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.