Respectful Insolence

ResearchBlogging.orgWith all the negativity around this blog lately, thanks to the continued moronic antics of the anti-vaccine contingent, which have irritated me more than they do usually, so much so that I can’t recall a time since Jenny McCarthy’s “Green Our Vaccine” anti-vaccination-fest nearly two months ago that they’ve been so flagrant in their lies, I thought it was time for some good news for a change. Fortunately, by way of the latest issue of The Lancet, some good news showed up in the form of a study. This study, reported late last week by the Antiretroviral Therapy Cohort Collaboration, a multinational collaboration of HIV cohort studies in Europe and North America, is yet one more piece of evidence that science-based medicine works. A press release describing the study sets the stage:

HIV-infected patients in high income countries are living some 13 years longer thanks to improvements in combination antiretroval therapy (cART), according to new research by the University of Bristol published in a HIV Special Issue of The Lancet today.

Improvements in and long-term effectiveness of cART have seen life expectancy increase by some 13 years from 1996-99 to 2003-05, and an accompanying drop in mortality of nearly 40 per cent in the same period.

By any stretch of the imagination, this is good news. The press release continues:

Professor Jonathan Sterne of Bristol University’s Department of Social Medicine and Professor Robert Hogg of British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University, Vancouver, Canada and colleagues from The Antiretroviral Therapy Cohort Collaboration (ART-CC) compared changes in mortality and life expectancy among HIV-positive individuals on cART.

This collaboration of 14 studies in Europe and North America analysed 18,587, 13,914, and 10,584 patients who started cART in 1996-99, 2000-02, and 2003-05 respectively.

A total of 2,056 patients died during the study period, with mortality decreasing from 16.3 deaths per 1000 person-years in 1996-99 to 10.0 in 2003-05 – a drop of around 40 per cent.

Potential life years lost per 1000 person-years also decreased over the same time, from 366 to 189 — a fall of 48 per cent. Life expectancy increased from 36.1 years in 1996-99 to 49.4 years in 2003-05, an increase of more than 13 years.

I decided to go to the study itself, because that’s usually the best approach in my experience when it comes to evaluating any peer-reviewed literature. This study appeared in the July 26 issue of The Lancet. It has several strengths. For one thing, it uses a concrete and undeniable endpoint as its measure, namely death. If there’s one endpoint that is unmistakeable and concrete, it’s death or, in this case, survival. Another strength of the study is that it looks at huge numbers of patients from multiple cohort studies for a grand total of 43,355 patients with HIV from several developed nations. The large collaborative nature of the study tends to smooth out local variations and statistical quirks, a characteristic which tend to average out highs and lows that can plague smaller studies and particularly single institution studies. On the other hand, one weakness is that the study didn’t take into account prior antiretroviral therapy use, which may be a confounding factor.

Basically, the investigators followed a large cohort of HIV-positive adults undergoing combination antiretroviral therapy from three time periods (1996-99, 2000-02, and 2003-05) and stratified subjects by sex, baseline CD4 cell count, and history of injecting drug use. They then estimated the average remaining life expectancy for those treated with combination antiretroviral therapy at age 20 and 35, as well as potential years of life lost from 20 to 64 years of age. The results were striking. In addition to the striking decreases in mortality reported above, it was found that today the average HIV positive 20 year old starting combination antiretroviral therapy can expect to live another 43 years; a 35 year old, 32 more years.

I was in medical school during the late 1980s, and I did an infectious disease elective in my last year of medical school, 1988. At that time, the diagnosis of an HIV infection was a death sentence. As an accompanying commentary put it:

Before 1996, clinicians who saw patients with HIV had to give bad news almost daily. We tried to restore hope by telling patients the cold hard facts that only 50% would progress to AIDS or death within 10 years, often acknowledging to ourselves that the tell-tale clinical features of immune deficiency had already appeared and the inevitable demise would surely be sooner rather than later.

I would note that a 50% ten year “progression-free” survival would not be so hot for many cancers. Also, I note that it is exactly this slow and variable progression of HIV to full blown AIDS is exactly the characteristic that gives HIV/AIDS denialists the opening to claim that HIV doesn’t cause AIDS and that antiretroviral therapy does more harm than good (for instance, when outliers go 15 or more years with HIV and do not progress or when the small subset of “nonprogressors” is examined). In any event, from my perspective, having dealt with AIDS patients in the era when there was nothing much that could be offered besides AZT, I find the prospect of patients being able to expect to live to an average age in their 60s while on antiretroviral therapy to be one of the most amazing successes of scientific medicine ever. In less than 25 years after having identified the virus that causes AIDS, we’ve gone from a disease that was a death sentence to a disease that can be managed on a chronic basis, with the expectation of patients living to a decent, if not ripe old, age. By any measure, this is an amazing, even unprecedented achievement and evidence that science works.

This study isn’t all sweetness and light, unfortunately. Although 20 and 35 year olds can expect to live into their 60s on antiretroviral therapy, it’s not clear why their life expectancy is not normal, which would be a life expectancy to around 80. Even with the new drug cocktails, these patients tend to die younger than patients without HIV. One thing this study shows is that starting treatment early is imperative if patients are to survive even this long. Starting treatment after patients have already become immunosuppressed shaves 10-20 years off of their anticipated time left. Being an IV drug abuser is good for the loss of around 10 years. It’s unclear exactly why, although it’s been speculated that the difference between IV drug abusers and those who do not abuse IV drugs may be due to poorer compliance with therapy in the former group. In the latter group, it is not clear why life expectancy has not yet been moved to normal, although it has been speculated that the effects of uncontrolled replication of HIV before treatment begins may produce long-term damage. Indeed, it’s speculated in the editorial:

Death is now increasingly due to serious non-AIDS illnesses, such as cardiovascular disease, cancers, and end-stage liver and renal disease….The most reasonable explanation for the 10-20-year gap in life expectancy so well documented by the ART-CC study is the previously unrealised clinical mischief of untreated HIV infection. The prevention of CD4 loss and perhaps immune activation by early treatment above a CD4 T-cell count of 500 cells per μL, a band which contains the lowest rates of serious HIV-related clinical events, is perhaps the most important clinical trial that should be done in the post-cART era. Hopefully, the START study, which compares starting cART with a CD4 cell count above 500 cells per μL versus deferring to a CD4 cell count of less than 350 cells per μL, will provide the evidence base to bridge the gap so elegantly defined by the ART-CC group.

Scientific medicine has done amazingly well in developing better treatments for HIV/AIDS. If someone had predicted to me in 1988 that in 2008 HIV would be in essence a chronic disease that shortened lifespans by 10-20 years if treated but still allowed a fairly normal life, I’d never have believed it given the death toll from this disease 20 years ago. For all intents and purposes, HIV has now become more like coronary artery disease or severe diabetes, a chronic disease that can be managed, than like cancer. However, clearly what scientific medicine has accomplished is not enough. HIV is still deadly if not treated soon enough, before serious damage to the immune system is done by the virus, and even perfectly treated patients do not live as long as uninfected patients. More importantly, the antiretroviral regimens are both expensive and onerous to follow, producing a major gap between results in developed nations (which were examined in this study) and Third World or developing nations, where HIV is such an enormous problem. Much has been accomplished, but much is still required if this scourge is to be vanquished, not the least of which is the development of far more inexpensive and less difficult combination drug regimens that poorer nations can actually afford.

The bottom line from this study is that it is yet another in a long line of studies that indicate that our current treatments for HIV infection are making a difference in the lives of patients. They are prolonging lives far beyond what was thought possible. That such advances occurred within my professional lifetime still astonishes me. What astonishes me even more is how people who for apparently ideological reasons simply can’t accept the copious science demonstrating that HIV infection ultimately results in AIDS in the vast majority of people infected and that treatments targeted at HIV work. They may not work as well as we would like yet, and their many drawbacks leave an opening for the denialists to obfuscate, but on balance the benefits they bring far outweigh the risks. Indeed, that combination antiretroviral therapy has improved the life expectancy of patients with HIV infection is a powerful refutation of the pseudoscience of the HIV/AIDS denialists.

REFERENCE

The Antiretroviral Therapy Cohort Collaboration (2008). Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. The Lancet, 372(9635), 293-299. DOI: 10.1016/S0140-6736(08)61113-7

Comments

  1. #1 Julian
    July 30, 2008

    This is good news but the anti-science community isn’t going to care one bit. The introduction of vaccines has had a huge impact on life-expectancy and child mortality rates over the last 200 years(one only need look at child mortality in Africa, where such vaccines aren’t prevalent to see how huge), and yet the vaccine denialist movement has likely the highest profile now than it has ever had before. It is so bizarre to me that the very fact that live has been made so much more secure by such successes breeds these ignorant backlash movements.

  2. #2 Richard Eis
    July 30, 2008

    We need a HIV vaccine !!!! One that is green coloured so everyone is happy.

    Of course now we also need to talk about the other little problem of world distribution of medicine.

  3. #3 Bob O'H
    July 30, 2008

    Although 20 and 35 year olds can expect to live into their 60s on antiretroviral therapy, it’s not clear why their life expectancy is not normal, which would be a life expectancy to around 80.

    Is there a problem in extrapolating beyond the data? I know roughly how these calculations are made, but I don’t understand the details to know if there’s some little catch, or if they have left out a covariate (social class?).

    Is there an epidemiologist in the house?

  4. #4 Ian
    July 30, 2008

    One of HIV’s many oddities is how successful antiviral treatments have been, compared to how unsuccessful vaccines have been. Both are pretty much unique among viruses; antiviral treatment for some herpesvirus infections may be almost as effective as antiretrovirals, but aside from that few antiviral drugs are very effective at all. In contrast, most serious attempts at developing antiviral vaccines have been rapidly effective (again, an exception might be for some of the herpesviruses, but even there, with the chicken pox vaccine and many veterinary vaccines, we’re seeing broadly effective vaccines).

    I wonder how much of this is cause and effect. Has effort been devoted to anti-retrovirals because of the lack of a vaccine? If polio vaccines had been as difficult to develop as are HIV vaccines, would we now have be able to cure polio infection with a little pink pill? Or is there a deeper cause, with the peculiar lifecycle of a retrovirus making it resistant to vaccines while increasing its susceptibility to pharmacology?

  5. #5 AIDSdebate
    July 30, 2008

    Before you declare the debate over, you may want to address the issues raised by Clark Baker. Apparently he is just getting started.

    http://www.californiaconservative.org/academia/hiv-aids-gallos-egg/

  6. #6 StuV
    July 30, 2008

    WARNING: That link will make your head hurt. It is twenty trillion words long, and all of it Not Even Wrong(TM).

    Money quote:

    “But when two dissenters persisted, Dr. Chalifoux asked me to conduct an independent investigation of Ms. Farber and Prof. Duesberg, citing my investigative experience, independence, and almost complete lack of knowledge about HIV and AIDS.” (Emphasis mine).

  7. #7 Orac
    July 30, 2008

    Indeed. Clark Baker certainly demonstrated his almost complete lack of knowledge about HIV and AIDS in the voluminous post linked to by Mr. AIDSdebate. The post, shockingly, even exceeded Orac-ian standards for length and loggorrhea. Too bad it was all HIV denialist talking points and full of the usual 20 year old studies and “challenges.”

    Really, the denialists will have to do better than that. That was pathetic.

    By the way, I just noticed that Steve Novella did a post on the same article. He’s even more explicit in taking out the HIV/AIDS denialists over this.

  8. #8 Dianne
    July 30, 2008

    Nice. Any word on the current rate of HIV related KS and NHL? NHL survival has increased nicely over the past few years. Partly due to fewer HIV related Burkitt’s?

  9. #9 Chris
    July 30, 2008

    Nice post. Surely this study ought to destroy any notion that anti-retrovirals cause harm. Does this paper add any new information on long term side-effects of combination antiviral therapy? Or is that outside the scope of the work?

  10. #10 Dianne
    July 30, 2008

    Surely this study ought to destroy any notion that anti-retrovirals cause harm.

    Fussy correction: Anti-retrovirals can cause harm. However, as this study shows, the benefit greatly outweighs the harm in the vast majority of cases. But that isn’t to say that any given individual might not get a nasty side effect from any given anti-retroviral.

  11. #11 pec
    July 30, 2008

    “Starting treatment after patients have already become immunosuppressed shaves 10-20 years off of their anticipated time left.”

    This can be explained by lead-time bias, if you are counting from the start of treatment, rather than from the start of infection. If HIV is diagnosed later there will be less time between diagnosis and AIDS symptoms. The treatment may have nothing to do with it.

    “Death is now increasingly due to serious non-AIDS illnesses, such as cardiovascular disease, cancers, and end-stage liver and renal disease….The most reasonable explanation for the 10-20-year gap in life expectancy so well documented by the ART-CC study is the previously unrealised clinical mischief of untreated HIV infection.”

    You are completely ignoring the well-known damaging effects of the drugs. Why jump to the conclusion that the shorter lifespan of AIDS patients has nothing to do with these side effects?

  12. #12 DLC
    July 30, 2008

    I’m not sure who’s worse, the anti-vax crowd or the HIV denialists.

  13. #13 Rogue Epidemiologist
    July 30, 2008

    Oh lord. I read the link AIDSdebate posted. It hurt my head.

    I’m maybe a few paces to the right of the political fence, but since when did AIDS denialism have anything to do with my taxes? Really, if they fancy themselves to be a clearing house for conservative information, then could they stick to the principles? Like limiting the power of the federal gov’t?

    I’m tired of all this “enemy of my enemy is my friend” bollocks. Just because teh gheys are liberal and often advocate for HIV/AIDS causes doesn’t mean conservatives want to get in bed with the denialists.

    For the record, I happen to really like (not just tolerate!) gay people.

  14. #14 Chuck Darwin
    July 31, 2008

    As Orac suggests, viral activity very soon after infection may indeed play a long-term role in the health of the patient.

    Soon after infection in most patients, central and, especially, effector memory CD4 cells in the gut – the major cohort of strong, antigen-primed cells in the body throughout adulthood – is decimated by HIV (it targets these cells specifically due to receptor expression (CCR5)).

    Even on after long-term, successful ARV therapy, evidence is accumulating that this cell subset (effector memory CD4s in the mucosa/gut) never returns to normal levels. It is currently hypothesized that the deficit in these cells may cause many problems, although they may be subtle.

    For example, these cells play an important role in the average healthy individual in promoting tolerance of all the mutualistic bacteria that houses in the gut. The long-term effects of this phenomenon are unclear.

    One of the great hurdles of fighting HIV successfully is its almost unique ability amongst viruses to target this extremely important immune cell subset. Only a vaccine that can truly limit HIV infection to a few days will probably circumvent such a hurdle.

  15. #15 Robster, FCD
    July 31, 2008

    Rogue, you hit on an interesting issue. If you take a close look at many of the leading luminaries of the HIV/AIDS denialists, you will find a disturbing amount of anti-gay hate.

    Harvey Bialy is positively unhinged in his hate for anyone who disagrees with him. I don’t know if his bigotry came first, or if the larger LGBT community’s recognizing him as a lying nut instead of a hero that brings his venom to the forefront.

    If you look into the main claims of the denialists, that AIDS is the result of hard partying, drug use, promiscuity, etc… you get the picture of a conservative anti gay stereotype causing AIDS. When an HIV+ denialist dies of AIDS, his/her former supporters quickly accuse the fallen of having been a drug abuser all along. Peter Duesberg, patron saint of denial, is a master of these maneuvers.

    Another favorite of denialists is the claim that AIDS is a result of group hysteria. Think about that. AIDS results from drama, yet another stereotype turned into pseudopothesis. The psychiatrist who wrote up that one, ironically, died of AIDS.

  16. #16 snerd
    July 31, 2008

    Will this finally shut Dave Grohl et al up, perchance?

    http://www.motherjones.com/news/feature/2000/02/foo.html

    He’s been harping on about this for a decade now.

  17. #17 Prometheus
    July 31, 2008

    Ian,

    The reason that HIV has been a tough bugger to make a vaccine for (and also why it evolves resistance to drugs so quickly) is that it is a retrovirus. The reverse transcriptase that retroviruses use to transcribe their RNA genome into DNA is extremely error-prone. It makes so many changes to the genetic code that only a small fraction of the virus particles produced are infectious.

    As a result of all these “mistakes” in transcription, the mutation rate in retorviruses is phenomenal, leading to rapid changes in coat proteins and also rapid adaptation to selection pressures – like drugs.

    There have been some other “issues” with HIV vaccines, not the least is the nasty – and not well-understood – effect of one of the investigational vaccines increasing morbidity and mortality.

    There are effective retroviral vaccines – against simian immunodeficiency virus (SIV) and Friend murine leukemia virus (F-MuLV) [there may be others] – but none in humans. If the experience with F-MuLV is any guide, the “usual” mechanisms for developing immunity against viral infections may not work for HIV.

    Prometheus

  18. #18 DrFrank
    July 31, 2008

    From the comments of the crazy article linked:

    Your dissertations about DNA and RNA bore me. This silly technobabble you all hide behind is bullshit. AIDS is political FRAUD you moron, who gives a shit about RNA DNA or Tcells?
    *facepalm*

  19. #19 Richard eis
    July 31, 2008

    -It makes so many changes to the genetic code that only a small fraction of the virus particles produced are infectious.-

    So basically…first we need to make a better HIV virus…then we can make a vaccine…

  20. #20 Patrick
    July 31, 2008

    …”who gives a shit about RNA DNA or Tcells?
    *facepalm*”

    That’s it mr facepalm, keep talking to your own hand, not that you wouldn’t even exist were it not for all of the bovine excrement you so detest. LOL

    (Sorry, I was trying to be quiet but the Devil made me do it!)

  21. #21 Prometheus
    July 31, 2008

    “-It makes so many changes to the genetic code that only a small fraction of the virus particles produced are infectious.-”

    So basically…first we need to make a better HIV virus…then we can make a vaccine…

    Actually, HIV makes thousands of copies of itself, so even if 99% of them are defective, the virus can spread the infection to new cells.

    The point is that the virus polymerase makes a lot of errors, which leads to a high “failure” rate. Of course, when you have thousands of “offspring”, you can afford to lose a lot of them.

    The “flip side” is that these “offspring” – the ones that are “viable” (“infectious” is the preferred term) – have a lot of genetic changes, which provides a lot of raw material to evolve new coat proteins (to evade antibodies) and new metabolic enzymes (to evade anti-viral drugs).

    The virus doesn’t need to be made “better” – it is already very effective at what it does. Reducing its “error rate” would probably make it less successful.

    Prometheus

  22. #22 Michael
    August 2, 2008

    Orac, you are as full of shit as ever:

    The just released study says it all, and I quote:

    Conclusion: Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART.

    http://www.biomedcentral.com/1471-2334/8/52

    Robster, you are just as full of shit as ever:

    The vast majority of those you call “denialists” are just like myself, gay men. Most of those gay men you call “denialists” are people diagnosed as HIV positive who flushed their antivirals down the toilet.

    More than half of all gay hiv positives DO NOT even take any antiretrovirals, and the deaths that you call “AIDS” deaths, are mostly liver failure in direct correlation to those taking the drugs.

    And don’t tell me the gay community is not swept up in drug addiction. The last edition of our local gay media ran a story declaring “Crystal Meth, Our Community’s Greatest Problem”.

    And it was even worse in the 80′s and 90′s than it is today.

  23. #23 David
    August 2, 2008

    For over 20 years now, my life has been turned upside down because of lies, intimidation, fear, politics and governmental/pharma interests. It started when I was called into the doctor’s office at the hospital and was given the HIV+ label by my then doctor who had ordered a routine blood sample of mine to be tested. This happened at the Hospital Hemophilia clinic while in my late teens with my parents present. I was completely asymptomatic then, completely healthy in every way but in effect from that time onwards until today I was told that I would be very sick, would need to take drugs and was the carrier of an infectious disease. The whole HIV=AIDS=Death Dogma was in effect a self fulfilling prophecy for most hemophiliacs at that time. Most would invariably test positive for antibodies on the non specific test and were told that they would be at risk for death. Of course, hemophiliacs like myself were never told that the test itself is neither specific, standardized or approved for dianostic purposes. I was never told that hemophilia itself and the administration (injection) of clotting proteins for my illness was one of over 70 conditions which can cross react with the test kit proteins themselves to cause a false positive reaction on the test. Moreover, I wasn’t presented with with any proof whatsoever that a purported retrovirus called HIV?! was the cause of AIDS or that my antibody response was an indication of infection.

    On behalf of my fellow hemophiliacs and all those harmed by the HIV=AIDS=Death Dogma I demand the full restoration of truth, reconciliation, compensation and reparations be restored back to our lives. Our stories need to be told and our voices must be heard. Now. When I think back to the mid 80s and early 90s when the fears of an epidemic were heightened, I realize that there was no examination of evidence or correction when the theory failed to fit facts and reality. All we got was fear campaigns, and more testing and treatments with toxic drugs. In fact, up to the time of the AIDS era the mortality rate of hemophiliacs that had died over the years was fairly predictable and life expectancy had dramatically improved with the higher quality of clotting treatments that had become more readily available. However, the massive sudden increase in deaths can be directly correlated with the use of AZT and other toxic drugs soon prescribed on a prophylactic basis. This is the absolute truth that has been covered up for so many years. i strongly believe that the record and documenatation of the deaths of so many hemophiliacs should be exposed in a court of law that really seeks to set the record straight. In my view the drug deaths of my peers is tantamount to murder.

    The truth with regards to the events of those years has indeed become much clearer and can easily be verified. Virtually all hemophiliacs on heavy drug regimens were killed off quickly. Most of them were asymptomatic at the time the AIDS treatment regimens were imposed on them. A few lucky survivors regained health when the drug regimens they were on was significantly reduced or ended. The very lucky ones like me who refused the drugs from day one have remained 100% healthy to this day. Yet all this evidence has been ignored and I still see that patients are being poisoned at the hospital to this day 2008! If there is any lesson I have learned over the years is that if we don’t fully unite together to fight the oppressors of the HIV/AIDS orthodoxy and their monetary interests they will continue without conscience as their crimes become ever more heinous in scope and magnitude on human life. Consider for instance how the definition of AIDS has changed numerous times when predictions of doom and so called infectious epidemics never materialized. We have an incubation period that once started out between 2-5 years when AZT monotherapy was prescribed that now stretches up to 30 years and beyond. A myriad number of diseases have been added to the mix like cervical cancer which are not even immune related. Furthermore, the usage of wholly inaccurate methodologies like the unspecific antibody itself, T cell counting and viral load tests have been proven to be false, misleading and I would say outright criminal in their application on healthy asymptomatic people. It should be noted too that the number one cause of deaths of HIV+’s today is liver and/or kidney failure which is definitively a direct result of drug toxicity and cannot be attributed to any hypothetical virus.

    On a personal level, I have had to live with the constant pressure to take the highly toxic HIV medications by my doctors and nurses for many years. My decision to take charge of my situation and refuse the toxic medications from the beginning indeed saved my life. While I feel fortunate to be alive when so many HIV positives died needlessly on the meds, it has saddened me greatly that the overall arrogance of the medical community has prevented correction of the current terrible state of affairs. To be told time and time again that you are “sick” and at “grave risk for impending death” for so many years, I believe is extremely psychologically damaging. A complete never ending nightmare! I have had many suicidal thoughts over the years. A few HIV positive friends of mine have admitted to me that they have come painfully close to the act of suicide itself. Because of the intense social isolation, psychological pressure, stigmatization and sense of utter hopelessness (that comes with the diagnosis), it is not surprising that suicide is the second leading cause of death of HIV positives.

    It must be pointed out that being HIV positive is analogous to being the societal equivalent of being a “social leper”. The judicial system and media have portrayed us as spreaders of disease, killers, murderers, and purveyors of death, etc. The truth of the matter that there is NO scientific proof that HIV causes AIDS or is sexually transmitted is conveniently ignored. The famous Padian study meticulously documented irrefuteable data showing no seroconversions occurring among hundreds of discordant couples having unprotected sex for upwards of ten years. All the predictions by the AIDS orthodoxy of mass epidemics afflicting the earth killing millions never materialized. Dr. De Cock of UN AIDS’ confirmation that the prior predictions of mass epidemics in the 80s was false was an admission of a failed theory, a sinking ship as it were sturggling to stay afloat against the changing tides. Moreover, Dr. De Cock confirmed that the theory had “0″ predictive value and that statistics had been fraudulently manipulated in conjunction with propaganda “fear campaigns” to benefit mass pharma profiteering and genocidal drug campaigns worldwide.

    The irrational policies of the AIDS orthodoxy have led to the wrongful conviction and imprisonment of innocent people for having consensual sex. It has destroyed lives, families and relationships. I have been terrorized by the institutional violence wrought by these policy makers. I have felt much sadness and frustration to read about HIV postives being flashed in the newspapers, paraded in the courts and treated like grotesque circus freaks. The apparent failure of the judicial system to properly examine and reject the fraudulent non science of the HIV theory will in my view undoubtedly geatly stain their collective reputations for many years in the future. In my view, their approval of the status quo represents tacit complicity and support of the real criminal murderers protected in the AIDS orthodoxy. The failure of the courts to allow debate and answer basic questions only adds to the growing stench of the ongoing coverup. Why have AIDS researchers refused to debate dissident scientists for 20 years? Why have the AIDS corporate nterests been able to evade the serious charges of fraud and scientific misconduct levelled at them by sincere oourageous scientists bearing no conflicts of interest? Who are the real “Denialists”? Why have AIDS doctors, pharma reps, governmental officials, etc. not yet answered for the deaths, disfigurement, stigmatization and terror imposed on HIV postives for decades? It seems clear now that the impending loss of power, money, prestige and public credibility is at the root of keeping the fraud alive in the face of so much evidence and opposition continually raised against it.

    It is my view that the disgraceful treatment of latter day ‘lepers’ (now euphemistically called “HIV Positives”) dragged into the courts to be mocked, prodded and jailed will not be easily forgotten. History will look back very harshly on the barbarism and betrayal by trusted institutions and the government on innocents.

    Now in my late 30s I face the future with a great deal of hope that better days lie ahead for myself and all those oppressed by the rules imposed on us by all those profitting from the HIV=AIDS=DEATH dogma. Collectively we must seize this movement and demand our freedom and compensation for the many crimes that have been perpetrated against us all. Personally I have been stigmatized and lived with much discrimination 24/7 because of the lies and the rules that have been associated with them over the years. The emotional toll of being “branded” so to speak has been an enormous imposition to me, affecting virtually every aspect of my day to day life. Virtually all my relationships have been short lived and I could not continue with some of my career plans as I had originally envisioned back in my 20s.

    When I consider the billions of dollars of profits pharma and governmental interests have made criminally on the lives of innocents without any correction, re-examination or apology, etc. for all these years it makes me feel very sick inside. If justice can be found in court, then they should have to give back their profits to the victims. I call out to you all, my brothers and sisters, to fight the tyranny which has damaged our lives until our freedom is finally fully restored.

  24. #24 Orac
    August 2, 2008

    Michael,

    No, it is you who are full of shit. Citing that particular article is a case of comparing apples and oranges, and you clearly indulged in some quote mining. Here, I’ll give the a few paragraphs of context for the sentence you quote-mined:

    Mortality was high in this cohort, and most of the deaths occurred within 3 months of starting ART. Severe and moderate anemia, thrombocytopenia and severe malnutrition were found to be independent predictors of mortality. The high early mortality observed in our study is in line with other similar studies from resource-limited settings [8-15]. Causes of death were not investigated in the present study; however, in a study from South Africa wasting syndrome, TB, acute bacterial infections, malignancies and immune reconstitution disease were the major causes of death [14]. In our cohort more than half of the patients had clinical AIDS at enrollment into HIV care, and other African ART programs have also reported high rates of advanced disease [8-12,14,15]. Stigma and delay in seeking health care, lack of voluntary testing and counseling services, and health system delays in referral and ART initiation are possible explanations. Thus, priority must be given to identify HIV-infected individuals and start treatment earlier in the course of their illness, before they develop severe opportunistic infections.

    Anemia was a strong predictor of mortality in our study. Patients with severe anemia had nearly 15 times higher risk of dying during the first year on ART compared to those with a normal hemoglobin level. Several studies from Europe and North America have shown that anemia is an independent predictor of mortality in patients on ART, even after controlling for CD4 cell count and viral load [22-24]. Recently, studies from developing countries have found the same association [9,13]. Indeed, in the largest African cohort study published to date, severe anemia (hemoglobin <8 g/dL) was the strongest independent predictor of mortality in 16 198 patients receiving ART in Zambia [13].

    It is uncertain whether the association between anemia and mortality is causal or whether anemia is rather a marker of progressive HIV disease. It is known that the incidence of anemia increases with progression of HIV infection [23]. Furthermore, anemia can be a feature of certain opportunistic diseases, like disseminated mycobacterial infection and parvovirus B19 [25]. Several other etiologic factors may be involved in the development of HIV-associated anemia, including micronutrient deficiencies, immunological myelosuppression, impaired erythropoietin production and blood loss from intestinal opportunistic disease [25]. The role of iron supplementation is controversial, as some reports have suggested adverse effects of iron excess in HIV-infected individuals in industrialized countries [26,27]. On the contrary, recovery from anemia after erythropoietin treatment has been associated with improved survival [23,24], but high costs limit its use in poor countries. More recently, ART has been shown to significantly reduce HIV-associated anemia in developed countries [28,29]; however, this has not yet been investigated in rural Africa. Further studies are needed to explore possible interventions against HIV-associated anemia in resource-limited settings, including the role of iron supplementation.

    Malnutrition was another strong, independent predictor of mortality in our study. Estimated one year mortality was nearly 50% among patients with severe malnutrition. Previously, studies from industrialized countries have shown that malnutrition in HIV infection is associated with morbidity and mortality, even after the introduction of highly active antiretroviral therapy in the late 1990s [30-32]. More recently, studies from developing countries have found that malnutrition is an independent predictor of mortality in patients starting ART [8,12,13,33]. However, it is not clear whether targeted therapy for malnutrition will result in improved survival [34]. Studies of nutritional interventions in HIV patients are urgently needed in developing countries, where malnutrition is often a result of poverty and food insecurity.

    We found a reduced risk of death in patients starting ART in later calendar years compared with the initial period 2003-04. A possible explanation is that many patients with severe AIDS were included in the initial period, as this was the first clinic to offer ART in the area. However, since the risk reduction persisted after controlling for clinical stage, we believe that it may also be attributed to improved skills among local staff managing HIV patients. The decline in mortality over time supports our experience that non-physician clinicians can be trained to follow-up and treat HIV-infected patients.

    It was pretty dishonest of you to leave out the context and thereby misrepresent the study. Basically, the investigators were trying to correlate clinical aspects of patients with risk of death, and they found some correlations. Also, because of resource limitations in Tanzania, these HIV patients weren’t treated for the most part until they had either clinical AIDS or other gross abnormalities in blood tests. It’s a very different thing than starting out with relatively healthy and comparatively wealthy Western patients.

    By the way, you and David might want to read Steve Novella’s take on the study as well.

  25. #25 Michael
    August 2, 2008

    Hey Orac. Why the dishonesty in everything you present. Is Glaxo paying you to keep it quiet that AZT is what killed most hiv positives prior to 1996? You present a study that claims the new meds “extend life” in hiv positives since 1996. Jellybeans would be just as “life extending” in comparison to the years of AZT.

    You neglect to mention that this supposed “life extension” is in comparison to the years of giving a drug that even the entire orthodoxy admits was a mistake.

    You also neglect to mention that there is not even a single one of these so called “life extending” drugs since 1996 that has ever been placebo tested or tested against nothing at all.

    1) Orac. Can you explain to us know nothings what the placebo effect is and why a placebo often works as well as a drug in treating many patients?

    2) Orac. Can you explain the same with the nocebo effect of giving a patient nothing when they believe they must have something?

    3) Orac. Can you explain why the long term nonprogressors such as David have survived simply by not taking any of the drugs and by expecting to live instead of taking the drugs while expecting to die.

    4) Orac. Are you a germophobe, baccillophobe, or possibly, and most likely, even a genophobe (fear of sex)? Sure seems like it to me.

    And Orac, don’t bother to tell me how few there are of long term nonprogressors. First of all, I know too many of them myself. Second of all they turned up more than 1000 a year or two ago in Boston alone when they advertised for them for a study. If they turned up a thousand to join a study then there must be many many more of them, since most people do not want to be in any studies.

    And most LTNPs that I know don’t even want anything at all to do with any studies of “modern” science or medicine, and would not go into any study because they simply want the hiv/aids “your all gonna die of aids” purveying asswipes, to stick it where the sun don’t shine and just leave them alone.

  26. #26 Michael
    August 2, 2008

    By the way, Orac, every one of the aids drugs carries an FDA “Black Label Warning”.

    Can you tell us all what an FDA Black Label is and what it means?

  27. #27 Michael
    August 2, 2008

    Gee Orac. You say you don’t understand why those taking art drugs don’t have a normal lifespan?

    I just found the definition of the black label. Could this be the answer to your mind bending puzzle?

    Doohhhhhhhh!

    In the United States, a black box warning (also sometimes called a black label warning or boxed warning[1]) is a type of warning that appears on the package insert for prescription drugs that may cause serious adverse effects. It is so named for the black border that usually surrounds the text of the warning.
    A black box warning means that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects. The U.S. Food and Drug Administration (FDA) can require a pharmaceutical company to place a black box warning on the labeling of a prescription drug, or in literature describing it. It is the strongest warning that the FDA requires.

  28. #28 Michael
    August 2, 2008

    Orac. Peoples fear of hiv and aids is truly fascinating also, as far as being fascinated by phobias goes.

    Perhaps your ego is just paranoid of dying. Have you considered seeing a psych for your germophobia and genophobia and hiv/aidsophobia and deathophobia. It is all likely what drives your fanaticism and obsession over hiv aids beliefs.

    All that fear and paranoia of yours is really very unattractive, Orac. A big turn-off for women too. Women prefer men who have courage, not cowardice. Think about it Orac, and get back to me after you talk to your psych.

    Like it or not, one day you will assuredly die. Maybe today. Maybe tomorrow. Maybe not for 50 years. But as sure as you are reading this, one day you will die, so you might as well get over your paranoia of death as well. Don’t you think?

  29. #29 trrll
    August 2, 2008

    You also neglect to mention that there is not even a single one of these so called “life extending” drugs since 1996 that has ever been placebo tested or tested against nothing at all.

    And considering the overwhelming clinical experience and statistical data indicating that these drugs extend life, they never will be. Such a study would be considered criminal, comparable to the notorious Tuskegee study in which syphilis patients were left untreated. AZT was tested against placebo, and worked so well that the study had to be terminated early because became clear that it was unethical to withhold it from the placebo group. Since then, new HIV/AIDS treatment regimens have been tested against the best known treatment, as standards of medical ethics require.

    Can you explain to us know nothings what the placebo effect is and why a placebo often works as well as a drug in treating many patients?

    A placebo controls for the fact that for most conditions there is typically some fraction of patients would do well even without treatment. Some people think that it may also control for possible psychological effects of treatment, although some recent studies suggest that this is overrated.

    Can you explain the same with the nocebo effect of giving a patient nothing when they believe they must have something?

    I’m not sure what you are talking about. The nocebo effect refers to the fact that some patients become convinced that they are experiencing drug-related side effects even when given no active drug at all.

    Can you explain why the long term nonprogressors such as David have survived simply by not taking any of the drugs and by expecting to live instead of taking the drugs while expecting to die.

    All drugs carry some risk. With almost any medical condition, there will generally be some fraction (generally a small proportion) who will do well without drug treatment, and for whom the drugs only add risk without conferring any benefit. Unfortunately, there is generally no way to tell in advance who they are, so doctors have to play the odds and treat everybody. There will always be some people who live to a ripe age of 101 despite being heavy smokers, but it is not the way to bet.

    Orac. Are you a germophobe, baccillophobe, or possibly, and most likely, even a genophobe (fear of sex)? Sure seems like it to me.

    I can’t speak for Orac, but I can tell you that one almost never encounters “germophobes” in the medical profession. For some odd reason, people with that sort of phobia seem disinclined to enter a profession that brings them into constant contact with sick people.

    And Orac, don’t bother to tell me how few there are of long term nonprogressors. First of all, I know too many of them myself. Second of all they turned up more than 1000 a year or two ago in Boston alone when they advertised for them for a study.

    And surely, you’ve never said anything that might lead such a person to want to contact you, right? Nobody doubts that nonprogressors do exist. But there could be 5 times that number of nonprogressors, and it would still be under 1% of the number of people who have died of AIDS in the US.

  30. #30 Michael
    August 2, 2008

    Orac and Company, Do you suppose that going through some of these following and difficult and emotionally painful situations might affect someones health and well being and even their lifespan? In the 35 years that I have spent as an “out” gay man in the gay communities, I have seen all of the following, especially in those who have passed from what you call AIDS.

    As you yourselves have had no such life experiences to compare to any of the following, I do understand your inability to fully empathize or understand or comprehend the impact. But just for a moment, consider this:

    Have you yourself ever:

    suffered the emotional trauma of being completely disowned by your family for being gay?

    lost a job or friends from being gay?

    been despised by your family for being gay?

    felt like you were a mistake that should never have been born?

    sniffed poppers and did any other dope cause you felt you needed to just to fit in?

    been addicted to drugs and felt like you could not go on without them?

    been addicted to sex to the point where you could not stop yourself from going out for sexual liasons, one after another, and would be with almost anyone regardless of the risks?

    suffered from extreme self loathing and hating yourself and feeling like you were a defect?

    had an internal death wish because you saw your life as hopeless and meaningless?

    ever had a lot of your friends and your lover die?

    had many shots of antibiotics for months on end from getting lots of std’s?

    gotten sick just from taking all of those antibiotics?

    been so stressed that you could not eat, sleep, work, or function?

    been told you had hiv and then given a diagnosis of early death?

    felt like a leper that if you ever had sex with anyone, that you would infect and kill them?

    been acutely depressed?

    been acutely suffering from loneliness?

    been acutely shamed for being gay?

    been told you must take toxic meds for the rest of your life that made you sick every day?

    The fact is, that none of you in science or medicine know what many gay men have suffered. Therefore, you are incapable of relating to any of it, or understanding the impact on health and well being.

    You may know what a cat is, but you do not know what it is to be a cat. And you do not know what the life experience of many gays was like particularly in the homophobic witch hunts of the 80′s and 90′s. You do not know how deeply so many of them suffered. You do not know how disabling and disempowering even the very idea of, let alone a diagnosis of, HIV can be or do to people.

    There were many things that contributed to gays becoming emotionally and physically broken, just as there are many things suffered by the poverty stricken in third worlds. Only a fool would think it was all just as simple as some sex virus, while you ignore the realities of other peoples lives.

    This inability of those in science or medicine to understand such simple facts is what created the entire episode of stressful hysteria in the gay community, as the media and medicine further hyped and damaged instead of confronted what the realities of the situation actually was all about.

    Today, the gay community is waking up to all of this, while now the black community is getting caught up and destroyed by the hysteria. And everyone ignores that hiv science is completely unsubstantiated and completely ignores the most important factors of human health and well being.

  31. #31 Michael
    August 2, 2008

    trrll said: And considering the overwhelming clinical experience and statistical data indicating that these drugs extend life, they never will be. To do so would be criminal…

    That is a lie. It is criminal not to do such a study. Most hiv positives do not take the drugs. And they are perfectly healthy. The drug studies are ALL paid for and directed by the drug companies who have a stake in bringing the drugs to market. They DO NOT want such a study, because such a study would clearly show the drugs to be useless, and it is criminal that they are not required to do so.

    trrll said: AZT was tested against placebo, and worked so well that the study had to be terminated early because became clear that it was unethical to withhold it from the placebo group.

    AZT was only tested for 4 short months, and thirty of those taking AZT that were claimed to have had benefit by it were only alive at the end of the 4 months because they had blood transfusions. All 30 died soon after the study finished. The study was completely run by Burroughs Wellcome and was a complete fraud, which soon enough proved to be true, or high dose AZT monotherapy would still be used and would not have been discontinued.

    What is criminal is that the 4 month study was ever permitted to be waltzed through the FDA and approved. Criminal and genocidal. It killed nearly half a million gay men. I myself would love to shove some down your throat troll.

    Especially since you, Terrell, are a wannabe assistant professor toxicologist that is of absolutely no scientific standing and you yourself have never produced a meaningful addition to science in all of your years at it. You are less than a nothing in science and medicine, Terrell, and your babbling about the validity of 4 month long studies in which everyone died, and 30 needed blood transfusions, as being some kind of evidence for how wonderful AZT was, simply shows you to be nothing less than a psychopath. No wonder your initials are one letter away from being “troll”. Maybe you were trying to tell yourself something when you took the handle.

  32. #32 Michael
    August 2, 2008

    The troll said:

    “Nobody doubts that nonprogressors do exist. But there could be 5 times that number of nonprogressors, and it would still be under 1% of the number of people who have died of AIDS in the US”.

    Define AIDS troll. AIDS is not a cause of death.

    Just how many died of “aids” troll, and how many died of what was called “complications of aids”, meaning that they died of drug effects?

    How many died of drug effects troll? What percentage troll? Come on, troll, you mean they never bothered to keep the statistics for how many died of drug effects?

    Why not, Troll? Why did they conveniently not keep statistics on who died of drug effects troll? Why not, you genocidal bastard?

  33. #33 Michael
    August 2, 2008

    Orac,

    trrll the genocidal bastard does not want to tell me where to find the statistics on how many people died from the effects of taking azt or any other aids drug. Since, you, Orac, are touting how wonderful and lifesaving the drugs are, perhaps you would be so kind as to tell us all where to find the statistics of exactly what cause of death that those who are taking the aids drugs are actually dying from.

    Please tell us also where to find the statistics on what the actual causes of death were in those taking AZT from 87 to 95.

    Surely, our brilliant scientists would want to know what the actual causes of death were. After all, AIDS is a syndrome, not a disease, and not a cause of death.

    Just who has gone through all these half million death certificates to find out the exact causes of death in those who supposedly died of “aids”?

    And if there are no such records, Orac, than explain to me, a gay man, why NOT? Exactly WHY are there no such records kept or made public?

  34. #34 Michael
    August 2, 2008

    Here is the next headline for your next blog, Orac:

    TWO HUNDRED AND FIFTY BILLION SPENT ON HIV AIDS RESEARCH AND NO RECORDS OF EXACTLY WHAT ANY OF THE DIAGNOSED ACTUALLY DIED FROM HAVE EVER BEEN KEPT!!!!

  35. #35 heheheheheeee
    August 2, 2008

    Wow! The single most extensively studied disease syndrome in all of human history and they have never kept records of the exact causes of death!

    Holy Shit!

    What a bunch of bungling bullshitters.

    Can’t believe that smart people like Orac couldn’t even see through it. Are they brainwashed or just too smart for their own good?

    I guess it takes stoopid people like gas station attendants and taxi drivers and ditch diggers to finally ask the right questions. Must be because the right questions to ask are much too simple for such illustrious and brilliant people like Bob Gallo, Fauci, David Ho, Orac, Tara, and troll to bother asking.

  36. #36 Laser Potato
    August 2, 2008

    Obvious flooder is obvious.
    This is giving me flashbacks to Cocksnack.

  37. #37 trrll
    August 2, 2008

    AZT was only tested for 4 short months, and thirty of those taking AZT that were claimed to have had benefit by it were only alive at the end of the 4 months because they had blood transfusions.

    That was all it took for the benefits to be so obvious that it was considered unethical to deny it to the other patients. By modern standards, it was a pretty poor drug–as the Lancet study indicates, it extended life, but not by much. Later refinement of dosing, and replacement of AZT with less toxic antivirals, greatly enhanced survival, yielding the benefits attested to by the Lancet study.

    Define AIDS troll. AIDS is not a cause of death.

    This sort of quibbling is like arguing, “The gun didn’t kill him, it was the bullet.” Or “The bullet didn’t kill him, he died because his heart stopped.” Considering that many people would have lived much longer if they had not developed AIDS, it is reasonable to refer to AIDS as having caused their deaths.

    How many died of drug effects troll? What percentage troll? Come on, troll, you mean they never bothered to keep the statistics for how many died of drug effects?

    Prior to the development of modern antiretroviral therapy, people with AIDS were very debilitated, and the contributions of their many health problems, along with the side effects of the treatment, were frequently impossible to disentangle. So there is no practical way that an accurate answer to such a question could really be obtained. Besides, asking what percentage is kind of stupid, because if a treatment is perfectly effective in preventing a disease from killing you, then 100% of the deaths associated with the disease will be due to the side effects of the treatment (and every effective drug carries some degree of risk). Ultimately, you have to look at whether the treatments have resulted in people living longer. The Lancet study shows that they have.

  38. #38 Orac
    August 2, 2008

    Obvious flooder is obvious.
    This is giving me flashbacks to Cocksnack.

    Yeah, he’s an irritating comment flooder and can’t even mount a coherent argument. In other words, he’s become very tedious. I tell ya, I spend a few hours going out to dinner with an old friend whom I haven’t seen in several years, and this is what I’m greeted with when I return home.

    That’s why from now on I’ve put him in my moderation filter. I’ll let his comments go through when I moderate, but he’ll have to wait until I get around to moderating him, which may be quick or may be several hours depending on when he posts. For example, if he posts at 1 AM, chances are I won’t get around to moderating his comments until morning because I have far more important things to do–like sleeping. If he behaves and stops flooding the comment thread, I’ll remove him from my moderation filter, even though he’s an HIV/AIDS denialist and clearly has nothing of interest to say or any valid scientific argument to make.

    Even for an HIV/AIDS denialist, he’s dumb. His “arguments” (such as they are) are the equivalent of the antivaccinationists’ “formaldehyde” or “toxins” gambit.

  39. #39 zy
    August 2, 2008

    Actually, a healthy fear of AIDS is quite an attractive quality in a man.

  40. #40 SteveF
    August 3, 2008

    Hi Orac,

    Did you see this report:

    Human Immunodeficiency Virus (HIV) researchers at The University of Texas Medical School at Houston believe they have uncovered the Achilles heel in the armor of the virus that continues to kill millions.

    http://www.physorg.com/news135360794.html

    It’s about an important (apparently) breakthrough in HIV research. I’d be interested in your thoughts.

  41. #41 Prometheus
    August 4, 2008

    Steve F,

    I’ll take a stab at this while Orac’s busy.

    gp120 is an HIV protein that binds to the CD4 protein on the surface of human T-cells and other immune cells. The binding causes a conformational change that allows for binding to a co-receptor – either CCR5 or CXCR4 – which then allows entry of the virus into the cell.

    gp120 was the target of earlier vaccine attempts, which were not too successful (as you might have gathered). The constant portion of this protein is a small target for antigens, but it might be a reasonable target for another class of entry-inhibitor drugs. There are already drugs targeting the binding to CCR5, but the virus can either use alternate co-receptors (e.g. CXCR4) or mutate to use another domain of CCR5.

    The advantage to a drug targeting gp120 binding would be that there is – so far as we know – no alternate receptor for gp120 and stopping the gp120 binding would stop the infection process one step earlier than the CCR5-directed drugs.

    However, a lot of work remains to be done, and we may find out that gp120 can use a different receptor or – as it did with CCR5 – HIV may mutate the gp120 to use a different domain of CD4 or even a different receptor entirely.

    In short – it’s a promising line of research but WAY too early to tell if it will pan out.

    Interestingly – and this may address some of the points raised earlier – a CCR5 mutation (CCR5-del32, to be specific) has been shown to provide resistance to HIV infection. People with two copies of this mutated gene (homozygous) are resistant to HIV infection and having a single copy (heterozygous) significantly slows the progression of the infection.

    About 5 – 15% of people of European descent have at least one CCR5 gene with this mutation, but almost nobody of African or Asian descent has this mutation.

    There may be other mutations that provide resistance to HIV, which would account for at least some of the reports of long-term HIV infection without progression to AIDS.

    Prometheus

  42. #42 SteveF
    August 5, 2008

    Thanks very much for your thoughts!

  43. #43 Tigger
    August 5, 2008

    Hey Prometheus

    So how does all that technobabble fit into the BASIC FACT that ‘HIV” tests do not detect specific ‘HIV antibodies” not to even mention the actual presence of the “HIV” retrovirus? The fact there is no “gold standard” for ‘HIV”?

    If there is no God, for all the venerated millions of pages written about him, would render even the bible itself a worthless fantasy.

    How much of all this scientific brilliance is based on solid scientific method and proven fact? How much of this is really science and not more akin to theology?

    “Your dissertations about DNA and RNA bore me. This silly technobabble you all hide behind is bullshit. AIDS is political FRAUD you moron, who gives a shit about RNA DNA or Tcells?”
    *facepalm*

    I second that statement too. ‘AIDS” IS a pure political CONstruct and an outrageous scientific FRAUD.

  44. #44 Orac
    August 5, 2008

    “Your dissertations about DNA and RNA bore me. This silly technobabble you all hide behind is bullshit. AIDS is political FRAUD you moron, who gives a shit about RNA DNA or Tcells?”

    So basically you don’t understand anything about the science of HIV; so you decide it’s all political.

    What a maroon.

  45. #45 DT
    August 5, 2008

    “Your dissertations about DNA and RNA bore me. This silly technobabble you all hide behind is bullshit. AIDS is political FRAUD you moron, who gives a shit about RNA DNA or Tcells?”

    If you are bored, go play someplace else.

  46. #46 Tigger
    August 6, 2008

    Ye ye ye…but you didn’t answer that BASIC question so maybe you will bore me a little less:

    So how does all that technobabble fit into the BASIC FACT that ‘HIV” tests do not detect specific ‘HIV antibodies” not to even mention the actual presence of the “HIV” retrovirus? The fact there is no “gold standard” for ‘HIV”?

    How is all this relevant when we do not have a SPECIFIC “HIV” TEST?

  47. #47 Tigger
    August 6, 2008

    I don’t need to understand the science beyond the fact it is PURE GARBAGE.

    “HIV babble babble babble toyle and trouble babble babble eye of newt and fin of fish and loads and loads of VIRAL DNA RNA babble babble bullshit in a kidney dish…

    DO WE HAVE A GOLD STANDARD FOR “HIV”?

    DO WE HAVE A SPECIFIC ‘HIV” TEST THAT DETECTS SPECIFIC ‘HIV” ANTIBODIES?

    That is the BASIC question here, because if we don’t then all this is babble babble babble…yawn yawn yawn yawn…burp.

  48. #48 Tigger
    August 6, 2008

    “So basically you don’t understand anything about the science of HIV; so you decide it’s all political.
    What a maroon.”

    Orac, I decided it was political precisely because I do understand the science, the basic science behind the “HIV” fantasy. It’s a banal fantasy. Period.

    We have NO test for specific HIV antibodies or virus yet we tell people they have a virus and a fatal disease based on this “test”. Since the idea of that being scientific is laughable, it must then be political, which makes it much more grave, when you consider that the “test” has not been validated, in fact, it is illegal.

    Of course, all scientists and doctors who push it are either stupid or criminals, now in your case I am quite convinced it is the latter.

    Now what has all that got to do with DNA you moron?

  49. #49 Undergraduate-gal
    August 9, 2008

    Hi Dr. Orac,

    I just want to say I really dig your blog. It’s like so brainy it makes me want to get into it and play with all you guys. But well, I guess I’m the kind of gal who likes to go for the gold right away if you know what I mean. All thse RNA or DNA or whatever loads gives me a headache sometimes. And you said yourself that that Novella hunk is even more clever than you are Dr. Orac so I guess that makes him like real smart. So anyway Novella says

    “[Christine Maggiore] argues that increased survival is due solely to expanding the diagnostic criteria so that more mild cases qualify as AIDS. This is a real concern in any epidemiological data, such as the current study. But the criticism is not fair and accurate because changing diagnostic patterns is a known and often controlled for factor. For example, in the current study the methods indicate that populations were stratified by baseline CD4 count. The CD4 cells are those T-cells that are primarily affected by HIV infection, and CD4 count is widely used as an estimate of disease severity. This ensures that populations with similar severity are being compared, so that prolonged survival is likely to be due to treatment, rather than just changes in diagnostic behavior.
    She then argues that increased survival is due solely to expanding the diagnostic criteria so that more mild cases qualify as AIDS. This is a real concern in any epidemiological data, such as the current study. But the criticism is not fair and accurate because changing diagnostic patterns is a known and often controlled for factor. For example, in the current study the methods indicate that populations were stratified by baseline CD4 count. The CD4 cells are those T-cells that are primarily affected by HIV infection, and CD4 count is widely used as an estimate of disease severity. This ensures that populations with similar severity are being compared, so that prolonged survival is likely to be due to treatment, rather than just changes in diagnostic behavior.” (Novella)

    This sure sounds scientific but I’m a real Insolence fan as well so I said to myself “Undergrad Gal” I said, “you know what? Dr. Orac says up there in his article that in his experience it’s often best to go to the study itself because that’s usually the best approach so maybe this is one of those times where it’s best to go to the source itself even though the source is not a scientific paper but this crazy hard-target denialist woman scientists like Novella really like to shoot at. . . from a safe distance”.

    So I peeked at Maggiore’s words on that cranky website of hers and you know what she doesn’t at all say what Novella says she says. Can you believe that? Iwas really impressed wit how novella is able to simpliy like beyonfd simple if you know what I mean. Just look at what the denialist-woman says:

    “a more likely explanation for decreased deaths would be the change in the official AIDS definition adopted in 1993 which allows HIV positives with no symptoms or illness to be diagnosed with AIDS. Since 1993, more than half of all newly diagnosed AIDS cases are counted among people who are not sick.” (Maggiore)

    Imagine that, “a”, as in ONE, “more likely explanation” becomes “sole explanation” after a quick spin in that scientific red Corvette mind of Novella.

    But ok before you guys get all jealoux just look what happens when Novella starts digesting information from bona fide scientific papers: Novella says Maggiore’s criticism is like totally unfair because the researchers have stratis…rati…stratos…fied or something their study subjects by CD4 count. I’m not sure what that means, and I bet most of you guys aren’t sure either, but it’s awesome anyway no doubt about it. But Let me see if I got this right Dr. Orac because we’re definitely getting way into this you know RNA and DNA and CD4 loads stuff that makes a girl all jelly-kneed when she sees a handsome man in a white coat. The pre-’93 definition of AIDS required an indicator disease but the post-93 merely requires a CD4 count below 200. So what the Novella dude is saying is that if I test positive and have a CD4 count of 199 it would be exactly the same as if I tested positive and had a CD4 count of 199 and PCP or TB?

    Wow, but that makes it real simple. All the study authors have to do is compare the T-cell count of for example a Christine Maggiore type HIV+ person and an HIV+ intravenous drug user with TB and if the T-cell counts was the same and the study sample large enough to “smooth out the statistical quirks”, they would have exactly the same prognosis, right? Novella is just sooo cool. The way he explains it is so simple it makes ME feel smart.

    I don’t know about you fellas, but I’m starting to dig this. Are you up for one more for the cheerleaders? Novella says:

    “Maggiore also makes the rather dubious argument that decreases in AIDS cases preceded the introduction of modern treatments by several years. But treatment is not primarily about preventing new cases, but prolonging survival of existing cases. It can decrease viral load and therefore reduce the risk of spread – but it does not eliminate it. Most cases are spread from those who do not yet know they are HIV positive, before they would be treated, in any case. The changes in the rate of spread of HIV has to do with changing behavior, not treatment.” (Novella)

    Wow! you see what I mean? Maggiore actually talks about decreases in AIDS deaths as well as AIDS cases. But see Novella knows that for the sake of an argument about the effectiveness of drugs in preventing death which Orac says is a good scientific endpoint it would just be plain anti-scientific to make a distinction bewtween an AIDS case and an AIDS death. Simplify simplify simply! That’s what it’s all about guys.

    But here is what you might have missed: Treatment ain’t about preventing new AIDS cases says Novella and I bet he got that info straight from a drug manufacturer friend.
    Since we know an Einstein like Novella wouldn’t confuse HIV cases with AIDS cases no matter how simple the anti-denialist argument gets this means he doesn’t think we should credit AZT with the drop in AIDS cases among those already infected. To the contrary he thinks we should credit behaviour with the fact that HIV positives stopped developing AIDS pre-’93.

    Ah I haven’t had so much fun since my first Barbie and Ken playset, but I just HAVE to run now gotta go. I need to crib my next biology essay off some even more obscure website before 12 o’clock. See you later I promise.

    O wait! Dr. Orac I don’t know do you think if I sent my panties to Novella he might wanna sign them on the rear because after all this playing scientist stuff I feel so intimate with him that’s the only place I would want to have anything of his.

    Thanks and tatah

    Undergraduategal

  50. #50 HCN
    August 9, 2008

    Not being an expert, just an engineer, but what does all that cutesy “gosh-all” gibberish have to do with anything? Maggiore still managed to pass HIV to her daughter, who actually did die.

    Somehow, if I had to go look for information it would NOT be Maggiore. I think you’d be better off reading the opinion of Dr. Bennett at Aidstruth.org.

  51. #51 Undergraduate-gal
    August 9, 2008

    Hi HCN

    I think that’s an excellent point. Why did Novella have to to Maggiore’s website, when he could get all his information from AIDStruth.

    Do you think it was because he wanted to be fair and balanced? Or do you think that like you he just wanted to talk about Maggiore instead of the study because it’s more difficult to read?

    Anyways nice talking to you I feel we’re on the same vibe. Are you an undergrad student too?

  52. #52 HCN
    August 9, 2008

    Here’s an idea: Go to Novella’s blog entry, read it in detail and then comment over there.

  53. #53 Tigger
    August 9, 2008

    How do you know Christine is ‘positive” or anyone else for that matter based on that test, that fraud.

    No one is positive and even if people were, they can still die of other causes you know. These fucking HIV apologist would still say you died of ‘AIDS” if a horse kicked you in the head and decapitated you if they deemed you were positive, whatever that shit means.

    Does an HIV test detect specific HIV? Does it?

    Will someone confront that BASIC reality and fact you bunch of “HIV” loving morons.

  54. #54 Laser Potato
    August 9, 2008

    [These fucking HIV apologist would still say you died of 'AIDS" if a horse kicked you in the head]
    Obvious strawman is obvious.

  55. #55 Undergraduate-gal
    August 9, 2008

    Hi HCN,

    Thanks for another fantastic idea. Now I know we’re on the same vibe.

    Actually I did go to Novella’s blog entry and read it in every painfully ignorant detail. Then I read the comments in every detail and noted that Novella had already left the building. He was probably afraid of running into that crazy denialist lady whom he had misquoted. Anyways I registered twice because I wanted Novella’s autograph so much but I still couldn’t log on so I thought to myself “Undergraduate gal” I thought ” You’re too stupid to sign up here. But Dr. Orac seems to love Novella just as blindly as you do so maybe he can help you on the autograph front”.

    Now HCN you’re probably saying “whoa whoa wait a minute there, Dr. Orac is not blind. In fact he’s one helluva critical thinker A real maverick.” And I agree with you HCN don’t get me wrong. Cuz just like Novella he has like totally reduced everything in the whole wide world to CD4 cells and DNA… ooops I mean RNA counts. Silly me. In fact just like Novella Dr. Orac has highlighted an etiological mystery even more puzzling than HIV: How come junkies don’t respond so well to the life-saving drugs?!!! Here’s Dr. Orac’s Ferrari-like mind two-wheeling it through one of the HIV curves:

    “Being an IV drug abuser is good for the loss of around 10 years. It’s unclear exactly why, although it’s been speculated that the difference between IV drug abusers and those who do not abuse IV drugs may be due to poorer compliance with therapy in the former group”. (Dr. Orac.)

    Gee that’s a real nut. What COULD it be about drug abusers that makes them more immunesuppressed than others, makes the more prone to heart and liver failure when you give them even more drugs? Mmmmm…. Nope I’ll have to leave that one to the real sexy minds of the business.

    By the way HCN I bet you didn’t know that it’s last year’s drugs which have made all the difference to HIV mortality. Yeah it’s true. Because in 2007 the average life expectancy on the life-savers was 23 years and now it’s 43.

    The like natural life-expectancy with HIV is like 12 years like. Or actually it’s a bit more apparently cause they’ve just figured they were about two years off on the latency period which they have used for all their models so far – but hey don’t knock that it just shows a healthy learning curve in HIV science. Bang for the buck if you know what I mean. I’m sure you do cuz you’re a clever guy yourself HCN. A Cornell Medical College student I bet.

    Anyways that means that from the time the first San Franciscan homo was infected by the first Haitian monkey blood worshipper and until 2007 the life-savers would gradually improve until they saved like 8-10 years extra on average. But beteen 2007 and 2008 that figure rose to like 30 extra years.

    HALLELUJA brother HCN!!! Dr. Orac is absolutely correct when he calls that a medical miracle. And it’s like totally perfectly timed too you know with the HIV drug-pushers’ Oscar show down there in Mexico. I don’t know about you but it makes me wanna go to church with my granny on sunday.

    Hey you know what that’s not a bad idea! Maybe I can meet Novella there. Better bring an extra pair of panties just in case.