not. Aneuploidy as an important factor in causing cancer was proposed 1910 by Boveri, as Duesberg correctly states. Later, it was not forgotten or ignored, as he claims, but was continuously on and off in the discourse. When he now proposes it as a major insight, reached by him, he is using exactly the same technique of distorting the facts and inflating himself, as he always does.

This is not a question of either oncogene mutations, or aneuploidy. Aneuploidy contributes to the malignization of the cells, by influencing the oncogenes and the suppressor genes. More variability is generated, and the cancer cell evolves more readily towards greater autonomy. But the rearrangement of the chromosomes does not alter the fact that it is the oncogenes and the suppressor genes that are the key players.

A correlation between the degree of aneuploidy and prognosis has been noticed by the German-Swedish pathologist Gert Auer and Duesberg may well have picked up the idea from him. Another German (German-American) cytogeneticist, Thomas Reed has similar ideas. In view of the fact that he invited Duesberg to speak at the NCI (according to him) he may be in support for Duesberg’s argument. But please notice that Duesberg’s input contributed is nothing but dialectics. I cannot see the slightest originality in his work or in his reasoning. The fact that he manages to make this appear as a new way of thinking that may advance the cancer problem, or, indeed, is more ingenious new thought contributed by a pariah (as Scientific American put it) or by a genius (Newsweek) is nothing but more Duesbergiana. It is amazing how well he plays this game and how he can find new consumers who have not yet realized that they are being misled.

George Klein MD, PhD, Professor Emeritus, Research Group Leader, Microbiology and Tumor Biology Center (MTC) Karolinska Institutet, Stockholm, Sweden. Personal communication, Oct. 12, 2009.

2. Duesberg frequently makes racist and sexism comments. In Nashville, TN, in April 2009, he referred to the impact of AIDS on “the populations of Africa, which”— snickering sarcastically—“we love so dearly,” It was clear that the prospect of millions of Africans dying didn’t bother him.

Swine Flu Shots Revive a Debate About Vaccines

Eduard Grebe — Mon, 19 Oct 2009 13:04:58 +0000

Jennifer Steinhauer writes in the New York Times:

People who do not believe in vaccinating children have never had much sway over Leslie Wygant Arndt. She has studied the vaccine debate, she said, and came out in favor of having her 10-month-old daughter inoculated against childhood diseases. But there is something different about the vaccine for the H1N1 flu, she said.

“I have looked at the people who are against it, and I find myself taking their side,” said Ms. Wygant Arndt, who lives in Portland, Ore. “But then again I go back and forth on this every day. It’s an emotional topic.”

Anti-vaccinators, as they are often referred to by scientists and doctors, have toiled for years on the margins of medicine. But an assemblage of factors around the swine flu vaccine — including confusion over how it was made, widespread speculation about whether it might be more dangerous than the virus itself, and complaints among some health care workers in New York about a requirement that they be vaccinated — is giving the anti-vaccine movement a fresh airing, according to health experts.

“Nationally right now there is a tremendous amount of attention on this vaccine,” said Dr. Thomas Farley, the New York City health commissioner. That focus has given vaccine opponents “an opportunity to speak out publicly and get their message amplified that they didn’t have at other times,” he said.

Barbara Loe Fisher, president of the National Vaccine Information Center, an advocacy group that questions the safety of vaccines, said the swine flu has “breathed new life” into the cause. “People who have never asked questions before about vaccines are looking at this one,” Ms. Fisher said.

The increased interest is frustrating to health officials, who are struggling to persuade an already wary public to line up for shots and prevent the spread of the pandemic. According to a CBS News poll conducted last week, only 46 percent said they were likely to get the vaccine. The nationwide poll, which has a margin of sampling error of plus or minus three percentage points, found that while 6 in 10 parents were likely to have their children vaccinated, less than half said they were “very likely to.”

Read the full article.

The Lancet Infectious Diseases reviews Denying AIDS

Eduard Grebe — Tue, 29 Sep 2009 11:14:57 +0000

Seth Kalichman's Denying AIDS is reviewed by Talha Burki in the latest issue of The Lancet Infectious Diseases.

Denying AIDS

Talha Burki

The Lancet Infectious Diseases. Volume 9, Issue 10, October 2009, Page 600

Seth Kalichman, Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy, Copernicus Books (2009) ISBN 978-0-387-79475-4 Pp 205. £13.99..

The Guardian: Pernicious film of Aids denialist propaganda

Eduard Grebe — Sun, 27 Sep 2009 10:30:55 +0000

Ben Goldacre writes in his Bad Science column for The Guardian:

This week, listening to the Guardian science podcast, I had a treat. Caspar Melville, editor of New Humanist magazine, leader of something called the Rationalist Association, had been to see two films at the Cambridge film festival. One was a dreary creationist movie that famously misrepresented the biologists interviewed for it. This was obvious bad science, he explained. But the other was different: House of Numbers, a new film about Aids, really had something in it.

I have now seen this film. It presents itself as a naive journey by one young film-maker to discover the science behind HIV. In reality, it's a dreary and pernicious piece of Aids denialist propaganda.

All the usual ideas are there. It's antiretroviral drugs themselves that are the cause of symptoms called Aids. Or it's poverty. Or it's drug use. HIV doesn't cause Aids. Diagnostic tools don't work, Aids is simply a spurious basket diagnosis invented to sell antiretroviral medication for a wide range of unrelated problems – and the drugs don't work either.

It would take two months of columns to address all the bogus claims of this film, and that blizzard, perhaps, is the point of making it, with all the classic rhetorical devices that have been honed by Aids denialists and creationists over decades. It engages, for example, in repeated overstatement of marginal internal disagreements about the details of HIV research, to the extent that 18 doctors and scientists interviewed for the film have issued a statement saying that the director was "deceptive" in his interactions with them, that it perpetuates pseudoscience and myths, and that they were selectively quoted to make it seem as if they are in disagreement and disarray, when in fact they agree on all the important facts.

Read the full article at The Guardian.

Thami Mseleku removed as head of South African health department

Eduard Grebe — Sat, 19 Sep 2009 23:57:32 +0000

The last holdover of the Mbeki/Tshabalala-Msimang era of state-supported AIDS denialism in South Africa, Director-General of Health Thami Mseleku, has been dismissed.

Health-e reports:

Mseleku axed

18.09.2009 Anso Thom

text Health department Director General Thami Mseleku, a destructive leftover from former health minister Dr Manto Tshabalala-Msimang’s reign, will leave the end of the month, with the Western Cape’s Director-General for Health Professor Craig Househam set to step in.

Unconfirmed reports of Mseleku’s departure and Househam’s appointment have been doing the rounds for several days and have been confirmed by several sources, some within the national health department.

Fidel Hadebe, spokesperson for health minister Dr Aaron Motsoaledi, has declined to comment while Househam denied, via his spokesperson Faiza Steyn, that he had been approached.

Dr Francois Venter, president of the Southern African HIV Clincians Society said he had also heard the rumours that Mseleku was on his way out.

“He, with Tshabalala-Msimang, grossly mismanaged our health system and cost hundreds of thousands of South African lives. In a just world, they would both go to jail. The HIV world is just pleased to see the back of him,” said Venter.

Mseleku, referred to in the corridors as “Manto’s bodyguard”, has not endeared himself to any of the stakeholders in the health sector.

He left his post as Education Director General and was appointed Health DG in January 2005. He shied away from involvement in health policy issues, opting to plunge head first into the political controversies involving the health department – most notably those involving HIV/AIDS.

He took a personal interest in controversial vitamin seller Dr Matthias Rath, exonerating him from any wrongdoing, asking a New Yorker journalist during an interview: “What, exactly, was Rath’s crime?”

Court papers later revealed that Mseleku’s claims that his department had investigated Rath, involved two telephone calls, both to Rath employees.

Later Mseleku refused to take action against uBhejane, a concoction sold as an AIDS cure by former truck driver Zeblon Gwala, and described criticism of uBhejane as “colonialist”.

Mseleku was also instrumental in getting the Treatment Action Campaign and AIDS Law Project excluded from a United Nations General Assembly Special Session on AIDS.

He had told unhappy AIDS activists in a meeting about the matter: “We are government. We have been given a mandate to govern. All of you must just shut up.”

In 2006, Mseleku ordered all provincial heads of department to refuse media interviews on HIV/AIDS in the wake of the health minister’s humiliation at the Toronto AIDS conference and a possible visit to the country by UN AIDS envoy Stephen Lewis.

In the same year, he forbade departmental officials to attend a meeting convened by the Nelson Mandela Foundation aimed at encouraging dialogue between government and HIV/AIDS scientists.

Last year, 19 of the world’s foremost health and human rights experts condemned Mseleku’s comment at a TB conference that “human rights are not relevant to the considerations of health policy in a developmental state”.

More recently, there have been calls for Mseleku’s head to roll over the poor handling of the occupational specific dispensation (OSD) for doctors, dentists, pharmacists and emergency medical personnel – which led to a widespread strike by doctors.

The implementation of OSD for nurses happened without anybody at the National Health Department, specifically Mseleku, fulfilling a proper and meaningful oversight role.

It is also widely accepted that Mseleku was the main instigator behind the firing of Deputy Health Minister Nozizwe Madala-Routledge in 2007. Described by many working in HIV/AIDS as their darkest time, Madlala-Routledge has spoken about how she had been sidelined, bullied, ignored and been made to feel like a “handbag, that can be picked up when they needed me or not” during her more than three years in the health department.

She revealed how she had been barred from getting access to any information from health department officials as Mseleku had instructed senior management to not liaise with her. “Instead I had to make a submission to the health minister and she would decide whether I could see it or not.”

Househam, DG in the province since 2002, will inherit a department low on morale and with a huge vacancy rate. Househam has been lauded for his achievements in the Western Cape, but has not endeared himself to academics at the Universities of Cape Town and Stellenbosch.

The former University of Free State professsor has not hesitated in diverting funds from academic hospitals to secondary and primary health care sites, placing massive pressure on the institutions and eliciting a backlash from senior specialists.

Poor provider care leads to poor health-seeking behaviour

Eduard Grebe — Sat, 19 Sep 2009 23:47:12 +0000

What are the causes of AIDS denialism? What are the factors that lead to a loss of public confidence in medical science? Often on aidstruth.org we have focused on debunking the false propaganda of prominent AIDS denialists, but there are other very important causes of people with chronic illnesses choosing to forsake scientifically based medical advice. A crucial one is the often substandard quality of care people receive from their medical practitioners. In the United States, tens of millions of uninsured and under-insured people experience the health system as uncaring and unproviding. In South Africa, where AIDS denialism had its worst effects, a study by Jane Goudge and colleagues at the Centre for Health Policy on the University of Witwatersrand found that "Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system." Healer shopping, or perhaps more appropriately quack shopping, is a consequence of poor health services characterised by disrespectful behaviour from overworked health staff, long waiting lists, queues, and the unavailability of essential medicines and diagnostics. It is here where prominent AIDS denialists and charlatans step into the breach and lead vulnerable people away from proven health interventions. This is yet another excellent reason why decent medical services need to be accessible by middle- and low-income people. Below is the abstract of this study.

Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa.

BMC Health Serv Res. 2009; 9: 75.

Pubmed abstract: http://www.ncbi.nlm.nih.gov/pubmed/19426533

Full free text available here: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid...

Goudge J, Gilson L, Russell S, Gumede T, Mills A.

Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa. jane.goudge@gmail.com

BACKGROUND: There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa.

METHODS: A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system.

RESULTS: In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others.

CONCLUSION: In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance.

Medical Editors Push for Ghostwriting Crackdown

Eduard Grebe — Sat, 19 Sep 2009 23:43:29 +0000

Failure to disclose conflicts of interest, substandard peer review and the involvement of some scientists in pharma profiteering weakens the public's trust in legitimate science and creates an environment in which denialism and pseudoscience flourish. We welcome the policy changes that some journals are implementing.

The New York Times reports:

The scientific integrity of medical research has been clouded in recent years by articles that were drafted by drug company-sponsored ghostwriters and then passed off as the work of independent academic authors.

Yet the leading medical journals have continued to rely largely on an honor system of disclosure to detect such potential bias, asking authors to voluntarily report any industry ties or contributors to their manuscripts.

But now, in light of recently released evidence that some drug makers have gone to great lengths to turn scientific articles into marketing vehicles for their products, some influential medical editors are cracking down on industry-financed ghostwriting. And they are getting help from some members of Congress.

These editors are demanding that journals impose tougher disclosure policies for academic authors and that the journals enforce their own rules by actively investigating the provenance of manuscripts and by punishing authors who play down extensive contributions by ghostwriters.

Read the full article.

Real Answers to the Fake Questions in “House of Numbers”

Eduard Grebe — Fri, 11 Sep 2009 00:48:52 +0000

by Jeanne Bergman

“House of Numbers” is a film with a hidden agenda: it tries to make viewers doubt the reality that the virus called HIV exists and causes AIDS. It conceals this agenda behind a false veneer of honest inquiry. The filmmaker, Brent Leung, told a Huffington Post blogger: “I am not a denialist. Posing questions is very different than denying something. … I traveled the globe speaking with scientists, activists, clinicians, journalists and patients asking questions. My main goal? To educate myself and others, and to generate discussion on important questions that have not yet been answered.” But Leung is an HIV denialist—he has said he is “neutral” on the issue of HIV/AIDS, which means he rejects the evidence-based science that has conclusively proved the existence of HIV and its causative role in AIDS, a fatal disease syndrome. His film is supported and promoted only by denialists. And Leung in fact got the information he sought from the legitimate scientists, doctors, and advocates he interviewed, but he then edited it out of the film to deceive and confuse viewers. The audience is manipulated to reach the wrong answers to the questions he ask. Since Leung leaves his own positions unstated, he dodges accountability for the film’s potential impact—namely, that people might decide that they don’t need to protect themselves or others from being infected with HIV, or that people living with HIV might reject medical care and the medications that could keep them healthy.

Here we summarize the fake “questions” Leung raises in the film, and provide real, evidence-based answers.

“House of Numbers” asks if there is really a scientific consensus about HIV/AIDS.

The real answer is: YES. There is an overwhelming scientific consensus, based on incontrovertible evidence, that HIV exists and is the cause of AIDS. The scientific evidence has shown conclusively that HIV exists, is transmitted by the blood and sexual fluids of infected people, and gradually destroys the human immune system, resulting in AIDS, a syndrome manifesting in various diseases that healthy people fight off but that cause illness and ultimately death in people with advanced HIV disease. Before the advent of antiviral medications, people with advanced HIV disease had multiple, devastating infections and symptoms that would not seriously harm a person with a healthy immune system. Since 1981, over 25 million people worldwide have died from HIV/AIDS.

The makers of “House of Numbers” deceived legitimate HIV researchers, infectious disease doctors, and AIDS activists and philanthropists to get interviews with them, and they edited the footage to make it seem that there is disagreement that HIV exists and is the necessary cause of AIDS. These facts have been established in laboratories, clinically, and by epidemiology, and published in tens of thousands of peer-reviewed publications. We have much still to learn about HIV and AIDS, and some scientists don’t like each other, but no legitimate, qualified scientist or doctor questions the existence or consequences of the virus.

“House of Numbers” questions the reliability of the HIV test. Does the HIV antibody test actually tell us anything at all?

The real answer is: YES. HIV tests are extremely reliable, sensitive and specific. What is usually referred to as the “HIV test” is just one step in HIV screening and diagnosis. The ELISA or EIA test screens for the presence of HIV antibodies in blood or oral fluids. In any diagnostic tests, there is a balance between sensitivity (recognizing everyone who is a true positive, who has the virus or whatever is tested for) and specificity (recognizing everyone who is a true negative, who doesn’t have the virus or whatever is tested for). Greater sensitivity always means more false positives, because very sensitive test will react to some things that are not the virus as if it were. Although rare, HIV false positives can happen: they are caused by the ELISA test reacting to antibodies produced in pregnancy or from some autoimmune diseases. (It is not true, as denialists claim, that 70 different conditions can cause false positives. And false positives are a feature of all screening tests, not just those for HIV. For example, some men will test positive for pregnancy. It doesn’t mean they are pregnant, or that pregnancy tests are totally useless, or that pregnancy doesn’t exist: it only means that the test is calibrated to capture all pregnancies when used correctly because a false negative is a bigger problem than a false positive.)

The ELISA test for HIV is very sensitive, because it is used to screen the blood supply and any false negatives could result in the HIV infection of hundreds of people. A positive ELISA test is 99.5% sensitive after the “window period” following infection, before HIV antibodies have developed. Because there is a small risk of a false positive, every HIV test is then confirmed with a Western Blot test. The two-test protocol is over 99.9% accurate, and clinical monitoring of a patient’s viral load and immune system by a physician further confirms the diagnosis. Misdiagnoses of HIV infection resulting in inappropriate treatment with antiretroviral drugs are extremely rare and are considered malpractice. (In 2007, an HIV-negative Massachusetts woman, Audrey Serrano, sued and won $2.5 million in damages against the doctor who treated her for AIDS without confirming that she was HIV infected. The HIV testing technology is so good that there is simply no excuse for the mistake that her doctor made.)

“House of Numbers” questions the practice of asking about risk factors in testing and diagnosis. Don’t doctors just want to know if you are gay or a drug user, and isn’t the diagnosis really bogus?

The real answer is: NO. Questions about risk factors are part of good screening, diagnosis and care. One step in many HIV testing protocols is an interview to assess the individual’s risk of infection. This has value as for prevention education; in addition, knowledge about risk helps frame the accuracy of a screening test. For straightforward statistical reasons, the likelihood of a false positive is higher where there are no risk factors and low prevalence than where risk factors and prevalence are high. But every positive ELISA test is still confirmed by a Western Blot or other test. The HIV tester in the movie who says that an AIDS diagnosis would be dependent on risks being acknowledged in an interview was simply wrong. It seems likely that she was asked misleading questions by the interviewers.

“House of Numbers” questions why some people who are exposed to HIV are not infected. Maybe HIV isn’t communicable? Maybe it doesn’t exist?

The real answers are NO and NO. There is no virus for which exposure always leads to infection. It should be obvious that not everyone exposed to a pathogen gets sick. Everyone knows that when someone in an office has a cold, some co-workers will catch it, and others won’t: how many do get sick depends in part on what steps people take to reduce the possibility of transmission. In the film, denialist Liam Scheff says that scientists say that HIV is so infectious it “leaps off penises into vaginas.” That’s a lie—people knowledgeable about HIV are clear that HIV is a hard virus to get—but the consequences of infection are serious, so prevention is crucial. The likelihood that a virus, including HIV, will be transmitted depends on many factors, including the nature of the contact, the innate transmissibility of the particular virus, the nature of the exposure or contact, how long the virus survives outside the body, and the viral load of the person who has it (people recently infected have very high levels of virus, while people on antiretroviral HIV medications have low, sometimes undetectable levels). This may be complicated, but it isn’t unusual at all. (And be aware that many HIV denialists reject the existence not only of HIV but of ALL viruses, and even of the role of germs in disease!)

“House of Numbers” questions how one disease varies so much in different people. Could it be that there’s no such disease as AIDS?

The real answer is: No. HIV infection will, over time, destroy the immune system in almost all infected people. The immune system is then unable to fight off opportunistic infections that are present in the environment, and they will get sick and die. Different strains of the virus and different regionally endemic diseases that affect immune-compromised people account for geographic variation in HIV disease patterns. Once a person is infected, the rate of disease progression is affected by many factors—the strain of the virus and the person’s age, overall health, environment, nutrition.

Causality does not require uniformity to be demonstrated. While there is a period averaging ten years when an HIV-positive person is clinically asymptomatic (that is, has no major symptoms), there is great variation between people’s HIV disease progression, even within the same region or even household. For example, Christine Maggiore, an HIV-infected denialist, said she first tested positive in 1992: she survived without HIV treatment for fifteen years until her death from AIDS last December. Her daughter, to whom she transmitted the virus perinatally, survived only 3 ½ years without treatment: she died, tragically and unnecessarily, of AIDS in 2005.

“House of Numbers” asks if a disease that is diagnosed differently on different continents is really only one disease.

The real answer is: YES. It is all HIV disease, and how the doctors and public health officials in different countries decide to mark the point at which it becomes full-blown “AIDS” doesn’t alter the reality of the virus and its effects. The virus doesn’t care what you call it, and the progression of the untreated disease is not driven by, but only expressed in, diagnostic language. Differences in diagnostic criteria by region reflect lack of access to HIV testing technologies and different clinical approaches: specifically, most African countries’ health systems cannot afford HIV testing. That doesn’t mean that HIV doesn’t exist or that poverty causes AIDS. Where HIV tests are not available, an AIDS diagnosis obviously cannot include HIV status as an element of an AIDS diagnosis, so the diagnosis is based on the presence of opportunistic infections that would only afflict a person with a compromised immune system.

“House of Numbers” asks if the profits that pharmaceutical companies make from HIV drugs might in fact be the reason for the invention of HIV/AIDS.

The real answer is: NO. The fact that the pharmaceutical industry does make money from HIV drugs does not mean that there is no such thing as HIV or AIDS. From the earliest days of the epidemic, AIDS activists have demanded the pharmaceutical industry and the government do smarter, more ethical, and expanded research. Activists have fought for the rapid development of better, more effective, more tolerable, and more affordable treatments for HIV, and the current generation of antiretroviral drugs for HIV are effective and easily tolerated by most people living with the virus. But that can lead to complacency and even the HIV denialism showcased by “House of Numbers. ” We must continue to fight to make HIV treatment accessible and affordable to everyone who needs it, including through the production of generics and international trade strategies like compulsory licensing that cut into the drug companies’ profits. We need to fight for prevention strategies that are science-based and really work, like needle-exchange and condoms, and more fundamentally address the structural injustices that render some populations much more vulnerable to HIV, as well as to other diseases. And we must press for the development of vaccines, other prevention technologies like microbicides and post-exposure prophylaxis, and ultimately for a cure.

Elsevier retracts Duesberg’s AIDS Denialist article

Eduard Grebe — Wed, 09 Sep 2009 22:51:51 +0000

There can be few greater embarrassments for scientists than for a publisher to retract their papers forcibly. This is exactly what has happened to two AIDS denialist articles, one of them co-authored by Peter Duesberg and David Rasnick. Here is what happened.

In 2008, the Journal of AIDS (JAIDS) published an article by Pride Chigwedere [1] and colleagues of Harvard University, who estimated that delays in providing antiretroviral drugs in South Africa due to state-supported AIDS denialism had caused over 300,000 deaths. This publication confirmed the results of a previous study by South African professor and aidstruth.org member Nicoli Nattrass. [2] AIDS denialist Peter Duesberg, whose influence on the disastrous South African government policies was mentioned in Chigwedere’s article, submitted a response to JAIDS that was co-authored by four others including Rasnick. After this article was rejected because of its poor academic quality, Duesberg et al. submitted it to a different journal, Medical Hypotheses. Two days later, the editor accepted the paper. Medical Hypotheses does not practice peer review, a process in which several scientists check a submitted academic paper for quality and suggest needed improvements over a period of weeks or months. The Duesberg et al. paper was accepted without such a review process, after inspection only by the editor of Medical Hypotheses.

That Duesberg’s paper was not properly reviewed by experts is painfully obvious, as neither facts nor logic are allowed to temper the authors’ denialist speculations and opinions. For example, they argue that AIDS is not a problem in Africa because the total population of Africa has increased during the AIDS era. One could as easily conclude that cancers are never fatal, since the population of California has increased despite the presence of these diseases. Duesberg et al. also say antiretroviral medicines have not reduced AIDS mortality, an obvious lie since these drugs have drastically lowered mortality. Worse, Duesberg et al. say they derived this idea from a scientific article. [3] In fact, the article they cite states nothing of the sort; it actually shows that a newer combination of antiretroviral drugs is not substantially better than an older combination. Of course, both these combinations are better than Duesberg’s favored treatment option – nothing. Doing nothing in the face of HIV infection is, however, very often a death sentence, as it was to over 300,000 South Africans. [1,2]

Duesberg’s article was the latest in a string of low-quality and in some cases offensive publications in Medical Hypotheses, including at least one apparently racist article and the other now-retracted denialist paper, entitled “Aids denialism at the ministry of health” by Ruggiero et al. (2009 Jul 6). [4,5]

How were these papers accepted in the first place? Medical Hypotheses is published by the prestigious publishing company Elsevier and, more importantly, indexed on PubMed, the definitive source of medical literature run by the National Library of Medicine (NLM) in the United States. Journals indexed in PubMed must meet certain standards. The NLM explains, “Scientific merit of a journal's content is the primary consideration in selecting journals for indexing. The validity, importance, originality, and contribution to the coverage of the field of the overall contents of each title are the key factors considered in recommending a title for indexing, whatever the intended purpose and audience.” [6] Because the Duesberg et al. and Ruggiero et al. papers so obviously lack scientific merit, several scientists became concerned that Medical Hypotheses does not satisfy the NLM’s requirements. By giving space to lies about HIV and AIDS, and by “legitimizing” AIDS denialists via inclusion of their names on PubMed, the journal has also become a potential threat to public health.

Aidstruth.org members therefore drafted a letter to the NLM outlining these concerns. It was signed by 20 scientists and activists and stated, “We, the undersigned, respectfully request that the journal Medical Hypotheses be reviewed for MEDLINE deselection at the earliest convenience of the Literature Selection Technical Review Committee. Medical Hypotheses does not appear to meet the standards for MEDLINE listing as established by the National Library of Medicine, and recent publications in the journal are inconsistent with the stated missions of the National Library of Medicine and the National Institutes of Health.” [7] The NLM responded that it would review the journal in October of 2009.

Separately, Elsevier was made aware of the problems. John Moore, an HIV scientist at Weill Cornell Medical College and a former, founding member of aidstruth.org, and Françoise Barré-Sinoussi, Nobel Prize Laureate and co-discoverer of HIV, each wrote to Elsevier objecting to the Ruggiero et al. and Duesberg et al. articles. To Elsevier's credit, Executive Vice President of Global Medical Research Journals, Glen Campbell, responded by stating that he shared the concerns expressed. In his letter to Dr. Barré-Sinoussi, Dr. Campbell referred to the Duesberg et al. article and the “implications of its wider dissemination for global health care.” [8] Campbell also stated that Elsevier had retracted both the Duesberg et al. and Ruggiero et al. articles with immediate effect, and had begun an internal review of the processes “by which these two articles were accepted.” Elsevier also committed to “reviewing the polices and practices of Medical Hypotheses.” We applaud Elsevier and Dr. Campbell for responding so constructively and effectively.

An additional area of concern is that Duesberg et al. declared in the Medical Hypotheses paper that the authors had no conflict of interests, a statement that is made by the corresponding author, Duesberg, on behalf of all the authors. This statement was inaccurate: Co-author David Rasnick was until recently employed in South Africa by vitamin salesman Matthias Rath, whose company's marketing strategy is based on undermining public confidence in antiretroviral drugs. [9] The attack by Duesberg et al. on the use of anti-retroviral drugs in South Africa could therefore be of considerable commercial value to Rasnick’s ex-employer, a conflict of interest that should have been declared in the paper. Complaints about this ethical issue have now been sent to both the University of California, Berkeley (where Duesberg has tenure) and Elsevier.

Aidstruth.org will give further updates on this matter as it develops. Meanwhile, where there was once the abstract of Peter Duesberg's latest AIDS denialist article, the following statement can now be found on PubMed:

This Article-in-Press has been withdrawn pending the results of an investigation. The editorial policy of Medical Hypotheses makes it clear that the journal considers "radical, speculative, and non-mainstream scientific ideas", and articles will only be acceptable if they are "coherent and clearly expressed." However, we have received serious expressions of concern about the quality of this article, which contains highly controversial opinions about the causes of AIDS, opinions that could potentially be damaging to global public health. Concern has also been expressed that the article contains potentially libelous material. Given these important signals of concern, we judge it correct to investigate the circumstances in which this article came to be published online. When the investigation and review have been completed we will issue a further statement. Until that time, the article has been removed from all Elsevier databases. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. [10]

[1] Chigwedere P, Seage G, Gruskin S, et al. Estimating the lost benefits of antiretroviral drug use in South Africa [Internet]. J Acquir Immune Defic Syndr. 2008. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18931626

[2] Nattrass, N. AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa. African Affairs, 2008. Available at: http://afraf.oxfordjournals.org/cgi/content/abstract/107/427/157

[3] May MT, Sterne JA, Costagliola D, et al. HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet, 2006. Available through: http://www.ncbi.nlm.nih.gov/pubmed/16890831

[4] The article is retracted on PubMed with a suitable notice. See http://www.ncbi.nlm.nih.gov/pubmed/19586724

[5] For examples of other poor-quality articles, as well as the racist one, published by Medical Hypotheses, see http://docs.google.com/Doc?docid=0AS7SzpS3zHZBZGQ2cWZjeGNfMjhobXYyaDcydA...

[6] NLM. Medline Journal Selection. http://www.nlm.nih.gov/pubs/factsheets/jsel.html

[7] The complete letter is here.

[8] The response from Elsevier to Barré-Sinoussi can be read here.

[9] See http://www.aidstruth.org/features/2009/david-rasnick-fails-declare-confl...

[10] See http://www.ncbi.nlm.nih.gov/pubmed/19619953

New York Times reviews "House of Numbers"

Eduard Grebe — Fri, 04 Sep 2009 13:59:57 +0000

From the New York Times:

Couched as a “personal journey” through the history of H.I.V. and AIDS, “House of Numbers” is actually a weaselly support pamphlet for AIDS denialists. Trafficking in irresponsible inferences and unsupported conclusions, the filmmaker Brent Leung offers himself as suave docent through a globe-trotting pseudo-investigation that should raise the hackles of anyone with even a glancing knowledge of the basic rules of reasoning.

Assembled from interview fragments with doctors, scientists, journalists and others, the film cobbles together an insinuating argument against the existence of H.I.V. as a virus and AIDS as the resulting disease. Among the many inflammatory claims is that diagnosis is a pharmaceutical-industry ruse to sell complex drug therapies (which the film then presents as the real cause of the syndrome we identify as AIDS). Evidence to support this and other highly dangerous contentions is found not in verifiable statistics (house of numbers, my foot) but in the impassioned anecdotes of individuals who have outlived the expectations of an H.I.V.-positive diagnosis.

Read the full review.

New York Times: Hope in South Africa

Eduard Grebe — Wed, 02 Sep 2009 21:10:35 +0000

The New York Times writes in an editorial titled Hope in South Africa:

For years, South Africa was an international laughing stock for its tragically absurd approach to the deadly AIDS epidemic. Now, that nationalnightmare may be ending.

The new government of President Jacob Zuma seems to have a clearer-eyed view of the problem, its remedies and the need to improve the overall health care system than its predecessor did. Fixing what’s broken will not be easy, but we are encouraged by signs of a commitment to do so.

To see how far South African leaders have come, one needs to recall where the country was.

The former president, Thabo Mbeki, compiled a record that is still hard to fathom: he embraced crackpot theories that disputed the demonstrable fact that AIDS was transmitted by a treatable virus. He insisted that antiretroviral drugs were toxic and encouraged useless herbal folk remedies instead. He even claimed he knew nobody with the disease, although nearly 20 percent of the adult population is said to be living with H.I.V.

Thousands of Africans were needlessly sickened and died. And the most influential country in sub-Saharan Africa squandered the opportunity to contain the AIDS epidemic. Although it has less than 1 percent of the world’s population, South Africa now accounts for 17 percent of the world’s burden of H.I.V. infection.

A saner approach began to take shape last year after Mr. Mbeki was forced out of office and Barbara Hogan was named health minister. Last week, the new health minister, Dr. Aaron Motsoaledi, went further.

He accepted a withering critique by South African scientists, who said the governing African National Congress party’s record on AIDS and health care was deeply flawed, and promised remedial action. “We do take responsibility for what has happened and responsibility for how we move forward,” Dr. Motsoaledi said in an article by The Times’s Celia Dugger.

South Africa’s leaders must espouse sensible, scientifically based advice about AIDS and put in place programs that seek to both treat and prevent the disease. That means expanding efforts to prevent mothers from infecting their babies, discouraging people from having multiple sex partners and offering circumcision to men, a relatively simple surgical procedure proved to have greatly reduced the risk of infection in South Africa.

The problem is bigger than AIDS. Even though South Africa spends more on health than any other African country, tuberculosis is rampant and child mortality rates are rising. The government must work to improve the quality of health care, ensure that all South Africans have access to the system and fire incompetent staff.

None of this will reverse the damage and deaths of Mr. Mbeki’s disastrous legacy, but it can offer the people of South Africa a better future.

Evidence accumulating on benefits of starting HAART earlier

Eduard Grebe — Thu, 20 Aug 2009 15:34:55 +0000

A number of studies showing a benefit to starting antiretroviral therapy earlier have been reported recently. These have resulted in important changes to guidelines including that infants should be treated immediately upon diagnosis and that adults should be treated as soon as their CD4 counts fall below 350 cells/mm3.

Determining the optimal time to start treatment is one of the most important unanswered questions about antiretroviral treatment. A large open-label treatment trial called START has begun and will likely answer this question within the next few years. It is open to HIV-positive volunteers with CD4 counts > 500 cells/mm3. Volunteers will be randomised to either start treatment immediately or defer treatment until their CD4 counts drop to below 350 cells/mm3 or treatment is clinically indicated.

A few of the studies showing the benefits of earlier treatment than guidelines previously recommended are listed below:

Effect of early versus deferred antiretroviral therapy for HIV on survival

N Engl J Med. 2009 Apr 30;360(18):1897-9.

Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, Hogg RS, Deeks SG, Eron JJ, Brooks JT, Rourke SB, Gill MJ, Bosch RJ, Martin JN, Klein MB, Jacobson LP, Rodriguez B, Sterling TR, Kirk GD, Napravnik S, Rachlis AR, Calzavara LM, Horberg MA, Silverberg MJ, Gebo KA, Goedert JJ, Benson CA, Collier AC, Van Rompaey SE, Crane HM, McKaig RG, Lau B, Freeman AM, Moore RD; NA-ACCORD Investigators.

BACKGROUND: The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain. METHODS: We conducted two parallel analyses involving a total of 17,517 asymptomatic patients with HIV infection in the United States and Canada who received medical care during the period from 1996 through 2005. None of the patients had undergone previous antiretroviral therapy. In each group, we stratified the patients according to the CD4+ count (351 to 500 cells per cubic millimeter or >500 cells per cubic millimeter) at the initiation of antiretroviral therapy. In each group, we compared the relative risk of death for patients who initiated therapy when the CD4+ count was above each of the two thresholds of interest (early-therapy group) with that of patients who deferred therapy until the CD4+ count fell below these thresholds (deferred-therapy group). RESULTS: In the first analysis, which involved 8362 patients, 2084 (25%) initiated therapy at a CD4+ count of 351 to 500 cells per cubic millimeter, and 6278 (75%) deferred therapy. After adjustment for calendar year, cohort of patients, and demographic and clinical characteristics, among patients in the deferred-therapy group there was an increase in the risk of death of 69%, as compared with that in the early-therapy group (relative risk in the deferred-therapy group, 1.69; 95% confidence interval [CI], 1.26 to 2.26; P<0.001). In the second analysis involving 9155 patients, 2220 (24%) initiated therapy at a CD4+ count of more than 500 cells per cubic millimeter and 6935 (76%) deferred therapy. Among patients in the deferred-therapy group, there was an increase in the risk of death of 94% (relative risk, 1.94; 95% CI, 1.37 to 2.79; P<0.001). CONCLUSIONS: The early initiation of antiretroviral therapy before the CD4+ count fell below two prespecified thresholds significantly improved survival, as compared with deferred therapy. 2009 Massachusetts Medical Society

PMID: 19339714

Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies

Lancet. 2009 Apr 18;373(9672):1314-6. Free full-text article.

When To Start Consortium, Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, Funk MJ, Geskus RB, Gill J, Dabis F, Miró JM, Justice AC, Ledergerber B, Fätkenheuer G, Hogg RS, Monforte AD, Saag M, Smith C, Staszewski S, Egger M, Cole SR.

BACKGROUND: The CD4 cell count at which combination antiretroviral therapy should be started is a central, unresolved issue in the care of HIV-1-infected patients. In the absence of randomised trials, we examined this question in prospective cohort studies. METHODS: We analysed data from 18 cohort studies of patients with HIV. Antiretroviral-naive patients from 15 of these studies were eligible for inclusion if they had started combination antiretroviral therapy (while AIDS-free, with a CD4 cell count less than 550 cells per microL, and with no history of injecting drug use) on or after Jan 1, 1998. We used data from patients followed up in seven of the cohorts in the era before the introduction of combination therapy (1989-95) to estimate distributions of lead times (from the first CD4 cell count measurement in an upper range to the upper threshold of a lower range) and unseen AIDS and death events (occurring before the upper threshold of a lower CD4 cell count range is reached) in the absence of treatment. These estimations were used to impute completed datasets in which lead times and unseen AIDS and death events were added to data for treated patients in deferred therapy groups. We compared the effect of deferred initiation of combination therapy with immediate initiation on rates of AIDS and death, and on death alone, in adjacent CD4 cell count ranges of width 100 cells per microL. FINDINGS: Data were obtained for 21 247 patients who were followed up during the era before the introduction of combination therapy and 24 444 patients who were followed up from the start of treatment. Deferring combination therapy until a CD4 cell count of 251-350 cells per microL was associated with higher rates of AIDS and death than starting therapy in the range 351-450 cells per microL (hazard ratio [HR] 1.28, 95% CI 1.04-1.57). The adverse effect of deferring treatment increased with decreasing CD4 cell count threshold. Deferred initiation of combination therapy was also associated with higher mortality rates, although effects on mortality were less marked than effects on AIDS and death (HR 1.13, 0.80-1.60, for deferred initiation of treatment at CD4 cell count 251-350 cells per microL compared with initiation at 351-450 cells per microL). INTERPRETATION: Our results suggest that 350 cells per microL should be the minimum threshold for initiation of antiretroviral therapy, and should help to guide physicians and patients in deciding when to start treatment.

PMID: 19361855

Early antiretroviral therapy and mortality among HIV-infected infants

N Engl J Med. 2008 Nov 20;359(21):2233-44.

Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, Jean-Philippe P, McIntyre JA; CHER Study Team.

BACKGROUND: In countries with a high seroprevalence of human immunodeficiency virus type 1 (HIV-1), HIV infection contributes significantly to infant mortality. We investigated antiretroviral-treatment strategies in the Children with HIV Early Antiretroviral Therapy (CHER) trial. METHODS: HIV-infected infants 6 to 12 weeks of age with a CD4 lymphocyte percentage (the CD4 percentage) of 25% or more were randomly assigned to receive antiretroviral therapy (lopinavir-ritonavir, zidovudine, and lamivudine) when the CD4 percentage decreased to less than 20% (or 25% if the child was younger than 1 year) or clinical criteria were met (the deferred antiretroviral-therapy group) or to immediate initiation of limited antiretroviral therapy until 1 year of age or 2 years of age (the early antiretroviral-therapy groups). We report the early outcomes for infants who received deferred antiretroviral therapy as compared with early antiretroviral therapy. RESULTS: At a median age of 7.4 weeks (interquartile range, 6.6 to 8.9) and a CD4 percentage of 35.2% (interquartile range, 29.1 to 41.2), 125 infants were randomly assigned to receive deferred therapy, and 252 infants were randomly assigned to receive early therapy. After a median follow-up of 40 weeks (interquartile range, 24 to 58), antiretroviral therapy was initiated in 66% of infants in the deferred-therapy group. Twenty infants in the deferred-therapy group (16%) died versus 10 infants in the early-therapy groups (4%) (hazard ratio for death, 0.24; 95% confidence interval [CI], 0.11 to 0.51; P<0.001). In 32 infants in the deferred-therapy group (26%) versus 16 infants in the early-therapy groups (6%), disease progressed to Centers for Disease Control and Prevention stage C or severe stage B (hazard ratio for disease progression, 0.25; 95% CI, 0.15 to 0.41; P<0.001). Stavudine was substituted for zidovudine in four infants in the early-therapy groups because of neutropenia in three infants and anemia in one infant; no drugs were permanently discontinued. After a review by the data and safety monitoring board, the deferred-therapy group was modified, and infants in this group were all reassessed for initiation of antiretroviral therapy. CONCLUSIONS: Early HIV diagnosis and early antiretroviral therapy reduced early infant mortality by 76% and HIV progression by 75%. (ClinicalTrials.gov number, NCT00102960.) 2008 Massachusetts Medical Society

PMID: 19020325

Starting Antiretroviral Therapy Earlier Yields Better Clinical Outcomes: Interim Review Leads to Early End of Clinical Trial in Haiti

Monday, June 8, 2009. National Institute of Allergy and Infectious Diseases (NIAID) - Press Release

A clinical trial has demonstrated that HIV-infected adults in a resource-limited setting are more likely to survive if they start antiretroviral therapy (ART) before their immune systems are severely compromised.

On May 28, 2009, an independent data and safety monitoring board (DSMB) met to conduct an interim review of an ongoing clinical study known as CIPRA HT 001, which is being conducted in Haiti. The DSMB found overwhelming evidence that starting ART at CD4+ T cell counts—a measure of immune health—between 200 and 350 cells per cubic millimeter (mm3) improves survival compared with deferring treatment until CD4+ T cells drop below 200 cells/mm3. In light of these results, the DSMB recommended that the trial sponsor—the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health—end the trial immediately, before its scheduled conclusion. NIAID agreed with the DSMB recommendation, and all study participants who have fewer than 350 CD4+ T cells/mm3 will be offered ART.

The study investigators say this new finding has the potential to change the standard of care for HIV infection in dozens of countries around the world where ART is initiated only when CD4+ T cell counts drop below 200 cells/mm3. Like the results of several recent epidemiologic studies in developed countries that examined the optimal time to begin ART, the new finding underscores the importance of identifying people who are HIV-infected earlier in the course of their infection and starting ART earlier.

“The public health community now has evidence from a randomized, controlled clinical trial—the gold standard—that starting ART at CD4+ T cell counts between 200 and 350 cells/mm3 in resource-limited settings yields better health outcomes than deferring treatment until CD4+ T cell counts drop below 200 cells/mm3,” says NIAID Director Anthony S. Fauci, M.D.

“The number of people who meet the medical criteria for receiving ART likely will grow as treatment guidelines are revised as a consequence of this finding, challenging the global community to supply antiretroviral drugs to all who need them,” adds Carl Dieffenbach, Ph.D., director of the NIAID Division of AIDS. “Today, only 30 percent of HIV-infected individuals in low- and middle-income countries who need ART are receiving it.”

The clinical trial CIPRA HT 001 began in 2005. It is funded by NIAID through the Comprehensive International Program of Research on AIDS (CIPRA) and is being carried out by the Haitian Group for the Study of Kaposi’s Sarcoma and Immune Deficiency Disorders (GHESKIO) Centers in Port-au-Prince, Haiti. The principal investigator is Jean William Pape, M.D., the director of the GHESKIO Centers and a professor of medicine at Weill Medical College of Cornell University.

The trial enrolled 816 HIV-infected adults ages 18 and older with early HIV disease and CD4+ T cell counts between 200 and 350 cells/mm3. Half of the participants were assigned at random to begin ART within two weeks of enrollment, and the other half were assigned to defer treatment until their CD4+ T cell counts dropped below 200 cells/mm3 or they were diagnosed with AIDS. This deferred treatment is in keeping with the standard of care in Haiti and the current guidelines of the World Health Organization (WHO). The first-line treatment regimen consisted of the anti-HIV drugs zidovudine, lamivudine and efavirenz.

At the time of the DSMB interim review, six participants in the early treatment group had died, while 23 participants in the standard-of-care group had died—nearly four times as many. The DSMB also found that, among participants who began the study without tuberculosis (TB) infection, 18 people in the early treatment had developed TB, while 36 people—twice as many—in the standard-of-care group had developed TB. These results were statistically significant.

In light of these results, the DSMB recommended that NIAID end the trial immediately and that the study team offer ART to all participants in the standard-of-care group who have fewer than 350 CD4+ T cells/mm3. The DSMB also recommended that the study team continue to follow all participants for another year and make every effort to ensure that participants receiving ART continue their therapy. NIAID concurred with these recommendations.

The study investigators are notifying all participants and have notified institutional review boards and national ethics committees involved with CIPRA HT 001 as well as the Haitian Ministry of Health about the findings of the DSMB. Investigators also have shared the information with WHO, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

For more information about CIPRA HT 001, see Questions and Answers: The CIPRA HT 001 Clinical Trial.

For more information about HIV/AIDS prevention, treatment and research, go to www.aids.gov.

Another myth debunked: HIV tests are unreliable and frequently produce false positives

Eduard Grebe — Sat, 01 Aug 2009 14:41:44 +0000

Fact: HIV tests for antibodies or the virus itself are highly reliable (both in terms of sensitivity and specificity).

There are two important measures when considering the accuracy of an HIV test or any screening or diagnostic test: sensitivity and specificity.

Two different HIV rapid tests both showing a positive result

Sensitivity is a measure of how likely it is that the test will return positive results if the person being tested has HIV. A highly sensitive test is calibrated to capture every positive sample, but will probably produce some false positives because it is so sensitive that may react to other substances as well.

Specificity is a measure of how likely it is that the test will return negative results if the person being tested does not have HIV. A highly specific test will only react to the substance being tested for and exclude all true negatives, but it will also produce false negatives.

Read the full debunking on the myths page.

David Rasnick fails to declare conflict of interests

Eduard Grebe — Fri, 31 Jul 2009 18:47:51 +0000

David Rasnick is a co-author with Peter Duesberg and others of an article in Medical Hypothesis which claims that HIV is not the cause of AIDS. The abstract of the article states, "we call into question the claim that HIV antibody-positives would benefit from anti-HIV drugs, because these drugs are inevitably toxic and because there is as yet no proof that HIV causes AIDS." [1]

We note an undeclared conflict of interests in this article by David Rasnick. Rasnick was a researcher for a company called the Rath Health Health Foundation Africa. This organisation promoted and distributed (and in terms of South African law, sold) micronutrient products as alternatives to antiretroviral treatment in South Africa. It also conducted an unauthorised clinical trial using these products as alternatives to antiretrovirals on people with HIV. The company never published the results of this trial in a peer-reviewed medical journal, but instead published adverts purporting to report the trial's results, a practice that is considered unethical in medical research. Rasnick is described in these adverts as one of the researchers on the trial.

A case was brought by the Treatment Action Campaign and South African Medical Association against the company's owner, Matthias Rath, the Rath Health Foundation Africa, Rasnick and others in the Cape High Court in which the court was requested to interdict the unauthorised trial from continuing. The court found in favour of the plaintiffs and ruled that the defendants, including Rasnick, had indeed conducted an unauthorised clinical trial. [2] Several deaths occurred on the trial which have been documented by the TAC and others. [3] This is not the first time Rasnick has been involved in academic misconduct. He has previously misrepresented his affiliation with the University of California Berkley. [4]

The Nuremberg code was established partly in response to Nazi experimentation on human subjects during World War II. It establishes the minimum standards experiments involving humans should adhere to. It states:

...

2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.

3. The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the experiment.

4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.

5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur ... [5]

The unauthorised trial in which Rasnick was involved breaches nearly every clause of the Nurember code, particularly those above. Proper informed consent from the trial participants was also not obtained. There can be few crimes by a medical researchers as heinous as running an unauthorised experiment on human beings. While the court ruling in South Africa was a civil one, there can be little doubt that Rasnick is guilty of a grievous crime for which he should be prosecuted.

References:

1. Duesberg, P.H., Nicholson, J.M., Rasnick, D., Fiala, C. & Bauer, H.H. HIV-AIDS hypothesis out of touch with South African AIDS - A new perspective. Med. Hypotheses (2009). doi:10.1016/j.mehy.2009.06.024 http://www.ncbi.nlm.nih.gov/pubmed/19619953

2. Zondi J. Judgment in TAC and Others v. Matthias Rath and Others. 2008. http://www.tac.org.za/community/files/file/TACAndSAMAVersusRathAndGovernmentJudgment.pdf
3. TAC. Analysis of deaths on Matthias Rath illegal clinical trial. 2005. http://www.tac.org.za/Documents/ns02_11_2005.htm
4. TAC. The Citizen's publicity for AIDS denialists is irresponsible. 2006. http://www.tac.org.za/community/node/2214
5. Nuremberg Code. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10, Vol. 2, pp. 181-182.. Washington, D.C.: U.S. Government Printing Office, 1949. http://ohsr.od.nih.gov/guidelines/nuremberg.html

Precursor to HIV causes disease progression in wild chimpanzees

Eduard Grebe — Thu, 30 Jul 2009 22:35:02 +0000

AIDS denialists have claimed that the lack of disease progression in chimpanzees infected with HIV is evidence that the virus is at worst a passenger in human beings and cannot be the cause of AIDS. This was, for example, implied by the journalist Celia Farber in her AIDS denialist piece published in Harper's in 2006.

In the response to Farber, to which several of the AIDSTruth.org team contributed, we wrote:

It is true that HIV replicates inefficiently in chimpanzees, to a much lower level than it does in humans so it usually does not cause disease. However, there are recorded examples of HIV causing immunodeficiency in these animals.

Many agents which cause disease in man are unable to cause disease in a host of other species because they fail to infect, or infect poorly, or produce a different response. HIV has probably been in the chimpanzee population for a very long time. Therefore it is plausible that natural selection has rendered it less harmful.

There is now new compelling evidence that we understated the extent of Farber's factual error. A team of researchers led by Brandon Keele and Beatrice Hahn have analysed mortality in wild chimpanzees infected with SIVcpz, the immediate precursor of HIV-1. They following 94 wild chimpanzees in Tanzania. They found a 10- to 16-fold higher age-corrected death hazard for SIVcpz-infected chimpanzees compared to uninfected chimpanzees. They also found that SIVcpz-infected females were less likely to give birth and had a higher infant mortality rate than uninfected ones. Furthermore, disease progression was associated with a declining CD4 T cell count and increased viral replication, which is characteristic of HIV infection in humans.

They therefore conclude:

These findings challenge the prevailing view that all natural SIV infections are non-pathogenic and suggest that SIVcpz has a substantial negative impact on the health, reproduction and lifespan of chimpanzees in the wild.

Denialists have claimed that AIDS in humans is caused by poverty, antiretrovirals and recreational drugs such as poppers. These explanations are debunked on the AIDStruth myths page and obviously cannot explain disease progression in SIVcpz-infected chimpanzees. This is further evidence that they are not the cause of AIDS in humans.

Here is the abstract of Keele et al.'s letter to Nature:

Keele, B.F. et al. Increased mortality and AIDS-like immunopathology in wild chimpanzees infected with SIVcpz. Nature 460, 515-519 (2009).

African primates are naturally infected with over 40 different simian immunodeficiency viruses (SIVs), two of which have crossed the species barrier and generated human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2). Unlike the human viruses, however, SIVs do not generally cause acquired immunodeficiency syndrome (AIDS) in their natural hosts. Here we show that SIVcpz, the immediate precursor of HIV-1, is pathogenic in free-ranging chimpanzees. By following 94 members of two habituated chimpanzee communities in Gombe National Park, Tanzania, for over 9 years, we found a 10- to 16-fold higher age-corrected death hazard for SIVcpz-infected (n = 17) compared to uninfected (n = 77) chimpanzees. We also found that SIVcpz-infected females were less likely to give birth and had a higher infant mortality rate than uninfected females. Immunohistochemistry and in situ hybridization of post-mortem spleen and lymph node samples from three infected and two uninfected chimpanzees revealed significant CD4⁺ T-cell depletion in all infected individuals, with evidence of high viral replication and extensive follicular dendritic cell virus trapping in one of them. One female, who died within 3 years of acquiring SIVcpz, had histopathological findings consistent with end-stage AIDS. These results indicate that SIVcpz, like HIV-1, is associated with progressive CD4⁺ T-cell loss, lymphatic tissue destruction and premature death. These findings challenge the prevailing view that all natural SIV infections are non-pathogenic and suggest that SIVcpz has a substantial negative impact on the health, reproduction and lifespan of chimpanzees in the wild.

New myth debunked: HIV is an endogenous retrovirus

Eduard Grebe — Wed, 08 Jul 2009 21:14:43 +0000

Fact: HIV has been shown to be exogenous throughout 20+ years of research.

An endogenous retrovirus is one whose genetic material has been incorporated into that of the host. This happens when the genome of the virus incorporates itself into the chromosome of the host's sex cell (sperm or egg) – or its progenitor – and thus, upon fertilization becomes part of the normal genome found in every cell in the body of the host. Over time, the endogenous retroviral genome usually accumulates deleterious mutations rendering it incapable of productive infection. One myth used by denialists is that HIV is one of these endogenous retroviruses. However, several lines of evidence from the published scientific literature refute this claim, and prove that it is an exogenous virus, found only in CD4+ T-cells and a few other CD4+ cell types (such as macrophages) and not found in most other host cells.

Early evidence:

In the very first publication regarding the identification of HIV, Dr. Luc Montagnier described several experiments showing that HIV was exogenous. The controls used in his co-culture experiments, for example, did not produce a reverse transcriptase signal, only those cells exposed to infected patient lymphocytes. This indicates that the signal did not originate from the genome of the uninfected donor cells. The RT signal (and thus the virus) was able to be passed on to other uninfected lymphocyte cultures and resulted in a similar RT signal pattern. This passing on of the virus is another line of evidence that HIV is unlikely to be endogenous [1].

Southern Blots:

The southern blot is a method for probing for the presence of a specific DNA sequence within a DNA sample. In southern blot hybridization, a small segment of single-stranded DNA is hybridized to genomic DNA. There is nothing in the human genome that hybridizes at reasonable stringency levels (i.e. the specificity of the test) to probes made from HIV-1 or HIV-2 proviral genomes[2]. One study did find two very short sequences (192bp and ~30bp) with some similarity (<60% and 95% respectively) to parts of the HIV genome. However, these two sequences were detected only under very low stringency (low specificity) and no other sequences with similarity to HIV were found [3].

PCR:

In experiments using PCR (another method for detecting specific genetic sequences) in infected patients’ lymphocytes, PCR detects HIV in only a fraction of the infected donor’s T-Cells [4]. This alone is enough to demonstrate that HIV cannot be endogenous. An endogenous virus, by virtue of its past integration in host germ cells, would be detectable in all nucleated cells of the host. In other experiments, HIV DNA was found in the lymphocytes of patients but only very rarely in sperm cells [5]. The absence of HIV DNA from certain cell types in patients again refutes the idea that HIV is endogenous.

The Genome Projects:

The genome projects have been a valuable tool in the field of genetics and also refute the idea that HIV is endogenous. At the time this article was being written, only two examples existed in the scientific literature of endogenous lentiviruses in mammals: one in rabbits and one in lemurs [6][7]. All sequenced primate genomes (including several human genomes) show no endogenous lentiviral genomes.

Common Sense:

Some common sense combined with a brief look at infections would likewise indicate that HIV is not endogenous. If it were endogenous, sequences would be most similar between family members and most different between distantly related individuals. However, this is not the case. Europeans of non-West African descent have been identified with HIV-2 infection, despite HIV-2 being predominantly found in West Africa [8]. Conversely, many Africans have been infected by HIV-1. If one claims that HIV is endogenous, one therefore also claims that West Africans with HIV-2 infections are more closely related to non-West African Europeans with HIV-2 infection than they are to their HIV-1 infected countrymen. This is simply absurd.

References

1. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, Dauguet C, Axler-Blin C, Vézinet-Brun F, Rouzioux C, Rozenbaum W, Montagnier L. Science. 1983 May 20;220(4599):868-71. PMID: 6189183

2. Characterization of a continuous T-cell line susceptible to the cytopathic effects of the acquired immunodeficiency syndrome (AIDS)-associated retrovirus. Folks T, Benn S, Rabson A, Theodore T, Hoggan MD, Martin M, Lightfoote M, Sell K. Proc Natl Acad Sci U S A. 1985 Jul;82(13):4539-43. PMID: 2989831

3. Novel human endogenous sequences related to human immunodeficiency virus type 1. Horwitz MS, Boyce-Jacino MT, Faras AJ. J Virol. 1992 Apr;66(4):2170-9. PMID: 1548756

4. Sensitive detection of HIV DNA in T4 lymphocytes of infected individuals by polymerase chain reaction.

Hsia K, Spector SA; International Conference on AIDS. Int Conf AIDS. 1990 Jun 20-23; 6: 160

5. HIV-particles in spermatozoa of patients with AIDS and their transfer into the oocyte. Baccetti B, Benedetto A, Burrini AG, Collodel G, Ceccarini EC, Crisà N, Di Caro A, Estenoz M, Garbuglia AR, Massacesi A, et al. J Cell Biol. 1994 Nov;127(4):903-14. PMID: 7962075

6. Discovery and analysis of the first endogenous lentivirus. Aris Katzourakis, Michael Tristem, Oliver G. Pybus, and Robert J. Gifford Proc Natl Acad Sci U S A. 2007 April 10; 104(15): 6261–6265. PMCID: PMC1851024

7. Parallel Germline Infiltration of a Lentivirus in Two Malagasy Lemurs. Gilbert C, Maxfield DG, Goodman SM, Feschotte C, 2009 PLoS Genet 5(3): e1000425. doi:10.1371/journal.pgen.1000425

8. HIV-2 infection in 12 European residents : virus characteristics and disease progression. Van Der Ende M. E.; Schutten M.; Thaoi Duong LY; Gruters R. A.; Osterhaus A. D. M. E. AIDS ISSN 0269-9370 1996, vol. 10, no14, pp. 1649-1655 (23 ref.)

New study shows AIDS deaths under-recorded in South Africa

Eduard Grebe — Mon, 06 Jul 2009 08:30:25 +0000

Former South African President Thabo Mbeki disputed that there was a large AIDS epidemic in South Africa. (1) This was a cornerstone of his promotion of denialist policies. It was echoed by journalist Rian Malan in articles he wrote in Rolling Stone, the Spectator and Noseweek. (2) Mbeki expressed his scepticism when a state institution, the Medical Research Council, released a report titled Adult Mortality in South Africa. It presented unequivocal evidence that HIV was a growing and major cause of death in the country. (3) Mbeki's health minister, Manto Tshabalala-Msimang, tried to suppress the publication of this report. (4)

Over the last decade, the evidence of the country's large AIDS epidemic has accumulated. It is perhaps most succinctly explained with this graph, which demonstrates the unusual and disturbing changing age-pattern of death among adult women in South Africa from 1997 to 2004 , that can only be explained by the AIDS epidemic:

Source: http://www.tac.org.za/community/node/2182

The graph shows how in 2004 the vast majority of female adult deaths occur in young adults as opposed to older ones (compared with Brazil in 2004 and South Africa in 1997). The same pattern occurs in males, albeit that it is not quite as stark.

One of the arguments raised by Malan is that HIV was ranked quite low as a cause of recorded deaths in Statistics South Africa's mortality data and therefore was not a major cause of death. Malan is wrong: many doctors do not write HIV or AIDS as the cause of death on death notification forms (the source of Stats SA's mortality data). There are probably two reasons for this: (1) the disease is highly stigmatised and doctors do not want to put surviving family members at risk of discrimination, despite the fact that death certificate data is supposed to be confidential, and (2) patients with AIDS often die without finding out their status.

A new study has been published in AIDS that confirms this, i.e. that doctors often do not write HIV, AIDS or even a euphemism for these terms (such as retroviral disease or immunocompromised) on death notification forms of people who have died of AIDS.

Patricia Yudkin and her colleagues examined the medical records of all people 28 days or older who died in two suburbs in Cape Town from 1 June 2003 to 31 May 2004. 683 death notification forms were included in their final analysis. (5) Two doctors independently analysed the medical records to determine if AIDS was the cause of death. In the case of a conflicting diagnosis, a third doctor decided. They identified 129 deaths caused by HIV according to medical records. Yet only 35 (27.1%) were ascribed to AIDS on the death notification form. When the various euphemisms for AIDS were accounted for (known as interpretive coding) only 83 (64.3%) indicated AIDS.

With one exception (a 12% sample of all the mortality data published seven years ago), Stats SA reports since 2001 have classified a death as HIV/AIDS only if explicitly coded as such on the death notification form. They do not use interpretive coding because it would be extremely time-consuming to classify all the country's deaths this way.

Only one death was noted as AIDS on a death notification form but not classified as such by the study doctors, though even in this case the death was suggestive of HIV. The method of classification used by Yudkin et al. would still not have identified deaths of people who died of AIDS before presenting to a health facility or private doctor for diagnosis.

This study provides further evidence against the dogma that there is not a large HIV epidemic in South Africa.

References

1. Cherry M. Mbeki disputes AIDS statistics [Internet]. Nature Medicine. 2001 Nov ;7(11):1170.[cited 2009 Jul 4 ] Available from: http://www.popline.org/docs/1558/175308.html

2. Geffen N. Rian Malan Spreads Confusion about AIDS Statistics [Internet]. 2004 Jan 20;[cited 2009 Jul 5 ] Available from: http://www.tac.org.za/newsletter/2004/ns20_01_2004.htm

3. Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa [Internet]. 2001 Sep ;[cited 2009 Jul 5 ] Available from: http://www.mrc.ac.za/bod/complete.pdf

4. Cape Argus. Minister demanded 'corrective action' at MRC [Internet]. 2002 Apr 17;[cited 2008 Dec 29 ] Available from: http://www.capeargus.co.za/index.php?fSectionId=3571&fArticleId=ct200204...

5. Yudkin P, Burger E, Bradshaw D, Groenewald P, Ward A, Volmink J. Deaths caused by HIV disease under-reported in South Africa [Internet]. AIDS. 2009 Jun 10;[cited 2009 Jul 5 ] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19521232