HIV/AIDS denialism

HIV denial refers to the view that AIDS (acquired immune deficiency syndrome) is not caused by HIV (human immunodeficiency virus), but by some other factor, or combinations of factors. This is based on bad scientific foundations and false accusations similar to those of vaccine denialists that ART (antiretroviral therapy) is toxic. Such ideas have been scientifically shown to have dangerous consequences — the most infamous of these being the deaths of over 330,000 South Africans while a "review council" was set up by HIV denialists, delaying treatment.[1]

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Note: This article refers to the idea that HIV is not the cause of AIDS—it does not address the various ideas that AIDS is punishment from God, Nature's way of thinning the herd, or other moral questions.

History

In the early 1980s, the CDC reported several cases of Pneumocystis carinii pneumonia, a rare respiratory disease that only strikes people with severely compromised immune systems.[2] All of these cases occurred in gay men who had been otherwise healthy. Hospital wards began to fill up rapidly with formerly healthy young men with bizarre illnesses related to immune deficiency. Over time, this syndrome became known as Acquired Immune Deficiency Syndrome.[3] It was soon noticed that intravenous drug users were also suffering from similar illnesses, as were hemophiliacs. Despite lack of support from the Reagan administration, CDC epidemiologists were able to piece together a picture of a new blood-borne infection that seemed to single out certain unpopular groups of people.[4] Eventually, sub-Saharan Africa emerged as the epicenter of what was to become a deadly pandemic.

Denialism

The loudest and earliest voice for denialism is Peter Duesberg, Ph.D., a prominent U.C. Berkeley retrovirologist. He is the most notable of the denialists because of his influence and his scientific acumen in non-HIV-related work. He has contended at least since 1987 that illicit drugs, AZT (an anti-HIV drug) and other factors are the real cause of AIDS. Some of his original assertions follow.[5]

Indeed the virus is not sufficient to cause AIDS
(a) because the percentage of symptomatic carriers is low and varies between 0 and 5% with the risk group of the carrier, suggesting a cofactor or another cause;
This has turned out to be false. Almost all people with HIV develop AIDS if untreated. A notable exception is people with mutations to the gene that codes for the CCR5 receptor, which is partially protective.
(b) because the latent period for AIDS is 5 years compared to an eclipse of only days to weeks for replication and direct pathogenic and immunogenic effects; and
A truly irrelevant observation. The latency of symptoms says nothing about causation.
(c) because there is no gene with a late AIDS function since all viral genes are essential for replication. Moreover, the extremely low levels of virus expression and infiltration cast doubt on whether the virus is even necessary to cause AIDS or any of the other diseases with which it is associated. Typically, proviral DNA is detectable in only 15% of AIDS patients and then only in 1 of 102 to 103 lymphocytes and is expressed in only 1 of 104 to 105 lymphocytes. Thus, the virus is inactive or latent in carriers with and without AIDS. It is for this reason that it is not transmitted as a cell-free agent. By contrast, all other viruses are expressed at high titers when they function as pathogens. Therefore AIDS virus could be just the most common occupational infection of those at risk for AIDS because retroviruses are not cytocidal and unlike most viruses persist as latent, nonpathogenic infections. As such the virus is an indicator of sera that may cause AIDS. Vaccination is not likely to benefit virus carriers because nearly all have active antiviral immunity.
Since the use of PCR and bDNA techniques, it has been shown that HIV virions, even in asymptomatic individuals, circulate at very high levels.

The next year,[6] responding to critics, he postulated that, among other things, HIV failed to fulfill Koch's postulates. A strong response was given by Gallo and other respected scientists in the field.

His latest ideas vary little from his publications of 20 years ago.[7][note 1] He continues to tout the "Chemical AIDS Hypothesis". AIDS is purportedly caused by a combination of recreational drugs, anti-HIV drugs, and malnutrition, and claims that HIV is neither necessary nor sufficient to cause AIDS. An editorial accompanying one of his papers endorsed this idea and cited the "gay lifestyle", which seems quite bizarre, given the AIDS pandemic is most prevalent in heterosexuals in the developing world. His criticisms have been dealt with in many publications, but, like any good crank, he recycles the same, unchanging arguments over and over.[8] His publications do not seem to address the fact that AIDS is successfully treated with anti-HIV medications.[9]

Another American organization which is associated with HIV denialism is Doctors for Disaster Preparedness. By a curious quirk of fate no less a personage than Andrew Schlafly was a featured speaker at Doctors for Disaster Preparedness' July 2008 annual conference, where he spoke on "The Education of the World's Great Thinkers".[10]

In Africa

In Sub-Saharan Africa there has been a significant, but very different denialist movement, mostly from political leaders such as Thabo Mbeki of South Africa, where AIDS has been referred to as an "Afrikaner Invention to Deprive us of Sex." Much of the denial rested on work of people like Duesberg, and allowed governments to avoid addressing the main issues of HIV prevention and treatment.

Mbeki's denialism was based, by his own admission, on research he had performed on the Internet[11], and partly because of skepticism and suspicion of all things Western. As the main makers of HIV drugs are Western, he might believe that pharmaceutical companies are simply trying to make money.[12] The other part of Mbeki's denialism is the desire to shift blame for South Africa's problem; if AIDS is the result of poverty or malnutrition, it's not the fault of the post-Apartheid government and the problem will be solved by reelecting Mbeki. But once blame has been shifted, even though the government didn't cause AIDS, avoiding responsibility for dealing with the problem means the government is directly responsible for the suffering caused by denial in the first place.

Another theory, espoused by South African satirical cartoonist Zapiro (and, in fact, most South African satirists), is that Mbeki has his head so deep in the sand he may be in violation of China's mineral rights.

In November 2008 the Guardian reported that the AIDS policy of Thabo Mbeki's government was directly responsible for the avoidable deaths of a third of a million people.[13]

There is a popular belief in many African and Caribbean countries that AIDS is caused not by HIV, but by voodoo curses.[14][15] Tragically, a proposed cure suggested to men afflicted with AIDS has been to rape virgin girls (the virgin cleansing myth).

In the Philippines

Sixty percent of young Filipinos believe that they cannot contract HIV, and 20% believe incorrect information about virus transmission.[16] The Philippines has "the fastest-growing HIV/AIDS epidemic in the Asia-Pacific in the past six years with a 140 percent increase in new infections".[17]

Evidence

AIDS presented a unique challenge of both ideas and technology. Fortunately, the technology necessary to identify HIV was just being developed for other purposes. The first AIDS patients were often afflicted by multiple infections and cancers, making the identification of a unique cause difficult.

Clues

One of the first clues to the cause of the AIDS epidemic was the mode of transmission. People who acquired AIDS were exposed to blood and body fluids of others with the disease. Hemophiliacs received multiple blood transfusions. Though the blood they received was filtered, they became ill. Viruses (and only viruses) were able to pass through these filters. Also, hemophiliacs were a more diverse group of people, without the other putative exposures of male homosexuals and IV drug users. This led epidemiologists and researchers to consider a virus as being the ultimate cause of AIDS, and not some combination of drugs, sexual practices, and co-infections.

Another clue came from cell biology. The primary cell-type destroyed in AIDS is the CD4+ lymphocyte. There had been recent discoveries that retroviruses could infect CD4+ lymphocytes.[18] In fact a model existed in HTLV-1, a virus that is blood borne and infects CD4+ cells. HTLV was one of the first viruses thought to cause AIDS. Once HIV was isolated, testing was developed, and HIV was found to be universally present in all people with AIDS, while no other agent was present in all of these patients. By 1984, HIV was found to be strongly attracted to CD4+ cells, was isolated from AIDS patients from many different areas, and similar viruses were found that caused AIDS in other primates.

Also, people who have mutations of the CCR5 surface protein (which assists in HIV's entrance to the cell) are resistant to HIV infection and AIDS. Also, drugs that inhibit HIV replication prevent progression to AIDS.

Koch's postulates

These postulates, which are followed (at least generally) to prove the nature of an infectious agent, have been fulfilled for HIV. Some examples are given below, but it is hardly comprehensive.

  • The microorganism must be found in all organisms suffering from the disease.
Of course, "all" is difficult to prove, given that there may always be someone with AIDS who is not known to the medical system, but studies have consistently found HIV in AIDS patients, and it is standard practice to test AIDS patients not only for antibodies to HIV but for HIV itself. Early studies of AIDS showed HIV in all patients examined.
  • The microorganism must be isolated from a diseased organism and grown in a culture.
This has been done.[18]
  • The cultured microorganism should cause disease when introduced into a healthy organism.
This has been shown in both humans and simians.
  • The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.
While not done in humans in the lab, genotyping has allowed scientists to trace known exposures and specific viruses, fulfilling the postulate.

Other claims

Those advocating HIV denialism often make a number of other claims regarding the relationship between HIV, AIDS and anti-retroviral medication that are false or misleading.

AZT

AZT (azidothymidine, zidovudine, originally marketed as Retrovir) is the first antiretroviral that was approved for use by HIV/AIDS patients. Objections to AZT still are routinely brought up by HIV denialists today, making reference to problematic high-dosage regimes that many early patients were put on, to the development of AZT resistance, or the difficult side effects of AZT.

While the points that HIV denialists make are sometimes true, this is all something of a historical red herring. AZT does not usually form the basis for current antiretroviral treatment of HIV and AIDS. A mixture or 'cocktail' of drugs is now used, with each drug in the cocktail using a different biological method to prevent the duplication and spread of HIV. As medical science has advanced, the drugs used in antiretroviral treatment have been modified to reduce the side effects.

Testing

HIV denialists claim that antibody tests used to diagnose HIV are unreliable and claim this is due to the use of antibody testing. Rapid HIV testing looks for the antibodies that the immune system builds up in response to the virus rather than looking for the virus itself. Rapid HIV antibody testing is used because it is fast and can be conducted by a nurse or even by the patient themselves (in the case of some home testing kits) rather than requiring expensive and time-consuming laboratory resources. An HIV diagnosis is not given on the basis solely of a rapid HIV test: if the rapid antibody test returns positive, it is always followed by a Western blot test. A positive Western blot confirms an HIV infection.[19] Numerous studies have been done that confirm that the false positive and negative rates from testing are extremely low.

Summary

HIV/AIDS has been an example of the most spectacular medical and scientific work of the last 50 years. Shortly after the discovery of an illness, the cause was found, and successful drugs were developed. With the introduction of protease inhibitors and Highly Active Anti-Retroviral Therapy in the late 1990s, hospital AIDS wards in the developed world closed down for lack of patients.

These achievements have been matched only by the massive public health failure in stemming the world pandemic of HIV.

While a scientific consensus (backed up with ample scientific evidence) regarding the link between HIV and AIDS exists, some continue to doubt it. However, their faulty arguments fall flat in the face of facts, though this does not seem to concern them or divert them from their conclusions. Quite astonishingly, many denialists seem capable of clinging to their conviction that AIDS either does not exist or has nothing to do with HIV until the day they die — from AIDS.[20]

It should be noted that declassified KGB documents have revealed that the Soviet Union had a little something going on known as Operation INFEKTIONFile:Wikipedia's W.svg which tried to pin the blame for AIDS on the US government.[21]

gollark: That's arbitrary.
gollark: Yes, it is... so what?
gollark: Yes, definitely.
gollark: Psi has good alternatives to jetpacks, though.
gollark: Perhaps.

See also

Notes
  1. Which, in a field characterised by intense research and a rapidly-changing state of scientific knowledge, is a major red flag all by itself.

References
  1. http://www.yale.edu/macmillan/apartheid/nattrassp2.pdf
  2. Pneumocystis pneumonia — Los Angeles. MMWR Morb Mortal Wkly Rep 1981;30:250-252)
  3. New England Journal of Medicine, Volume 344:1764-1772 June 7, 2001, Number 23
  4. Shilts, R. And the Band Played On. St. Martin's Press, 1987.
  5. Peter H. Duesberg. Retroviruses as Carcinogens and Pathogens: Expectations and Reality. Cancer Research, Vol. 47, pp. 1199-1220.link
  6. Peter H. Duesberg. HIV Is Not the Cause of AIDS.Science, Vol.241, pp. 514-517, July 29, 1988. link
  7. Duesberg, P., Koehnlein, C. and Rasnick, D. (2003) The Chemical Bases of the Various AIDS Epidemics: Recreational Drugs, Anti-viral, Chemotherapy, and Malnutrition. (J. Biosci. 28: 383-412)Link
  8. Ascher, M.S., Does drug use cause AIDS? Nature. Volume 362, 11 March 1993.
  9. Ormaasen V, Sandvik L, Dudman SG, Bruun JN. HIV-related and non-HIV related mortality before and after the introduction of highly active antiretroviral therapy (HAART) in Norway compared to the general population.Scand J Infect Dis. 2007;39(1):51-7.
  10. | Schlafly teaches world's greatest thinkers shock!
  11. Smith TC, Novella SP (2007) HIV Denial in the Internet Era. PLoS Med 4(8): e256. doi:10.1371/journal.pmed.0040256
  12. NY Times article on Mbeki's attitude towards AIDS pharmaceuticals
  13. Guardian — Thabo Mbeki's responsible for 330,000 deaths. A press release for the JAIDS paper can be found here and the paper in African Affairs can be found here.
  14. http://news.bbc.co.uk/2/hi/americas/3280749.stm
  15. http://www.virusmyth.com/aids/hiv/mivoodoo.htm
  16. Three-Fifths of Filipino Youth Believe They Are Immune to HIV/AIDS, Survey Finds Kaiser Health News
  17. HIV: Philippines has highest infection rate in Asia-Pacific, United Nations says (August 1, 2017, 8:10pm) ABC News.
  18. Gallo, R. and Luc Montagnier. The Discovery of HIV as the Cause of AIDS. NEJM 349:24, 2283-2285. December 11, 2003
  19. http://www.nlm.nih.gov/medlineplus/ency/article/003538.htm
  20. AIDSTruth: Denialists who have died
  21. https://www.cia.gov/library/center-for-the-study-of-intelligence/csi-publications/csi-studies/studies/vol53no4/pdf/U-%20Boghardt-AIDS-Made%20in%20the%20USA-17Dec.pdf Soviet Bloc Intelligence and Its AIDS Disinformation Campaign PDF
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