When Duesberg was recently given space in Scientific American I think the blogosphere was rightly chagrinned that they would give space to a crank whose crackpot ideas are thought to be responsible for the deaths of hundreds of thousands. But it seemed at the time he had been keeping his denialism on the down low, maybe appearing to have given up on his crank view that HIV does not cause AIDS. Not so anymore. He’s back, and has secured publication of a paper denying HIV/AIDS in an Italian Journal.


The title, AIDS since 1984: No evidence for a new, viral epidemic – not even in Africa, seems such a denial of reality that you wonder if part of it is he can’t reverse now because then he’s responsible for a great many AIDS deaths, especially in South Africa. Specifically the paper is a refutation of the above linked paper discussing excess AIDS deaths likely due to rejection of anti-retroviral medications.

Their argument, which is bizarre, is that AIDS has not been a big enough problem to truly be infectious.

The germ theory of disease predicts that a new (relative to a population) patho-genic virus or microbe causes an exponentially spreading epidemic of new microbe-specific illnesses and deaths within weeks to months after the arrival of the new
pathogen (Encyclopædia Britannica, 2010).

According to the authors this should result in a bell-shaped curve with rapid rate of infection then passage of the pathogen from the population. This is, of course, absurd because HIV is not yersinia pestis or plague. HIV does not get transmitted through casual contact and it does not have a rapid onset of action, often taking years before the syndrome becomes clinically apparent. Effectively, they’re comparing apples and oranges and saying HIV can’t be an infectious epidemic because it’s not acting like the spread of the black plague through London. I am serious, that is their comparison.

I suggest now that you take five minutes to go outside and scream, or maybe gently hit your head against a hard surface.

Then they use WHO statistics showing that population is still growing in South Africa, Uganda and sub-Saharan Africa to suggest AIDS deaths in this location have been exaggerated, and worse, use South African statistics which claim only 10,000 AIDS deaths per year between 2000 and 2005.

Even if we believed these data were accurate, in an environment when HIV diagnosis conferns social disgrace and under a government that similarly denied the link between HIV and AIDS, this is proof of nothing.

Finally, he has an extensive section criticizing HIV/AIDS drugs as toxic, and singles out AZT for criticism. It has side-effects that are bad, it’s true, but medicine is about risk versus benefit, not whether or not there are no risks to a therapy. He also cites many papers that are pre-HAART, and are irrelevant.

But even so he misrepresents the literature, including this paper to suggest that AZT is ineffective.

In 1994 the ability of AZT to prevent AIDS was tested by the British-French Concorde study, the largest, placebo-controlled study of its kind (Aboulker and Swart,
1993; Seligmann et al., 1994). This study investigated the onset of AIDS and death
of 1749 HIV-positive, mostly male homosexual subjects, which had been divided into an untreated and an AZT-treated subgroup. It was found that AZT is unable to prevent AIDS and increases the mortality by 25%. In view of this it was concluded, “The results of Concorde do not encourage the early use of zidovudine (AZT) in symptom-free HIV-infected adults.” (Seligmann et al., 1994).


This is a misrepresentation of the findings. The study was not between treated and untreated groups. Subjects were divided between treatment before and after onset of AIDS. All subjects received AZT when they became ill. This study did not suggest patients should not receive AZT with onset of AIDS, only that there was no benefit to treatment with a single drug before onset of symptoms. This is still an issue of some contention, especially with issues of patient compliance, whether there is benefit to long term treatment with anti-retrovirals before onset of any AIDS defining illness. Here is what was said by Aboulker and Swart:

By contrast with the differences in CD4 count, there was no significant difference in clinical outcome between the two therapeutic strategies. The 3-year survival rates were 92% (90-94%) in the Imm [treatment at randomization] group and 93% (92-95%) in the Def [treatment after AIDS-defining illness] group (p=0.15, two-tailed), with no significant differences overall or in subgroup analyses by CD4 count at baseline (table I). This conclusion was unchanged when analyses were restricted to deaths classified as probably HIV related. Similarly, there was no significant difference in rates of progression of HIV disease: 3-year progression rates to AIDS or death were 18% in both groups, and to “minor” ARC, AIDS, or death these rates were 29% (Imm) and 32% (Def).

AZT did not worsen outcomes, but as a monotherapy it did not help prevent progression to AIDS or death. For the life of me I can’t figure out how he got AZT increased death rates by 25%.

But all of this is besides the point. HIV monotherapy is not even standard of care for these reasons. We know HIV rapidly becomes resistant to a single therapy, hence the need for combination therapy. You need proof combination therapy prevents progression of disease and death? JAMA on protease inhibitors, or how highly-active anti-retroviral therapy (HAART) decreases mortality to a third of that on a single drug? Or how AIDS mortality decreased with introduction of HAART? Or how when people are non-compliant with the medication they are much more likely to progress to AIDS and die.

If you look at the effect of inferior therapy on HIV/AIDS survival, yes, the results aren’t great, but Duesberg is ignoring reams of data and current standard of care with HAART therapy. As for HAART therapy he castigates it for the side effects of the drugs, not for efficacy in preventing mortality. The drugs have known long-term toxicities, but this is besides the point. If the drugs extend your life beyond what you would have had without it, and you eventually die of a toxicity years later, they have still served their purpose and extended life. No one is saying these drugs are perfect. They are hard to take, they cause gastrointestinal upset, they can cause mitochondrial injury with long term use, injury to other organ systems with prolonged therapy. This is true, but that’s an argument for continued research and refinement of these drugs to ideally find a less-toxic next generation anti-retroviral, not an argument against their use.

Finally, he suggests the harm from HAART to unborn children or the use of single-dose AZT to prevent transmission during pregnancy may have untoward side-effects on the growth and development of exposed children. A valid point. But given the choice between life + side effects of drug, versus possible transmission of HIV to children there is no choice. Only for a denialist who doesn’t believe HIV is the causitive agent of AIDS (ignoring all the basic science demonstrating the molecular mechanisms of HIV destruction of t-cells) is there any question that you should take the small risk of a drug side-effect over the dramatically shortened life span of a child with HIV.

I can’t help being personally offended by this drivel. I’m in Baltimore, with a population known to be living with HIV of 2.5%. Although the actual prevalence of HIV in the city is much higher as there are thousands living with HIV but without the diagnosis. I treat patients with HIV all the time, and operate on them, and have personally seen what happens when HAART is started on patients with AIDS-defining diseases, and how hopeless it is when non-compliance has sabotaged a potentially life-saving therapy (the virus can become resistant to any drug and this is increased with non-compliance). These cranks don’t treat these patients, they ignore the data that would help these patients and undermine public health. The publication of this denialist trope is a tragedy.

Comments

  1. #1 Tony Mach
    January 6, 2012

    You’re missing a ” in your first link!

    I think it should read like this:

    When Deusberg was recently given space in Scientific American I think the blogosphere was rightly chagrinned that they would give space to a crank whose crackpot ideas are thought to be responsible for the deaths of hundreds of thousands.

  2. #2 David Robert Grimes
    January 6, 2012

    Great post Mark, I feel your anger on this. I looked at this recently, are the infection statistics correct ?

    http://www.avert.org/usa-states-cities.htm

    Why is the HIV rate so high in Baltimore ? That figure of around 10% shocked me, am I missing something ?

  3. #3 Nick Johnson
    January 6, 2012

    I think you a word in your first sentence.

  4. #4 Paul
    January 6, 2012

    Duesberg is far from the first HIV/AIDS denialist to misrepresent the Concorde study examining early versus late AZT treatment, I remember getting into a long argument with a denialist about this paper on a FaceBook AIDS/HIV research group back in 2007. Then as now the delialist wouldn’t admit that the paper didn’t say what he thought is said.

  5. #5 Paul
    January 6, 2012

    I’m missing something in your first sentence. I’ve read it five times and I still can’t parse it. I suspect it’s missing a word or two.

  6. #6 Emil Karlsson
    January 6, 2012

    The criticism presented against the claim that “population growth entails exaggeration of HIV/AIDS deaths” is reasonable, but can be improved and expanded.

    Kalichman (2009, pp. 77-78) points out that countries in southern Africa, including South Africa, have seen a massive decrease in life expectancy over the years that correspond to the occurrence of AIDS pandemic. He writes that:

    “Life expectancy in many countries that were improving during the post-colonial years of the 1960s and 1907s began to erode in the 1980s and 1990s, and life expectancy in many countries is now worse than even during the 1950s, the last full decade of colonialism. The reason why some countries afflicted by AIDS sustain positive population growth is simply due to high birth rates.”

    For many countries, such as South Africa, it has dropped with about 20 years (Fig 3.2 p. 77 from Kalichman [2009], original data from United Nations Population Division [2004]. Word Population Prospects: The 2004 Revision).

    Gregson et. al. (2007) makes a similar point about Zimbabwe.

    Correlation does not entail causation, but this helps to debunk this particular claim made by Duesberg et. al: A growing population does not entail that HIV/AIDS deaths are exaggerated, only that birth rates are high. A look at life expectancy rates for the countries in question shows the severe impact of HIV/AIDS.

    References:

    Gregson S; Nyamukapa C; Lopman B; Mushati P; Garnett GP; Chandiwana SK; Anderson RM. (2007). Critique of early models of the demographic impact of HIV/AIDS in sub-Saharan Africa based on contemporary empirical data from Zimbabwe. Proc Natl Acad Sci U S A. 104:14586-14591.

    Kalichman. S. (2009). Denying AIDS: Conspiracy Theories, Pseudoscience and Human Tragedy. New York: Copernicus Books.

  7. #7 MarkH
    January 6, 2012

    Sorry, broken tag. I’m out of practice.

  8. #8 _Arthur
    January 6, 2012

    Duesberg, not Deusberg.

  9. #9 MarkH
    January 6, 2012

    Yeah, I had that spelled wrong about 50%.

  10. #10 MarkH
    January 6, 2012

    David, known cases of HIV in Baltimore represent about 2.5% of the population (found a plos article on hiv diagnosis in different metropolitan areas from 2007. Those are the cases that have been diagnosed and tested, however, those represent only a small fraction of those living with HIV in Baltimore City and our estimates . The prevalence of HIV among homosexuals in baltimore is as high as 38%

    I’m actually having trouble finding the 10% estimate but I recall it from a lay press article rather than an actual study. I’ll update to reflect better sourcing until I can find a source for total estimated prevalence in the city.

  11. #11 Barry Levine
    January 6, 2012

    Duesberg is an outstanding crank. Neurologically, I wonder what’s going on inside his noggin. Not that he’s especially unique among fellow humans. But this kind of denial/cognitive dissonance/crankism is something we’d best understand at some point.

  12. #12 Dave
    January 6, 2012

    Depressingly good article. Duesberg makes me feel sad for the world. On a nitpicking notes, you have a malformed href in the last paragraph. Your code shows…

    of 2.5%

    Whereas I assume you meant…

    of 2.5%

  13. #13 vlily
    January 6, 2012

    You can receive treatment for an STD at Your Regular Medical Practitioner, Local Health Departments, or Public Hospitals. Not sure where you live. but if you want, you can find a near one on the largest and most trusted Herpes dating and support community datehsv,,c o m .. they list hundreds of STD care locations.

  14. #14 MarkH
    January 7, 2012

    Fixed. Sigh.

    Have to get back in practice. I’ve made too many coding mistakes in these few entries.

  15. #15 Pierce R. Butler
    January 7, 2012

    … Duesberg was recently given space in Scientific American …

    2007 qualifies as “recently” in what time frame?

    In his SA piece, Duesberg describes how “a new cancer model” in the ’70s, called proto-oncogenes, proposed that “… some triggering event, such as a mutation in a human cell’s own version of src, could ignite tumorigenic powers…”

    As a layperson, I have a vague impression that this idea persists (the excerpt at the link above provides only two ‘grafs, so the main thrust of the article remains hidden – and apparently no comments have come along in over three years). Setting aside the deplorable article targeted by this blog post, does the SA “Chromosomal Chaos and Cancer” article have any redeeming scientific value?

  16. #16 MarkH
    January 7, 2012

    Recently is since I’ve been blogging I guess. I remember it being a stink at the time. Orac actually covered it extensively, and his conclusion, briefly, was interesting but cranky.

  17. #17 SLC
    January 7, 2012

    When is Prof. Duesberg going to take an injection of HIV positive blood which he promised to do to demonstrate his view that HIV doesn’t cause AIDS. AFAIK, all we have heard from him is excuses.

  18. #18 Luna_the_cat
    January 7, 2012

    @Barry Levine — I suggest a look at On Bullshi by Harry G. Frankfurt.

  19. #19 resim
    January 9, 2012

    Duesberg is far from the first HIV/AIDS denialist to misrepresent the Concorde study examining early versus late AZT treatment, I remember getting into a long argument with a denialist about this paper on a FaceBook AIDS/HIV research group back in 2007. Then as now the delialist wouldn’t admit that the paper didn’t say what he thought is said. Why ?

  20. #20 articles on science
    January 9, 2012

    Mark, thanks for this great insight! What alarmed me is this point of view “AIDS has not been a big enough problem to truly be infectious,” how can they say its not a big problem when people are being diagnosed and dying without receiving the proper treatment that they deserve?

  21. #21 Jack Knight
    January 10, 2012

    The comments section at the Nature.com article have all been deleted…or at least they are no longer coming up. It may have been due to the Denialists like Clark Baker making comments with libel and slander such as accusing those who disagree with him as being “meth trannies” and accepting pharma kickbacks and worse!

  22. #22 Snout
    January 11, 2012

    there was no benefit to treatment with a single drug before onset of symptoms. This is still an issue of some contention, especially with issues of patient compliance, whether there is benefit to long term treatment with anti-retrovirals before onset of any AIDS defining illness.

    While there was some contention in the early 1990s about the value of AZT monotherapy in early HIV disease compared to in people with CD4 counts below 200, no competent infectious diseases physician today would recommend delaying combination ARV treatment till after the onset of the first AIDS-defining illness.

    I’ve written a little on the background of the IJAE paper and two earlier papers published in that journal by the same authors. Click on the moniker to find them.

  23. #23 Ed Rybicki
    May 5, 2012

    Hi Mark: great article; I’ve read a lot about Duesberg over the years, and this was one of the better pieces.

    You write: “I can’t help being personally offended by this drivel. I’m in Baltimore, with a population known to be living with HIV of 2.5%.”

    I come from South Africa – where the prevalence is currently around 11%, with rates as high as 45% in pregnant women in places like KwaZulu-Natal. I have seen AIDS affect people near me, and I have seen the near-miraculous effects of combination therapy with ARVs. It seriously angers me, therefore, that Duesberg and his ilk can keep on banging a very outdated drum, in the face of overwhelming evidence to contrary, about how the problem with HIV is the drugs, and not the virus. I have met Duesberg, and Harvey Bialy, and have had public spats with Rasnick – and what they all have in common is a truly amazing ability to ignore facts, and propagate their own virulent brand of misinformation.