As promised, a discussion on the paper, Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study.
First, let's backtrack a bit and see what's already been said, lest I repeat myself. The little summary below can also catch anyone up who's not up to wading through 250-odd comments. Those who've already done so can skip the quoted parts and scroll down...
[Note: I've uploaded a .pdf of the Padian paper for anyone to access Here.]
Hank Barnes said here about the paper:
1. It was the longest and largest epidemiological study of heterosexual tranmission of HIV (1986-1996);2. For 10 years, it followed 175 discordant couples, who had a lotta sex. "Discordant" means for each couple, 1 person was HIV+, and one was not.
3. So, obviously, if you're gonna have lots of sex with an HIV+ person, you're gonna get the virus, get AIDS and die, right?
4. After 10 years, the scientists found NO seroconversions.
5. The couples who used condoms, did not transmit the virus
6. The couples who failed to use condoms, did not transmit the virus
7. The couples that exclusively engaged in vaginal intercourse did not transmit the virus;
8. In fact, 39% of the couple engaged in anal sex -- they too did not transmit the virus.The only logical, scientific conclusion from the Padian report is that AIDS is not a sexually transmitted disease.
Indeed, How can you have a sexually transmitted disease, that is not transmitted by sex?
If anyone here disputes any of the fact I've recited above re Padian, please feel free to read the paper and tell me where I've erred.
More importantly, assume my recitation of the paper is true. Then, what logical, scientific conclusion would YOU reach regarding HIV?
Hank is factually correct about some aspects of the Padian paper. No seroconversions occurred during the course of Padian's study although some may have occurred prior to the study. Over 400 individuals in stable relationships were initially identified as potential participants in this study. When their partners were tested, 15% of the 400 couples were excluded at the outset because the partner was already HIV positive. There was no way to know whether the partners had acquired HIV from each other but neither was there any way to demonstrate that they hadn't.However, Hank is wrong about the duration of the study. Individuals were recruited over a ten year period. No couple was actually followed for anything even approaching ten years. 3000 couple months of follow-up for 175 serodiscordant couples - that's an average of less than two years per couple.
Also there have been other studies of heterosexual transmission of HIV that do show apparent seroconversion in individuals with no known risk factors other than a seropositive spouse. The conclusion of heterosexual transmission is subject of course to all the caveats that apply to studies of human beings.
Enter Darin Brown in the rudely hijacked thread:
Unfortunately, what you say is completely wrong, assuming that the sexual encounters are identically and independently distributed, which would seem to be a fairly reasonable assumption in this case.Have you heard of random variables? Expected value? The situation you're describing is something studied in lower-division stats courses -- it's called the geometric distribution. You have a trial with 2 outcomes: success (probability p) and failure (probability q = 1 - p). The geometric distribution assigns to each positive integer n the probability of exactly n trials before success is reached. The situation you describe above is the case p = 1/1000.
Of course "3 seroconversions per hundred couple years doesn't mean 1 serodiscordant couple can go at it in relative safety for 33 years; or to use your numbers, that an HIV negative individual can have 999 sexual encounters before running into a problem." That's not what is being claimed. What's being claimed is a mathematical statement: that the expected number of sexual encounters before "success" is 1000 = 1/p. And, in fact, that is the case. A random variable with geometric distribution does indeed have mean equal to 1/p.
You are quite wrong with the lottery ticket analogy. It does not matter WHO buys the tickets, what matters is that the trials of buying a ticket to see if you win are identically and independently distributed. And this is true for lottery tickets, regardless of whether one person buys 1,000,000 tickets or 1,000,000 people each buy one ticket. The trials don't give a hoot about who's buying the tickets...why should they?
and Dale responds:
Darin, Your post in response to my post on the other hand demonstrates a lack of understanding (or a masterpiece of ignorance if you prefer that term) of biology.In particular your statement "assuming that the sexual encounters are identically and independently distributed, which would seem to be a fairly reasonable assumption in this case."
That might be a reasonable assumption to a mathematician but no biologist would ever make such an assumption, particular as applied to human beings.
Human beings are not a homogenous population, neither genetically nor with regard to the environments they live in. Some are more susceptible to HIV infection than others. Sexual encounters are not all the same,some incorporate more risk factors for transmission than others. The viruses themselves also vary genetically and that too will affect transmission rates.
The identification of any individuals in whom sexual transmission of the virus has occured says the virus can be transmitted sexually and a hundred or a thousand population studies such as Padians will not determine the true probability of transmission for any given individual at any given sexual encounter.
Hank Barnes impatiently returns:
1.The year is 1985 -- one year after the supposed "cause" of AIDS has been discovered -- a virus called HTLV-III (now called HIV). 2. The thought is HIV is sexually transmitted. 3. The thought is once acquired, within 2 years, you die. 4. Most of the folks dying of AIDS are gay males. But, this is a bit nonsensical, since viruses don't discriminate. They are real dumb and real small. 5. The thought is an infectious disease will likely move into the general population and kill a lot of people. 6. So, a buncha brilliant epidemiologists from San Francisco set out test the hypothesis: Find HIV+ people and observe what happens to their partners when they have a lotta sex. Clean. Easy. Crisp science. 7. So, the a priori hypothesis is this: We expect the uninfected partners of HIV+ people to become infected at some rate. 100%? 50%? Who knows? Padian does not say (for good reason). 8. We get a lotta $$ from the gov't to fund this study. It lasts 10 years. We test a lotta people for HIV. We follow them for years. They have a lotta sex. We keep re-testing them. So, How many got infected? The answer is:Zero. Zip. Zed. Nada. Nil. Nothing. Nobody.
NOT ONE SINGLE PERSON (175 discordant couples), after unlimited, abundant, (dare I even say wild and kinky?) sexual acts over 10 years contracts HIV. Not one.
Buried in the paper on pg 354 ("We observed no seroconversions after entry into the study").
Those are the facts. So, what is one to conclude?
My conclusion is that the connection between sex and AIDS has been proven false. Some folks don't like that conclusion. The ostrich crowd has emotionally invested in the wrong paradigm, and are unwilling to change their beliefs, despite the evidence. Not very scientific, mind you.
Myself, I go with the facts. NO SEROCONVERSIONS. You cannot have a sexually transmitted disease, where sexual activity is abundant, yet sexual transmission is non-existent.
So, put that in your pipe and smoke it!
Some mostly off-topic comments (for the Padian paper analysis anyway), and then Hank asked for this:
Please provide a cite for a 10-year study (or less, if you like) where uninfected folks did in fact become infected from heterosexual transmission of HIV.
Chris Noble enters with this:
OK I'll bite.Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda.
The Rakai cohort studies began in 1994.
While the researchers did not have the genitalia of the couples under an electron microscope at the time of transmission they did do sequence analyses to confirm transmission.
Note the strong dependence on the stage of infection upon transmission risk. This confirms earlier studies showing a relationship between viral load and transmission risk. It is also common sense. The risk of transmission of HSV is not constant. It varies with viral load and the amount of viral shedding.
The HIV+ member in Padian's serodiscordant couples had been infected for a period of time before the start of the study. None were in the initial infection stage.
The HIV dissidents may be surprised that this is exactly what Duesberg has been saying - that the transmission of HIV should be highest during the initial infection stage.
Hank then shifts the goalposts:
Your Ugandan study on heterosexual transmission is interesting, thanks.But, it seems awful late in the game (published in 2005, regarding results in 1994)
By the mid-1980's, the scientific community had already declared that HIV was heterosexually transmissible. Padian began her work 10-year study on this topic in 1985. I assert that her results, actually refuted the working-hypothesis.
The question is, What study of heterosexual transmission in the early 1980's formed the foundation to support the scientific assertion that AIDS was a sexually transmitted disease? Your cite of Rakai is interesting, but dislocated from the historical development of the disease.
Noble "ET AL" -- You really must learn to read the body of scientific papers in addition to the abstracts, just like Hank has pointed out (n-times, n > 7). Because if you had read the body, you would know that overall transmission rate in the Rakai study was 1 in 856, over a whopping total of 6700 couple-months. That's more than TWICE as many couple-months as Padian! They even admit in the discussion, "The overall rate of HIV transmission...is consistent with previous estimates from Rakai, Europe, and North America." But since this would further confirm HIV can't possibly cause a sexually transmitted disease, they had to hide this fact a few pages deep into the paper, and let all the lazy eyes glaze over ".0082/coital act within ~2.5 months after seroconversion" in the abstract, a ridiculous statement given the fact it's only based on 10 couples who were only surveyed ONCE every TEN months...but wait, you would have to actually READ the paper to know that! Silly me.
and JP adds this study:
But this whole debate piqued my interest, and I ended up stumbling across this:"Incidence of HIV Infection in Stable Sexual Partnerships: A Retrospective Cohort Study of 1802 Couples in Mwanza Region, Tanzania" (Hugonnet et al. 2002 JAIDS 30(1)73-80).
In the text (which I read this time), they show that, of the 42 discordant couples, there are 6 seroconversions in 2 years.
For comparison, there are 1742 couples where both partners are HIV- at the outset. After 2 years, there were 21 seroconversions. The difference between the two groups is significant.
I don't think you have a strong argument that HIV isn't sexually transmitted, no matter how you frame it.
A bit more off-topic discussion, followed by JP's comment:
Darin Brown--"6 transmissions out of 8400 coital acts is a transmission rate of 1 in 1400. Unless you're misrepresenting the data."
Sure. Here's a comparison:
The transmission rate per sexual act for herpes simplex 2: 1/1200 (from "Effect of Condoms on Reducing the Transmission of Herpes Simplex Virus Type 2 From Men to Women JAMA 2001 285(3100-3106)")
Herpes is considered to be sexually transmitted. Why not HIV?
[Adding from the conclusion of that paper: "Our study revealed several new findings about the frequency and prevention of transmission of HSV-2 infection to sexual partners. Among monogamous couples with 1 partner who had known symptomatic genital herpes and 1 who was susceptible, we showed that the rate of transmission from men to women is 8.9/10 000 sex acts. This rate is similar to that seen with sexually acquired HIV.--Tara]
followed by me logging on and getting pissed that y'all ruined my happy nephew news with more of this after I already noted I'd come back to it at a later date. Patience, anyone?
So, let me start my portion by summarizing my thoughts on the Padian paper. As others have noted, the paper had 2 parts--a retrospective analysis, and a prospective analysis. The retrospective portion showed findings similar to previous studies--anal sex, history of other STDs, injection drug use, and not using condoms increased the risk of transmission. Nothing too surprising here, and nothing that's really been harped on by Hank or others. So, let's get to the meat of the objections.
The prospective portion began in 1990. As noted, 175 couples were enrolled where one person was HIV+ and the other partner negative. However, there were only 282 couple-years of followup, they note that "attrition was severe," and the longest duration of follow-up was 12 visits (6 years). Additionally, while "3384 couple-months of followup" was observed, note that there were only 2 visits per year. They also say on page 351 that "the couple was counseled together regarding safe sexual practices," and the stats bear out that many of the couples got the message. Abstention increased from 0% at baseline to 14.5% in the final follow-up visit; consistent condom use increased from 32.3% to 74%, and any anal intercourse decreased from 37.9% to 8.1%. Obviously, these behavioral changes would severely decrease the ability to detect the transmission of *any* sexually-transmitted disease (borne out by the study on herpes cited above).
What's missing from their paper is data on the distribution of follow-up of the couples. 282 couple-years of follow-up for 175 couples that are only seen every 6 months ain't a lot. If all of the couples were followed for at least a year, that alone takes up 175 of the couple-years, and only 3 visits per couple (assuming a visit at enrollment, 6-month followup, and 12-month followup). They note that at least one couple made it the whole 6 year period, but it's not clear from their paper how many couples had significant follow-up (and the risk factors associated with said couples). This also makes their discussion less impressive. As Hank notes, they say that "no transmission occurred among the 25 percent of couples who did not use condoms consistently at their last follow-up nor among the 47 couples who intermittently practiced unsafe sex during the entire duration of follow-up," but was this duration 6 months? A year? More? How many sexual encounters occurred during this period? Obviously no one reports every single bit of data, but knowing even the average duration of follow-up would be helpful.
Continuing on, as noted in one of the exchanges above, they note they don't have data on the incidence of the HIV+ partner's infection--in other words, was the infected partner diagnosed a month before enrollment? A year? Longer? Other studies have shown that HIV is most infectious shortly after acquiring the virus, so that's another piece of data that would have been nice to have. Additionally, they note in the discussion that there have been a number of host factors identified that have been associated with decreased susceptibility--and none of them were examined in this study. They also noted a low rate of other STI prevalence in the couples included in the retrospective study, but don't specifically say what this was in the couples involved in the prospective portion. Was it similarly low? Concurrent STI is another risk factor for acquisition of HIV, and if that was essentially absent in the prospectively studied population, that's another key data element missing.
Next, any study that uses volunteers brings in potential biases, the most obvious one being, "is this group representative of the general population?" Again, they're lacking stats on a number of things epidemiologists usually look at when grappling with this issue--things like education and socio-economic status (they do provide race and age data). They don't even mention, however, the total number of couples invited to particpate, or how they recruited couples, though they reference 2 older papers--not available online--and say "study protocol and data collection methods ahve been described in detail previously." The abstract of one of those says "Participants were recruited from various HIV counseling and testing sites throughout California," suggesting that they offered enrollment to a cohort of individuals--some accepted, likely many declined. This also brings bias into the study--why did those who declined, do so? Were those who accepted the invitation representative of the group? Why or why not? Again, this may have been addressed in the 1991 paper linked above, but IMO it's also worth noting briefly in the new paper.
These criticisms may seem like I'm really down on the paper. I'm not, really--overall, it's not bad, not great. Thing is, I find it rather strange that it's being used to beat down the idea that HIV is a sexually-transmitted disease. For one, their first analysis clearly shows support for that hypothesis. Two, even the prospective portion of the study wasn't designed to "catch" sexual transmission in the act. Their introduction notes the reason for the study:
...to address this shift in the epidemic toward heterosexually-acquired infection, a deeper understanding of risk factors for heterosexual transmission is imperative. We have been able to identify risk factors at the individual level that affect the likelihood of transmission between infected individuals and their heterosexual partners. Elimination or modification of these factors could result in reduced transmission of HIV. In addition, predictions about the epidemic might be refined by identification of such risk factors, because their prevalence signifies potential for future epidemic spread.
That's why their analyses focused on the risk factors for transmission, and how they changed over time--including in the prospective cohort. Indeed, their prospective study design--even without the flaws I note above--is a pretty poor setup for detecting a transmission event. A better--but still far from perfect--design is this study, which collected not only blood but also vaginal swabs, so that the presence of other co-factors could be examined, and the HIV strain could be subtyped. Viral load was also measured, and data was collected regarding stage of infection. That's data you want when you're carrying out a study trying to witness transmission events.
Finally, there's a lot of "this can't happen" being thrown around by those who don't accept that HIV causes AIDS. Again, this goes back to my question of why this virus/disease receives special treatment. JP already noted that similar rates of transmission have been found with herpes as are seen with HIV, so you can't rightly say that HIV "can't be" a STI without saying the same thing of herpes. (In the study referenced above, they had an even *lower* rate of condom use than the Padian study--so theoretically, with identical levels of condom use, herpes could be even less transmissible than HIV). Duesberg and others note that HIV "discriminates" by race and gender, yet rates of syphilis and gonorrhea are nearly 30 times higher in blacks than in whites. Do these also not cause the diseases they've long been associated with? Similarly with male-to-female ratios of the disease: we've seen the same thing during outbreaks of hepatitis A and shigella, among others. As I said before, this can easily be explained as a type of founder effect due to the original group HIV was introduced into in the US. The rest of the arguments are just more of the same--retroviruses "can't" kill cells, or HIV "can't" cause disease after antibodies are present (what about shingles?), or is too small or "simple"--it "can't" cause AIDS (what about rabies, West Nile, polio, HPV, influenza--all with genomes of similar size? Or teeny-tiny Hepatitis B at only 3000 bp, going around and causing all that cancer? [Of course, Drs. Bialy and Duesberg don't think viruses cause cancer, either]). You get the point.
Last but not least, even though I may be young (though I'm not exactly a "recently minted" PhD--I finished grad school in 2002), even I'm not naive enough to say some microbe "can't" do something--others have done it, and been proven wrong. If anything, studying all sorts of microbial life over the past decade-plus has made me aware of all the crazy things microbes can do. Hell, that's one reason I started this site--there's a never-ending stream of fascinating new discoveries in the microbial world to discuss. And this will further piss some people off, but again, I see a parallel here between creationists and many of y'all who rail against HIV. We don't have all the answers yet, therefore, hey, let's just throw in the towel. One of the oddest objections to me is that we don't have a vaccine yet, "despite 20 years of searching." Again, I'll note that we don't have vaccines against group A or B streptococci, even though group A has been studied for well over 100 years, and group B for 30 years now. Nor do we have vaccines for other pathogens that emerged 'round the same time as HIV, such as E. coli O157:H7. Like I said--special treatment. Mystifying.
Anyhoo, apologies for this being a bit long and rambly--I'm trying to get some answers to objections in that I think fit in with the Padian paper analysis. I've not overlooked other questions waiting for me, and have some other posts in the hopper, but I'd prefer to try to keep this a bit more focused. I think the material above provides a lot of fertile ground for discussion, but I'll note a few things: 1) I ain't at your beckoned call--I have a life, a family, and a grant due Tuesday, so if I can't answer your right away, them's the breaks; and 2) must you resort to name-calling? "Dumbass"? "Weenie?" If you're going to fling insults, dear lord, at least do it at a junior high level. Graduate to "vagina blood fart" or something.
Okay, have at it.
Comments
May I point out that a more instructive and readable (if I say so myself) account of the mini-marathon leading to this remarkable post by Dr. Smith is to be found at
http://bialystocker.net/files/Pipedream.pdf
Posted by: Harvey Bialy | February 23, 2006 12:08 PM
As I said before, have you nothing better to do than spam your site?
Posted by: Tara | February 23, 2006 12:16 PM
1. Is the Padian study, the longest and largest epidemiological study of the heterosexual transmission of HIV?
2. In the prospective study (the one that mattered), How come not one uninfected partner who had sex with an HIV+ person contracted the virus?
3. How come not one uninfected partner contracted the virus from anal sex?
4. What was Padian's a priori hypothesis before she embarked on the prospective study?
5. Don't the Padian results lend greater support to the hypothesis that HIV is a garden-variety endogenous retrovirus, rather than a sexually-transmitted pathogenic killer of t-cells?
6. The scientific community declared that AIDS was a sexually-transmitted disease by the mid-1980's. Upon what epidemiological study was this based?
7. When did you first learn of the existence of the Padian study?
Hank Barnes
Posted by: Hank Barnes | February 23, 2006 12:17 PM
Hank, did you even bother to read what I wrote? How about some of you answer *my* questions for a change?
Posted by: Tara | February 23, 2006 12:26 PM
Dr. Tara,
Of course, I read what you wrote! It's not bad.
Anyhoo, apologies for this being a bit long and rambly
I'm just "having at it" as you invited, cutting thru some of your ramble. You don't have to answer immediately, though, I know you're busy.
Take your time.
Hank Barnes (Doctor of Democracy)
Posted by: Hank Barnes | February 23, 2006 12:35 PM
Tara, Empirical observation from one of the longest (albeit unpublished) studies of the Internet behaviour of AIDS dissidents, suggests that most likely Hank will either continue to spout his "talking points" about Padian or attempt to change the subject by challenging you to address some other cherry picked piece of data from a published paper. The probability that he will actually engage in a discussion of the merits of your arguments is, unlike the probability of heterosexual transmission of HIV, truly vanishingly small. Not a single occurrence has yet been observed.
Posted by: Dale | February 23, 2006 12:42 PM
You still didn't answer any of the questions I posed above, Hank. :) And I addressed most of your points in the post, and don't see what others have to do with anything (for example, #7). I also addressed your question #6 in a previous comment.
Posted by: Tara | February 23, 2006 12:45 PM
Dale,
No need to continually follow me around the internet. Particularly, when you have nothing of interest or substance to add. If you wanna answer those questions posed, feel free to.
Tara,
No, you haven't answered the questions. You have given a "long and rambly" smorgasbord of this and that, ranging from Padian to shingella to e. coli to creationism to other stuff.
If you don't want to or can't answer the questions, just say so. It seems a bit odd to me that a highly intelligent, Professor of Epidemiology would dodge such simple, straightforward questions -- in the field of her own specialty, no less.
But, hey, that's life!
Also, to be fair, feel free to ask me any questions on the topic.
Cheerfully yours,
Hank
Posted by: Hank Barnes | February 23, 2006 12:56 PM
Fine, Tara. I also have a life, 4 classes to teach, and I'm job-hunting to boot. So, I totally understand. But there was no reason to close those threads. The name-calling was not beginning to threaten the discussion.
Posted by: Darin Brown | February 23, 2006 1:05 PM
The way I understand Tara's critique of the Padian study is to substitute chicken pox for HIV. I hope I do not have to elaborate, but the same problems arise with cross couple infection--unless the infected partner is in the early stage of chicken pox, no way the other partner is likely to get it from them. This problem stands regardless of the mode of transmission.
Mike
Posted by: mgr | February 23, 2006 1:34 PM
Hank,
re your questions, sure I'll answer and I'll be very brief.
#1. It may have been at the time but there are now studies in the literature, like the one Chris Noble linked, that are larger.
#2. There is no reason to believe the prospective study is any more important than the retrospective study and in fact one might argue it is less important since this and other studies suggest that awareness of HIV status modifies sexual behaviour in ways that will reduce the probability of viral transmission. As to why no seroconversions were observed in this study, ask Darin Brown to explain statistical inference to you.
#3. See the answer to #2.
#4. Her stated hypothesis was that there would be factors associated with increased probability of heterosexual viral transmission.
#5. No they don't because (1) they can't be taken in isolation from other epidemiological studies and (2) epidemiological studies can't be used to dismiss case reports demonstrating heterosexual transmission.
#6. Based on case reports, contact tracing and data being compiled by the CDC. Also based on what was being learned about HIV.
#7. I think I learned about it from you Hank.
Posted by: Dale | February 23, 2006 1:37 PM
Tara writes:
To me, this is the major flaw in the argument the AIDS deniers (sorry if y'all don't care for that term) seem to be making here. This experiment cannot be used to support the hypothesis that the HIV cannot be sexually transmitted, because it was never designed to test that. At best, if you ignore the retrospective part of the experiment and all the other experiments linking HIV and heterosexual transmission, then that remains only a possible hypothesis to be tested with better designed experiments like the one to which you linked.
Note: It seems the kind of study the AIDS deniers really want to see is one where humans volunteer to have unprotected sex with someone HIV-seropositive in a controlled setting without any efforts made to mitigate transmission. Such experiments are of course unethical and would not be published by any reputable journal if they were done (although AIDS deniers are welcome to try, using themselves as the guinea pigs).
Such experiments have been done using animals, although that also raises ethical concerns in some. The result being that the animal versions of that virus (simian, feline, bovine) can be passed sexually. Although that is not the only mode of transmission in animals. In horses for instance the equine version of the virus can apparently be transmitted via horse-fly bites.
Yes, I know these are not the human form.
Note 2: What is the best paper that shows that cholera can be transmitted by contaminated water? What is the first paper to demonstrate positively the link between sneezing and influenza transmission? If we knew this, perhaps it would be easier to know what kind of evidence the AIDS deniers (they know who they are) would accept showing that HIV is transmitted sexually.
Posted by: Dave S. | February 23, 2006 1:40 PM
Well...they can't:
"Since on average only 0.1% (1 out of 500 to 3000) of T-cells are ever infected by HIV in AIDS patients, but at least 3% of all T-cells are regenerated (Sprent, 1977; Guyton, 1987) during the two days it takes a retrovirus to infect a cell (Duesberg, 1989c), HIV could never kill enough T-cells to cause immunodeficiency. Thus even if HIV killed every infected T-cell (Section 3.5.10), it could deplete T-cells only at 1/30 of their normal rate of regeneration, let alone activated regeneration. The odds of HIV causing T-cell deficiency would be the same as those of a bicycle rider trying to catch up with a jet airplane." (Duesberg, "AIDS Acquired by Drug Consumption and Other Noncontagious Risk Factors")
What part of the above paragraph is unclear?? Even if (*IF*) HIV killed T cells, it could never kill enough to overcome the body's regeneration of T cells. The argument above seems clear and compelling to me. It's astonishing to me how certain people just disregard the above argument.
Gee, Tara, I'm really beginning to wonder if you've ever read *ANY* of "Infectious AIDS" or Duesberg's papers, as you were so quick to claim earlier:
"The virus would be a plausible cause of AIDS if it were reactivated after an asymptomatic latency, like herpes viruses. However, HIV remains inactive during AIDS." (Duesberg, "HIV is Not the Cause of AIDS")
And this is the point: it's not just the puzzling fact that HIV is supposed to cause AIDS after antibodies are present, it's the fact that after the latency period, when HIV is supposedly causing AIDS, HIV is inactive. That's why the word is called: "re-ACTIVation". You can't say something is "reactivated" if it's inactive.
From what I understand of shingles and reactivation of herpes viruses, this occurs when the immune system is compromised so much that reactivation is possible. This makes perfect sense to me. Reactivation should occur only in cases when there is some other reason for severe immunosuppression. But HIV is completely backwards in this regard -- it's supposed to be the CAUSE of the immunosuppression itself...but if it "reactives", there must be something else suppressing the immune system? In other words, reactivation of HIV causes the immunosuppression, but at the same time, the reactivation wouldn't be possible without that very immunosuppresion in the first place. So, yet another example of circular logic.
Whoa, let's slow down. First, you're falling into the same erroneous argument I mentioned earlier of trying to compare "AIDS" with other traditional diseases that have specific, restricted clinical symptoms. I discussed this earlier in some depth in the previous threads.
Second, the comparison with these other diseases actually lends support against HIV/AIDS hypothesis. Because HIV *DOES* cause disease -- namely, a small, mononucleosis-like disease that is quickly neutralised by antibodies within a few weeks or months after infection. And that agrees pretty well with the comparison to the other diseases you mention. "AIDS" does not agree well with the comparison.
Posted by: Darin Brown | February 23, 2006 1:47 PM
Dave S,
This experiment cannot be used to support the hypothesis that the HIV cannot be sexually transmitted, because it was never designed to test that.
Huh?!!? Did you not read the title of the piece, we are discussing?
The study is called, the "Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study."
It was designed to study the rate of heterosexual transmission of HIV. The study found...."no seroconversions" after entry into the study (Padian, pg 354).
Dave S, despite your name-calling, I'm not an "AIDS Denier", and I generally hate to be rude to people, but, really, you are lost beyond hope.
If you continue with ad hominem, you're going to get it back harder and better from me. Please stop embarrasing yourself.
Barnes, Hank
Posted by: Hank Barnes | February 23, 2006 1:58 PM
Hank, wasn't it you who chided folks for reading only the abstract on one of the earlier threads? As I mentioned in the post, the goal of the study was to examine *risk factors* that influenced transmission--both retrospectively and prospectively. One can examine risk factors without seeing any transmission if they are highly protective, as the ones in the study were found to be.
Posted by: Tara | February 23, 2006 2:04 PM
Darin, I'm beginning to wonder if you ever read anything *but* Duesberg.
Let's step away from HIV for a moment and look at another retrovirus, called the visna virus. It's kind of an HIV cousin, and certainly can kill cells. Still want to say "retroviruses can't kill cells?"
Sometimes, yes. Other times, there's no clear indication of immunocompromise. We don't fully understand it for herpesviruses, which have been studied much longer than HIV--yet again, no groups out there rallying against varicella as a cause of shingles, just 'cause we don't understand the whole clinical picture.
Because I don't see the dichotomy. *NO* pathogen has "restricted" symptoms. Hell, group A strep can cause 25 different disease pathologies all by itself. You're trying to make a division where there is none. Sure, strep has some "typical" symptoms--pharyngitis is, of course, a common manifestation, resulting in fever, achiness, sore throat. HIV also has a common manifestation--decreased T cell count, resulting in immunosuppression leading to secondary disease. (Y'know, influenza does this as well--most influenza deaths aren't due primarily to the influenza virus, but to secondary bacterial infections that set into viral-damaged lungs: just like the secondary infections that result from HIV). But no one criticizes influenza simply because it's associated with so many different species of secondary infections.
Again, special treatment. That's the heart o' the matter.
Isn't anyone going to answer why herpes can't be a STD, according to your criteria?
Posted by: Tara | February 23, 2006 2:18 PM
Hank Barnes -
Please read more carefully. The paper was never designed to test the hypothesis that HIV was transmitted sexually, but to address risk factors in a particular small population. That no seroconversions took place in the prospective portion of the experiment does not mean that HIV cannot be transmitted sexually. That is only one possible hypothesis that someone might formulate, until that is they had seen the retrospective portion of that experiment or the hundreds of other experiments showing this link unequivocally. Then that hypothesis would be rightfully rejected (unless one has a pre-existing notion that would absolutely prevent such a conclusion).
Another more reasonable hypothesis given this data might be that concilling and safer sex practices work.
Posted by: Dave S. | February 23, 2006 2:22 PM
Hank Barnes said:
Perhaps you could explain what aspect of your questions, specifically, Tara hasn't answered, rather than just asserting that she hasn't answered your questions and waltzing away.Posted by: Orac | February 23, 2006 2:23 PM
'Tis okay. I assume it's a dance he learned from Harvey, who still hasn't filled me in on all the mistakes I made in the Bethell post.
Posted by: Tara | February 23, 2006 2:25 PM
Dr. Smith wrote:
As I mentioned in the post, the goal of the study was to examine *risk factors* that influenced transmission--both retrospectively and prospectively.
Retrospectively, nobody can tell how or when or under what circumstance the HIV+ people contracted HIV. Every human being is born, every human being has sex. So, it's fallacious to attribute --without evidence -- HIV transmission to either of these 2 events.
One can examine risk factors without seeing any transmission if they are highly protective, as the ones in the study were found to be.
Not quite, Tara. Here's Padian, pge 356.
While lack of transmission in our prospective
study may in part be due to such unidentified protective factors, we also observed significant behavior change over time...
Ok, great.
Nevertheless, the absence of seroincident infection over the course of the study cannot be entirely attributed to significant behavior change. No transmission occurred among the 25 percent of couples who did not use condoms consistently.....
Translation:
The folks who used condoms didn't contract the virus! (Yea for condoms!)
The folks who didn't use condoms failed to contract the virus as well. (Darn, back to the drawing board.)
Padian's results -- squarely, defiantly, unambiguously -- support Duesberg's hypothesis that AIDS ain't a sexually-transmitted disease.
Barnes
p.s. Dale answered my questions above (I'll comment on those after lunch). Why won't you?
Posted by: Hank Barnes | February 23, 2006 2:27 PM
Barnes writes:
Assertions don't get more convincing with repetition. No matter how "defiant" you are.
Is that all you got?
Posted by: Dave S. | February 23, 2006 2:34 PM
I find it quite telling that after it was shown that Hank's claim
2. For 10 years, it followed 175 discordant couples, who had a lotta sex. "Discordant" means for each couple, 1 person was HIV+, and one was not.
was a blatant misrepresentation of the paper, he deftly drops this claim and continues to argue as if none of his points have been adequately adressed.
Hank: answer these 8 points
multiple answers come in
Hank: you still havent adressed these 7 modified points.
Posted by: TonyL | February 23, 2006 2:41 PM
Excellent. This, again, must then also be applied to every infectious disease known to man. All retrospective disease studies are out yonder window. That'll ease my teaching burden immensely, thank ye kindly.
Hank, perhaps you're missing that it *is* those "significant behavior changes" that were exactly the risk factors under examination. Let me add in the part you quote-mined out of Padian's paper that precedes that (the "unidentified protective factors" they're discussing):
That doesn't negate the fact that the risk factors they examined--condom use, anal sex, and any sexual activity--were indeed protective. They just aren't the full story. I addressed that in my post:
We know things like the CCR5 delta 32 mutation play a role in infection--this wasn't examined in their study. You're only further proving my case for me.
I already addressed this above as well. There's no data on how long those couples didn't use condoms consistently, or indeed, even what "consistently" meant. Did they miss one time? Rarely used condoms? Practically never? How many follow-up visits did they have? Hardly "back to the drawing board"--it just opens new areas for investigation.
Then you'll have no problem stating that herpes isn't an STD either.
Dale's more generous than I am. Your questions are boring to me, and you've not answered any of mine. I'm selfish that way.
Posted by: Tara | February 23, 2006 2:45 PM
Barnes writes:
Why? Does the fact that many people who drive drunk don't end up dying in a car wreck mean that it's safe to drink and drive?
Posted by: Dave S. | February 23, 2006 2:48 PM
Barnes, Hank writes:
Reading beyond the title, all the way to the first sentence in the abstract you find ...
To examine rates of and risk factors for heterosexual transmission of human immunodeficiency virus (HIV)...
Clearly the question of whether or not HIV can be transmitted by heterosexual sexual contact at all was not the issue.
Posted by: Dave S. | February 23, 2006 3:13 PM
"The folks who didn't use condoms failed to contract the virus as well. (Darn, back to the drawing board.)"
Not so, Mr. Barnes. Remember the empirical universe operates probabalistically - if you do the "horizontal mambo" with an HIV+ person, you are more likely to get the virus. Your odds of winning increase if you do the dance without a condom.
GE
Posted by: Guitar Eddie | February 23, 2006 3:28 PM
One more thing:
Well, now, that latter just ain't true, now is it? What's the rate of HIV infection in virgin priests and nuns? By your examples, it shouldn't be any different than the population at large, if they acquired it at birth.
Posted by: Tara | February 23, 2006 3:33 PM
Whoa, you're pulling out influenza now. That's kind of a stretch. MILLIONS of people in the US get influenza every year, and only a few thousand die from it. Most of these (not all, I know) occur in very young people, older people, or people with chronic medical conditions or pre-existing immunodeficiency. In other words, these people are generally ALREADY beat up or immunocompromised before the influenza, and they are people you would already suspect to be more at risk, unlike HIV, which is supposed to be able to strike "anyone".
Posted by: Darin Brown | February 23, 2006 4:25 PM
Tara,
You still haven't answered how HIV kills T cells when it doesn't even infect cells fast enough to cover regeneration. Nor how HIV causes clinical AIDS when it's inactive.
Posted by: Darin Brown | February 23, 2006 4:29 PM
First, you totally missed the point of my bringing up influenza. Y'see, very few people die from "influenza." They die from the secondary bacterial infections that set in as a result of influenza-damaged cells in their lungs, just as HIV-infected individuals die from secondary infections resulting from an HIV-damaged immune system. And both of them can strike "anyone." Look at the age-adjusted mortality curve for the 1918 influenza virus.
Second, as I mentioned and you didn't address, the idea that there's some magical symptom restriction for specific pathogens is just bunk. Again, take influenza. Some cases of recent H5N1 infections haven't even presented with influenza-like illness--they had severe diarrhea, fer crimeny's sake. I'm sure you're an excellent mathematician, Darin, but as I told you before, you really need to bone up more on infectious disease. It's an immensely interesting subject once you break out of the "this virus can only do this, this bacterium can only do that" box.
Like I told Hank, I'm bored of answering your questions. You answer mine for a change. Just from my last post to you, you've still not touched:
Still want to say "retroviruses can't kill cells?"
Why does HIV get special treatment?
Isn't anyone going to answer why herpes can't be a STD, according to your criteria?
Your move. Surprise me for a change.
Posted by: Tara | February 23, 2006 4:37 PM
Oh my! ... it's a mutating attack from all angles:) (Tara, Dale, Dave S, Orac, some dude name Tony L, Guitar Eddie)
Or, I reckon, a swarm of gnats to be swatted.
I'd like to single out Dale, though. In all seriousness, he has (without all this circumlocution, snark, obfuscation, and evasion) answered the questions, and for that, he deserves genuine credit.
The best answer, of course, is No. 7:
7. When did you first learn of the existence of the Padian study?
I think I learned about it from you Hank.
I might frame this -- Hey, you take what you can get:)
Gentlemen, Doctors, Scholars:
Had Padian's prospective study resulted in, say, 125/175 seroconversions (71%) or 100/175 (57%) or 42/175 (24%), you would be touting Padian as evidence that HIV was in fact heterosexually transmissible, and, hence, that AIDS is an infectious disease. (As would I).
Padian, herself, starts out her paper with the following:
As of June 1996, a total of 44,980 cases (8 percent) of AIDS among adults and adolescents have been reported to the CDC that were attributed to heterosexual contact with a high risk or infected partner.
An honest scientist, conducting an honest study, in hopes of honestly trying to explain this phenomenom known as AIDS, in hopes of honestly helping and/or curing patients would -- after obtaining zero seroconversions -- pause (one would hope), reflect on this result, and seriously question the afore-mentioned 44,980 cases attributable to heterosexual contact. Perhaps, they would also question what they believe about AIDS and why they believe it. (As I did).
They might also question how the infinitesimal risk of heterosexual transmission explains how 1 million people in US are infected with HIV, and, why Padian's data doesn't strongly suggest that these 1 million HIV+ were simply born with said retrovirus.
We might go back and forth all day on this, but I can confidently state 4 things:
1. Y'all were ignorant of the Padian study for 9 years.
2. Y'all are furiously trying to disregard/reinterpret its findings so that it is harmonized with your pre-existing beliefs and biases.
3. The one fellow who figured all this out well before any of you, is Dr. Peter Duesberg, National Academy of Science.
4. And you hate Dr. Duesberg, because he exposed y'all as absolute poseurs and charlatans on this topic.
To conclude: We know that Dr. Hwang Woo Suk of stem cell frame is a fraud. We also know that Dr Robert Gallo of AIDS fame is a fraud, too.
Does that mean our scientific system is corrupted on the whole? I don't know. But the question remains: Is there any more fraud we should know about?
Hammerin' Hank Barnes
Posted by: Hank Barnes | February 23, 2006 4:43 PM
Perhaps this is addressed in the paper, but I see a major issue with looking at seroconverion in discordant couples. Given that HIV transmission rates vary by individual (both for being infected and for infecting someone else). Then the discordant couples will be enriched for those where seroconversion is less likely than the general population, since couples were transmission is most likely are the couples most likely to have already experienced seroconversion before the study began and would thus be excluded. The greater the variance in individuals, the stronger would be this effect. And we know that some people are highly resistant to HIV infection.
Only couples were both partners were HIV-negative before the study began, and one partner became infected during the study would be useful for gauging HIV-transmission rates within couples.
Posted by: Gene | February 23, 2006 5:17 PM
Gene,
That's a good point, and no, they don't mention it.
You'd need a huge cohort, though. More realistic would be to enroll a couple as soon as one partner is found to seroconvert so that at least it's known that it's early in the infection, and go from there. Swabs could also be taken to *really* look at only transmission, since the Padian study is looking at transmission + seroconversion, two related but distinct processes.
Posted by: Tara | February 23, 2006 5:25 PM
Now George Kaplan informs me that he cannot post to this thread, nor can Darwin nor Mr. Barnes.
I trust this is only a glitch....cf. "fair debate" etc. above.
Posted by: Harvey Bialy | February 23, 2006 5:44 PM
Glad it was only a temp. glitch. Carry on. Don't mind me.
Posted by: harvey Bialy | February 23, 2006 5:45 PM
Well, I guess I have been un-banned. Sorry for the multiple posts.
Barnes
Posted by: Hank Barnes | February 23, 2006 5:45 PM
You were never banned in the first place. Posts with multiple links get sent to the junk box, from which I have to move them. As I said, email me rather than assuming I banned anyone. Sheesh, if I've let all Harvey's self-promotion posts stand, there's no reason I'd ban someone I simply disagree with.
Posted by: Tara | February 23, 2006 5:49 PM
..there's no reason I'd ban someone I simply disagree with.
Well, good. It's all squared away then.
Barnes, Hank
Posted by: Hank Barnes | February 23, 2006 5:52 PM
In the meantime, Hank, you gonna answer any questions, or just keep repeating the same ol' schtick? At least Harvey's interesting with his creative insults.
Y'know, creationists claim Darwin was a fraud too. Even if all that's true, does it disprove evolution?
Posted by: Tara | February 23, 2006 5:53 PM
In the meantime, Hank, you gonna answer any questions, or just keep repeating the same ol' schtick?
Sure, I'll answer your questions. What are they? Or do I have to sift thru your smorgasborg and discern which ones are rhetorical?
Ask away
At least Harvey's interesting with his creative insults
I haven't insulted a solitary person on this thread -- except I did call Ivan a "dumbass".
Y'know, creationists claim Darwin was a fraud too. Even if all that's true, does it disprove evolution?
Well, I ain't a creationist, and think Darwin was a great scientist, so the matter is moot.
Darwin once said:
If it could be demonstrated that any complex organ existed, which could not possibly have been formed by numerous, successive, slight modifications, my theory would absolutely break down. But I can find out no such case.
Often, creationists or ID guys omit the last sentence, but I think Charles Darwin has it exactly right here: A falisifiable theory, that has not been falsified. Beautiful.
Which reminds me:
1. If you contend that HIV is the sole cause of AIDS, what evidence would falsify this causal connection?
Hank "the Tank" Barnes
Posted by: Hank Barnes | February 23, 2006 6:05 PM
One quickie then I'm out for the evening--
Any I posed above to Darin would be a fine starting point. Is herpes a STD, since it has a similar transmission rate as HIV? Why the special treatment for HIV in the first place? Do you realize by pushing the objections you do, that you're denying not only HIV causation of AIDS, but essentially the entire germ theory of disease?
And did I say you were Harvey?
Um, no, it's not. You miss my point. You're trying to use Gallo's sketchy image as a reason to dismiss HIV causation of AIDS, just as creationists use Darwin's deconversion or other personal matters to dismiss evolution. Beautiful example of a classic ad hominem. I'd rate it a 8.5 since you botched the landing.
I already discussed this. Like I said, you're boring me.
Hopefully your dance team is back with some new material in the morning. (And please, if a comment doesn't get published, don't resubmit it a thousand times. I'll approve it when I get in tomorrow morning).
Ciao.
Posted by: Tara | February 23, 2006 6:14 PM
One last question--Hank, what would it take to get you to accept that HIV is the cause of AIDS?
Okay, really out...
Posted by: Tara | February 23, 2006 6:19 PM
Tara's Questions:
1. Is herpes a STD, since it has a similar transmission rate as HIV?
Yes, Herpes is an STD. I don't know that it has similar transmission rate at HIV. Nobody dies from Herpes. The "anti-viral" given to Herpes patients, Acyclovir, is prescribed for 3 or 4 days, only during active infection. Not for life. Not when the person is asymptomatic. Not as a prophylactic. By the way, Gertrude Elion was very hot during her younger years.
Why the special treatment for HIV in the first place?
Huh? I don't know the "special treatment" to which you refer. Medical treatment? Scientific treatment? Cultural treatment? What are you trying to say?
Do you realize by pushing the objections you do, that you're denying not only HIV causation of AIDS, but essentially the entire germ theory of disease?
No, you are grossly wrong. The germ theory is alive and well. Small pox is caused by a germ, the variola virus. Said virus has been conquered by a vaccine.
The hard part is discerning between a pathogenic germ and a passenger germ. There are millions of passenger germs infecting healthy people, that do absolutely nothing.
Now, quit dodging and answer my questions:
1. Is the Padian study, the longest and largest epidemiological study of the heterosexual transmission of HIV?
2. In the prospective study (the one that mattered), How come not one uninfected partner who had sex with an HIV+ person contracted the virus?
3. How come not one uninfected partner contracted the virus from anal sex?
4. What was Padian's a priori hypothesis before she embarked on the prospective study?
5. Don't the Padian results lend greater support to the hypothesis that HIV is a garden-variety endogenous retrovirus, rather than a sexually-transmitted pathogenic killer of t-cells?
6. The scientific community declared that AIDS was a sexually-transmitted disease by the mid-1980's. Upon what epidemiological study was this based?
7. When did you first learn of the existence of the Padian study?
Bonus Question:
8. If you contend that HIV is the sole cause of AIDS, what evidence would falsify this causal connection?
Posted by: Hank Barnes | February 23, 2006 6:44 PM
HB,
you asked 7 questions and I answered them. Your response to my answer :
"And you hate Dr. Duesberg, because he exposed y'all as absolute poseurs and charlatans on this topic."
That doesn't even really qualify as an ad hominem attack - it's more of a non sequitur.
Perhaps if you'd address my responses to your questions, Tara would be more inclined to answer your questions herself.
Posted by: Dale | February 23, 2006 6:51 PM
HB's answer to Tara's question "1. Is herpes a STD, since it has a similar transmission rate as HIV?
Yes, Herpes is an STD. I don't know that it has similar transmission rate at HIV. Nobody dies from Herpes. The "anti-viral" given to Herpes patients, Acyclovir, is prescribed for 3 or 4 days, only during active infection. Not for life. Not when the person is asymptomatic. Not as a prophylactic. By the way, Gertrude Elion was very hot during her younger years."
Neither the difference in mortality nor differences in treatment between HIV and herpes are relevant to the definition of an STD.
Posted by: Dale | February 23, 2006 7:06 PM
Dale,
Hey, I singled you out for credit above-- so I don't place you in the "poseur" or "charlatan" group.
Hank & Dale's Q & A:
1. Is the Padian study, the longest and largest epidemiological study of the heterosexual transmission of HIV?
It may have been at the time but there are now studies in the literature, like the one Chris Noble linked, that are larger.
Grade: B-. "may have been" is sketchy, better answer is "Yes"
2. In the prospective study (the one that mattered), How come not one uninfected partner who had sex with an HIV+ person contracted the virus?
There is no reason to believe the prospective study is any more important than the retrospective study and in fact one might argue it is less important since this and other studies suggest that awareness of HIV status modifies sexual behaviour in ways that will reduce the probability of viral transmission. As to why no seroconversions were observed in this study, ask Darin Brown to explain statistical inference to you.
Grade: D+. The better answer is that HIV is probably an endogenous retrovirus, that is passed from mother-to-child at birth, and resides in the cell doing nothing. Remember, it is estimated that 8% of the human genome <