Is The AIDS Virus A Science Fiction?
Immunosuppressive Behavior, Not HIV, May Be the Cause of AIDS
By Peter H. Duesberg & Bryan J. Ellison
Policy Review Summer 1990
A report published by the Centers for Control (CDC) on June 5, 1981, startled the
medical community in the United States. This report described five unusual medical
cases that had been observed between October, 1980 and May, 1981. All five had
developed cases of Pneumocystis carinii pneumonia. P. carinii is a microbe present in
the lungs of most healthy people, but can cause sickness when the host immune
system has somehow been severely weakened. Immunosuppression in these cases
was confirmed by the presence of various other opportunistic infections. Medical
authorities were most surprised at the identity of the patients: these cases with severe
immune collapse all involved 20-to-40-year-old men, typically considered a healthy
age group. Further, all of these men were homosexual.
A subsequent report by the CDC on August 28 listed 21 additional cases showing
similar severe immune suppression problems. Along with P. carinii pneumonia,
esophagal candidiasis (a yeast infection), and other diseases typical of immune
deficiencies, a number of these patients displayed a rare condition known as Kaposi's
sarcoma. This is a growth in the blood vessel linings, manifesting as reddish lesions
on the skin. The CDC referred to these new patients with strange combinations of
conditions as "previously healthy homosexual men." Since growing numbers of
healthy men should not simultaneously develop severe sickness, the full complement
of observed in them was grouped together into a syndrome presumed to have some
single underlying cause; first called Gay_related Immune Deficiency (GRID), the
syndrome eventually became known as Acquired Immune Deficiency Syndrome, or
AIDS.
Since this syndrome was first defined, over 130,000 Americans have been diagnosed
with AIDS, and over 80,000 of these have died. Male homosexuals continue to
comprise the major risk group for AIDS, but intravenous drug users, blood
transfusion recipients, and hemophiliacs also have been included as AIDS victims.
Since 1981, the list of indicator diseases for diagnosing AIDS has been expanded by
the CDC to include P. carinii pneumonia, tuberculosis, Kaposi's sarcoma, dementia,
lymphoma, candidiasis, diarrhea-altogether 25 conventional diseases. The most
commonly diagnoses of these is P. carinii pneumonia, found in about 53 percent of
new AIDS cases last year, followed by wasting syndrome in 19 percent, candidiasis
in 13 percent, Kaposi's sarcoma in 11 percent, and dementia in 6 percent.
Federal funding has grown with the syndrome. In the earlier years of the epidemic,
spending was at a few million dollars a year. Since 1984, with the announcement by
the Secretary of Health and Human Services that an AIDS virus had been discovered
and could possibly affect the general public, spending on AIDS research, education
and treatment has grown enormously, and has now reached $2.9 billion for this fiscal
year.
Immune Breakdown.
As a syndrome defined by several conventional diseases, AIDS was seen as being the
result of an underlying deficiency in the immune system. In many of the early
patients, the main abnormality appeared to be a depletion of one specific subgroup of
cells in the immune system, the T-helper cells; these cells respond to the presence of
invading microbes and stimulate other cells to produce the proper antibodies against
new germs. But the actual estimates of "proper" levels of T-helper cells were largely
speculative because little research had previously been done on this aspect of the
immune system. Because the average number of T-helper cells in AIDS patients was
lower than among other people, the notion developed that this syndrome was caused
by something depleting these particular cells.
Among the earliest proposed causes of AIDS were the nitrite inhalers used almost
exclusively by homosexuals in the bath houses. Some early work connected their use
to the incidence of Kaposi's sarcoma, but this hypothesis could neither account for the
full spectrum of AIDS diseases nor for AIDS in heterosexuals, and it was soon
dropped.
Most of the interest instead focused on the search for an infectious agent causing
AIDS. Beginning with the first report of AIDS cases, the CDC noted that all of the
early cases had either current or previous infection by cytomegalovirus, a member of
the herpes group of viruses. Cytomegalovirus was know to have immunosuppressive
ability, and this possibility was pursed for some time. But, because this virus was
widespread in the general population, and since not all AIDS patients had been
infected, this was ultimately abandoned as well.
The question of the cause of AIDS was officially settled on April 23, 1984, when the
Department of Health and Human Services announced the isolation of the AIDS
virus. Called Lymphadenopathy-Associated Virus (LAV) by its French discoverer,
and Human T-cell Leukemia Virus III (HTLV-III) by American scientists, it has
since 1986 been officially referred to as the Human Immunodeficiency Virus (HIV).
The belief that HIV causes the immunosuppression underlying AIDs became the
generally accepted view in the scientific community with the 1986 benchmark
publication "Confronting Aids," published by the National Academy of Sciences and
the Institute of Medicine. The predominant view today holds that this virus causes
immune deficiency by depleting the body of T-helper cells, dooming 50 to 100
percent of infected people to develop AIDS and die.
However, since 1987 an increasing number of medical scientist and physicians have
been questioning whether HIV actually does cause AIDS. Some of these dissident
scientists simply demur that HIV has never been proved to cause AIDS, and therefore
its role is unclear. Others believe that the evidence essentially rules out HIV as
playing any part in AIDS at all. Many more maintain that HIV cannot cause AIDS
alone, but may need additional, unidentified factors. Currently, most of these
doubters prefer not to be quoted, out of fear of losing research funding or of
disapproval by peers. This challenge is so far a minority view, due largely to
inadequate attention provided by media sources. In spite of the well-established
credentials of many of the more outspoken opposition scientists, their views have yet
to be heard by most Americans.
The Case for HIV
An article by Luc Montagnier, French discoverer of HIV, and Robert Gallo, the
leading American HIV researcher, in the October 1988 issue of "Scientific
American", discussed in part the rational behind searching for an AIDS virus in the
first place. Noting the sudden onset of diseases previously considered uncommon in
young men, they argued that only the recent introduction of a new microbe could
account for this increase.
The exact means by which HIV kills T cells is still not known. Gallo and his
colleagues have repeatedly pointed out that although the mechanism may be unclear,
the evidence that HIV does cause AIDS has been well established. They primarily
cite evidence from epidemiology, they study of how diseases spread.
They point out that the people who get AIDS are those who have antibodies to HIV.
Studies following HIV-infected people in AIDS risk groups over time observe a
progression to sickness characteristic of AIDS.
Proponents of the virus-AIDS hypothesis stress the geographic correlations between
AIDS and HIV infection. AIDS is most common in Africa and in cities such as New
York and San Francisco were HIV is widespread. Neither AIDS nor HIV can be
found extensively in Asia or the Soviet Union and Eastern Europe.
Proponents also give special attention to the more than 1,600 infants, over 1,100
hemophiliacs, and roughly 3,000 recipients of blood transfusion in the United States
who have developed AIDS years after being infected with HIV. The October 1988
Scientific American cited an example of a hemophiliac family, in which the father
and son both contracted HIV and developed AIDS. A well-publicized example was
Ryan White, the young hemophiliac who contracted HIV, developed AIDS, and
recently died at the age of 18. The late California legislator Paul Gann, who led the
Proposition 13 anti-tax movement, also received some attention, having received HIV
through a blood transfusion and subsequently developing a fatal case of AIDS
pneumonia. Since infants, and the majority of hemophiliacs and transfusion
recipients, can be presumed to be neither intravenous drug abusers nor active
homosexuals, their principal apparent risk factor has been their infection by HIV.
Although most viruses cause disease within weeks of acute infection, HIV
purportedly causes AIDS after an average latent period of 10 to 11 years. To support
this notion, defenders of the virus-AIDS hypothesis cite models of other viruses that
cause in animals and humans, often with latent periods of 10 to 40 years between
infection by the virus and the development of disease. Such "slow viruses" have been
credited in recent years for various leukemias both in humans and animals, as well as
for certain other specific cancers. Female cervical cancer is widely thought to be
caused by assorted strains of human wart viruses, while the cancer known as Brukitt's
lymphoma is often believed to be the result of the virus that also causes
mononucleosis.
Further, Simian Immunodeficiency Virus and Feline Immunodeficiency Virus, both
viruses in the same class as HIV, often cause sickness or even death when introduced
into laboratory monkeys and cats, with conditions referred to as equivalents of human
AIDS.
Koch's Postulates Unmet
Scientists dissenting against this widely accepted virus-AIDS hypothesis often raise
as their most fundamental point that this theory has simply never been proven.
Introduced by Robert Koch in the past century, the classical criteria for showing
whether a disease is infectious and caused by a particular microbe are called Koch's
Postulates. But as the Harvard molecular biologist Walter Gilbert, a Nobel laureate,
points out, these criteria have not been met for HIV:
Postulate 1: The germ must be found in the affected tissues in all cases of the disease.
However, no HIV at all can be isolated from at least 10 to 20 percent of AIDs
patients; until the recent advent of highly sensitive methods, no direct trace of HIV
could be found in the majority of AIDS cases. Further, HIV cannot be isolated from
the cells in the lesions of Kaposi's sarcoma, nor from the nerve cells of patients with
AIDs dementia.
Postulate 2: The germ must be isolated from other germs and from the host's body.
The amounts of HIV in AIDS patients are typically so low that the virus must be
isolated indirectly from a patient, only after first isolating huge numbers of cells from
the patient and then reactivating the virus. In classical diseases, enough active virus is
present to isolable directly from the blood or affected tissue; anywhere from one
million to one billion units of virus per milliliter of body fluid can be found during
the time most viruses cause , and viruses of the same class as HIV are found at levels
between 100,000 and 10 million units per milliliter. HIV, on the other hand, is
usually found in less than five units and never in more than a few thousand units per
milliliter of blood plasma.
Postulate 3: The germ must cause the sickness when injected into healthy hosts. HIV
has not been shown to cause disease when injected experimentally into chimpanzees,
nor when accidentally injected into human health care workers, even though the virus
successfully infects those hosts. If for ethical or other reasons this third postulate
cannot be tested from some particular germ, strong alternative evidence has to be
provided by specific therapies that neutralize the microbe and thereby prevent the
disease; such therapies would include antibiotics or vaccines. However, no therapies
or antibodies against HIV have been able to prevent AIDS diseases, although new
drugs and vaccines are continually being proposed.
Postulate 4: The same germ must once again be isolated from the newly diseased
host. Until the third postulate can be met, this one is irrelevant.
The failure to meet Koch's postulates raises questions about whether AIDS is even
infectious at all. Koch's postulates are the standard criteria for determining disease
agents. When they are not met, strong alternative evidence must be produced to
support any infectious agent hypotheses.
The burden of such proof is therefore on those who claim that HIV causes AIDS, as
noted by Beverly Griffin, director of the Department of Virology at the Royal
Postgraduate Medical School in London. This burden is especially high for HIV
hypothesis supporters in view of the special characteristics that had to be attributed to
HIV in order to connect it with AIDS. First, the virus had to be credited with a latent
period of several years between infection and AIDS. But when diseases are said to
occur only years after infection by a virus, it can be difficult to be sure that other risk
factors have not instead caused the disease. Second, because HIV is conspicuously
absent form lesions, scientists had to hypothesize that the virus caused disease by
indirect means in the body, in spite of a troubling lack of evidence for such notions.
Inventions such as these can be used to blame virtually any microbe for any disease.
Definitional Paradoxes
A second set of criticisms of the HIV hypothesis concerns the clinical definition of
AIDS. This definition involves a list created by the CDC in 1987 of about 25
conventional diseases; if any one of these is diagnosed, and antibodies against HIV
can be found in the same patient, a diagnosis of AIDS is made. The list includes not
only Kaposi's sarcoma and P. carinii pneumonia, but also tuberculosis,
cytomegalovirus, herpes, diarrhea, candidiasis, lymphoma, dementia, and many other
diseases. If any of these very different diseases is found alone, it is likely to be
diagnosed under its classical name. If the same conditions is found alongside
antibodies against HIV, it is called AIDS. The correlation between AIDS and HIV is
thus an artifact of the definition itself.
Another definitional concern relates to how a single virus could lead to such a
spectrum of diseases. Harry Rubin, biologist at the University of California at
Berkeley and recipient of the Lasker Prize for his work on viruses, is one of several
dissenting scientists who argue that these should never have been grouped together,
and that no new microbe is needed to explain the occurrence of these old conditions
among behavioral AIDS-risk groups in recent years.
The rational for combining these separate diseases into a single syndrome is the
assumption that they all have a single underlying cause: immune deficiency
purportedly caused by HIV. However, immune system failure cannot account for
some of the conditions on the AIDS lists, particularly the cancers and dementia.
While many scientists still hope to find ways of fighting cancer using the immune
system, experimental work has long shown that cancers do not necessarily increase in
the presence of immune deficiencies. After all, the immune system can only fight
foreign particles, but cancer cells are actually part of the patient's body. Dementia is
likewise not directly prevented by the immune system, because antibodies do not
normally reach brain tissue. Microbes that reach the central nervous system are free
to grow without interference by the antibody defenses, even in a fully healthy
individual. HIV must therefore be credited with doing far more than simply depleting
the immune system; it would have to destroy neurons and make cancerous certain
other cells, while simultaneously killing or preventing the growth of immune cells.
Indeed, any AIDS microbe would face the same difficulties.
Little Detectable Virus
A third difficulty with the HIV hypotheses is that there is very little detectable virus
in AIDS patients. Fewer than 1 out of every 10,000 of the host's T-helper cells are
actively infected by HIV even during AIDS; moreover, the tiny amount of virus
produced by these few cells is neutralized by the same antiviral antibodies that are
detected by the "AIDS test." Fewer than 1 in 500 of a host's T cells contain even
dormant HIV which can only be found by isolating these cells from the body and
stimulating them artificially with compounds that help reactivate these latent viruses
from within the cells. The resulting difficulty, and often impossibility, of isolating
HIV from AIDS patients make the presence of antibodies against the virus the only
practical basis for diagnosis.
It is very difficult to understand how HIV would be able to devastate the immune
system while never infecting more than a tiny fraction of its cells. Even if every
infected cell were killed, the number of T cells lost at any time would be roughly
equivalent to the number lost through bleeding from shaving. Such losses could be
sustained indefinitely without affecting the immune system, because the body
constantly produces new T cells at far higher rates. Virtually no reactivation of the
virus occurs when AIDS patients develop sickness, leaving unexplained how the
virus could possibly case immune suppression, and then only after years of latency.
After the body produces antibodies against HIV, the virus remains at low levels for
the rest of that person's life, precisely the same as for all viruses of its class. This
would help to explain why transmitting HIV is typically so difficult; antibodypositive people have almost no virus to spread.
A few studies describe rare cases of brief flu-like conditions shortly after infection by
HIV but these patients recover rather quickly once their immune systems have
created antibodies against HIV. This emphasizes the paradox: how could an inactive
virus cause a fatal after 10 years, when the same virus causes at most a mild condition
when it was first active?
Misleading Animal Models
A fourth paradox of the HIV hypothesis has been noted by several virologists. HIV
belongs to a class of viruses known as the retroviruses, which are very simple in
structure and contain much less genetic information than most other viruses. Most
types of viruses are lytic, meaning that they kill the cells they infect and thereby
cause disease. Retroviruses, on the other hand, do not generally kill cells. Upon
infecting cells, they copy their genetic information into the DNA of their new host
cells. From that point forward, retroviruses depend on allowing their host cells to
continue living, while they slowly produce new virus particles that are ejected from
the cell. Retroviruses are therefore poor candidates to blame serious diseases on,
particularly fatal conditions involving the deaths of huge numbers of cells, such as
AIDS. Indeed, some 50 to 100 latent retroviruses have been found to reside in the
DNA of all humans, passed along to each successive generation for as long as human
beings have existed.
Past research by Harry Rubin has shown that retroviruses cannot infect any cells that
do not divide. Neurons in the human brain do not divide after the first year of life, so
HIV cannot possibly infect those cells. This would explain why HIV has not been
isolated from these cells, and confirms the difficulty it would also face in causing
dementia.
Harvey Bialy, research editor of the professional journal Bio/Technology, argues that
the simple genetic structure of HIV does not differ sufficiently from other
retroviruses to account for its supposedly different behavior. The genetic information
carried by HIV is not unusual for retroviruses; it contains no gene different enough
from the genes of other retroviruses to be a possible "AIDS gene." In addition, HIV
uses all of its genetic information when it first infects, rather than saving some to be
used years later. In other words, there is no conceivable reason HIV should causes
AIDS 10 years after infection, rather than early on when it is unchecked by the
immune system.
Bialy also points out the misinterpretations made of animal models. Simian (monkey)
AIDS, for example, does not actually resemble human AIDS. The animals do not
develop a wide spectrum of diseases, not do they suffer any conditions even remotely
similar to Kaposi's sarcoma or dementia. There is no long latent period between
infection by Simian Immunodeficiency Virus and the development of sickness. The
animals become sick within days or weeks after infection, or not all. The sickness
sometimes developed in these animals by such viruses resembles more the flu-like
conditions occasionally observed in humans shortly after infection by HIV. Such
viruses cause fatal animal only when they are present in large amounts, and only in
highly susceptible inbred animals kept in laboratory conditions.
Although a widespread belief holds that certain retroviruses cause other fatal
conditions after long latent periods in sheep, goats, and horses, these viruses are
actually found in the majority of healthy animals. Only a tiny number of animals
develop such diseases, throwing into doubt the roles of these viruses.
HIV without AIDS
Arguments used most often in defense of the HIV hypothesis concern the field of
epidemiology, the study of how diseases spread.
The most common method used in epidemiology today in searching for the cause of a
disease is to find correlations between phenomena and their possible causes. The only
scientifically conclusive method is the controlled study, in which two sets of people
are matched for every potentially important factor except for the possible cause, and
the two sets are then compared to see whether one group is more likely to contract the
disease. Only uncontrolled epidemiology has been cited to support the HIV
hypothesis. However, the opponents of the virus-AIDS hypothesis point to a number
of paradoxes in this uncontrolled epidemiology.
Evidence increasingly indicates that large number of people infected with HIV,
probably the majority, will never develop AIDS. In 1986, the CDC estimated the
extent of HIV infection to range from 1 million to 1.5 million in the United States.
The figure was changed within the last few months to an ex post facto estimate of
750,000 HIV-positive Americans by 1986, with about one million today. This
revision was based simply on back-calculation models, since fewer AIDS cases had
occurred than expected, the CDC decided that fewer people must have been infected
with HIV than was first estimated. About 130,000 Americans have been diagnosed
with AIDS over the past decade, fewer than 15 percent of the newly estimate number
of HIV-positive Americans.
AIDS appears to be levelling off now. Michael Fumento, author of "The Myth of
Heterosexual AIDS," but not an opponent of the HIV hypotheses, has pointed out a
slowing of AIDS diagnoses by late 1987. A study published in the March 16, 1990,
issue of the Journal of the American Medical Association, based on mathematical
modeling of the growth of AIDS, has concluded that this syndrome began to level off
in 1988.
These trends create a tremendous gap between the large number of people estimated
to be infected with HIV and the relatively few developing sickness. To accommodate
this gap, the CDC has steadily increased its estimate of the latent period between HIV
infection and diagnosis of AIDS from three or four years to about 10 years at present.
Roughly, for every year that passes, an additional year is added to this latent period.
Africa's Non-Epidemic
The situation in Africa is even more puzzling and casts further doubt on the HIV
hypothesis. Most of the media publicity in America on AIDS in Africa is based on
the large extent of HIV infection, not on the extent of AIDS cases themselves.
Nonetheless, although HIV infection appears to be extremely widespread, present in
many areas in 10 to 15 percent of the population, the total number of AIDS cases so
far reported in the entire continent of Africa amounts to merely 41,000. Proponents of
the HIV hypothesis often try to argue that this low figure is the result of under
reporting of AIDS cases. Even in Uganda, however, which has a reputation for
conscientious reporting, 800,000 people are HIV positive, but only 10,000 are
reported to have died of AIDS. A paper and accompanying editorial in the July 25,
1987, issue of the British medical journal "The Lancet" argued that AIDS in Africa is
actually not a major epidemic; the paper was written by a doctor from Cromwell
Hospital in London, Felix Konotey-Ahulu, who had just returned from an extensive
investigative tour of the areas of Africa with the most AIDS cases.
The story in Haiti is similar. Only 2,3000 AIDS cases have been reported during the
past decade in a country where HIV infection is thought to be rampant. Even if this
number is underreported, the prevalence of AIDS is much lower than would be
predicted by the HIV hypotheses.
No controlled studies have been conducted to determine whether HIV causes AIDS.
However, one reasonably controlled study of 19 hemophiliacs was published in the
January 1989 issue of the "Journal of Allergy and Clinical Immunology," in which
the patients with HIV antibodies were compared to those without them The
researchers found no difference in immune deficiency between the two groups,
though the sample size was too small to draw firm conclusions.
Accidental infection of humans by HIV, by means other than specific risk behavior,
is especially revealing. Some 19 health care workers in the United States have been
presumed infected with HIV by accidental needlestick or other medical injuries,
based on the inability to identify any other modes of transmission in their cases. One
of these cases was reported in 1988 as having developed AIDS, but that diagnosis
was changed shortly after that patient recovered spontaneously. Now the CDC claims
that two of these workers have converted to AIDS, but has failed to publish any data
confirming this claim.
Thus, there are still no confirmed cases of AIDS among health workers after
accidental infection with HIV, whereas the HIV hypothesis would predict conversion
to AIDS of most of these infected health care workers by this time.
AIDS Diseases without HIV
A critical question about the role of HIV is how it is associated with the various
AIDS diseases. One widespread impression holds that many of the AIDS diseases
were extremely rare before 1980, and only began reappearing with the presumed
introduction of HIV. In reality, not only have all 25 of these AIDS conditions existed
for decades at a low level in the population, but HIV-free instances of the same
diseases are still being diagnosed today. These diseases are actually increasing in
parallel with their HIV-associated counterparts. A letter by CDC researchers in the
January 20 issue of "The Lancet" reports the existence of male homosexuals with
Kaposi's sarcoma but without HIV. Robert Root-Bernstein, MacArthur fellow and
associate professor of physiology at Michigan State University, also published a
paper in "The Lancet", of April 25, in which he reviewed the existing literature on the
incidence of Kaposi's prior to AIDS. Since the first recognition of this condition in
1872, a number of cases have been reported each year in the United States and
Europe. Many of these were in people under 50 years of age, or even in children-not
just in older men, as originally thought. A number of these cases were fatal. Some
cases were associated with blood transfusions or with pneumonia, although many
were apparently not connected with any other conditions. Root-Bernstein concluded
that during the 1970's approximately 100 U. S. cases of Kaposi's per year could have
been diagnosed as AIDS. However, Kaposi's sarcoma was not a disease reportable to
medical officials before AIDS, and these cases were therefore not recognized.
Kaposi's was only noticed once it was found clustered in young homosexual men in
1980-81.
A similar situation has existed for P. carinii pneumonia. First recognized in 1911,
these conditions may affect a surprisingly large percentage of the population; a 1973
study of Europeans found that between 1 and 10 percent of the population had
postmortem evidence of this pneumonia. Often P. carinii pneumonia has been
associated with hemophilia, tuberculosis, cytomegalovirus infections, venereal
diseases, and malnutrition. Patients receiving transplants, heavy antibiotic therapy, or
chemotherapy against cancer have also high rates of this condition. Most cases have
been associated with malnutrition rather than with underlying infectious diseases.
Before the 1980's, this disease was usually diagnosed only by autopsy; this, combined
with the availability of drugs to treat P. carinii pneumonia in the 1970's, caused low
reporting of this not uncommon disease. P. carinii pneumonia had also probably been
previously misdiagnosed as other types of pneumonia. Easier diagnosis and clustering
of the disease among active homosexuals, played a large part in focusing renewed
attention on this condition with the beginning of AIDS.
Root-Bernstein has collected similar data on cryptococcocsis, cytomegalovirus
disease, and progressive multifocal leukoencephalopathy prior to the AIDS epidemic.
Strange Distribution of AIDS Diseases
Gordon Stewart, emeritus professor of public health at the University of Glasgow,
considers the continued restriction of AIDS to very selective risk group even 10 years
after AIDS was first recognized to be one of the greatest epidemiological weaknesses
of the HIV hypothesis. The distributions of AIDS diseases and HIV infection are also
inconsistent with each other.
Although AIDS in Africa is evenly distributed between males and females, over 90
percent of AIDS cases in the United States continue to be diagnosed in males. This
proportion has not changed since AIDS was first defined. The paradox is emphasized
by a study in the April 18 issue of the "Journal of the American Medical Association"
which examined over one million teen-aged applicants to the military between 1985
and 1989. In the most extensive study of its kind yet published, the proportion of
males with antibodies against HIV was found to be identical to the proportion of
infected females, although AIDS is diagnosed in four times as many males as females
for that age bracket. In short, males with HIV are more likely than females to develop
AIDS, even though they have the same virus.
The annual rates at which HIV-positive people develop conditions diagnosed as
AIDS varies tremendously between different risk groups. The annual rate among
HIV-positive Americans engaging in risk behavior or who have hemophilia varies
from 2 to 25 percent. Though three-quarters of American hemophiliacs are HIVpositive, only 6 percent have been diagnosed with AIDS over the past decade.
The total number of AIDS diagnosed among American infants receiving blood
transfusions continues to increase, with 40 new cases in 1989, even after the drastic
reduction in HIV transmission through the blood supply four years ago; this is
incompatible with the two-year latent period AIDS is claimed to have in those
children.
Health care workers, who might be thought to have a greater than average risk of
contracting HIV, present another anomaly: three-quarters are female, yet over 90
percent of these workers diagnosed with AIDS are male. Stranger still, the CDC
reports that 95 percent of them fall into the same risk groups that 95 percent of all
other AIDS cases do.
In addition to the inconsistent distributions of AIDS as a syndrome, specific AIDS
diseases develop largely within specific risk groups. This occurs in spite of all these
groups being infected by the same virus.
For example, Kaposi's sarcoma in the United States is almost exclusively found in
male homosexuals. Kaposi's is further distinguished by the fact that it is the only one
of the AIDS conditions that has been declining for several years, while the others
continue to increase. P. carinii pneumonia, on the other hand, has been diagnosed in
an increasing proportion of the total number of U. S. AIDS cases. The AIDS diseases
seen among infants tend to be the typical pediatric diseases, including tuberculosis,
pneumonias, and various bacterial infections. In Africa, the predominant AIDS
disease is a wasting syndrome, often called "slim disease." While this condition is
seen among some U. S. AIDS patients, it is not nearly as synonymous with AIDS.
Montagnier's Startling Admission
Some recent developments have begun to signal the beginnings of retreat by the
proponents of the HIV hypothesis. A startling admission by Luc Montagnier, the
French discoverer of HIV, was published in the March 1990 issue of "Research in
Virology." Montagnier demonstrated conclusively that HIV is not able to kill T cells
in culture dishes, contrary to previous arguments raised by the supporters of the HIV
hypothesis.
In that same paper, Montagnier first suggested that HIV alone may not cause disease;
he offered the possibility of some unidentified bacterium also being involved. He has
since endorsed the suggestion of Shyh-Ching Lo, of the U. S. Armed Forces Institute
of Pathology, who argued in the May 11, 1990, issue of "Science" that his recently
discovered bacterium Mycoplasma incognitus, might play a role in AIDS.
Montagnier now holds that HIV and the bacterium together cause the disease. Any
mycoplasma, however, would face many of the same difficulties as HIV; it would not
cause the full set of AIDS diseases, it would have already spread AIDS into the
general population, and most of all, this particular one is not different enough from
other mycoplasmas to account for such unusual abilities. Mycoplasmas are
reasonably common germs, existing throughout the population, and are responsible
for about one-third of the mild pneumonias sometimes developed by humans. HIV
and M. incognitus may soon be branded as co-factors in causing AIDS, but this
would simply be an invention to try to fill the gaps in any theory that blames the
AIDS diseases on the microbe.
Perhaps the most spectacular recent study on AIDS was published in "The Lancet" of
January 20, 1990. Researchers at the CDC concluded that Kaposi's sarcoma is not
caused by HIV after all. The bases for this conclusion were simply that Kaposi's is
not observed to be equally distributed among the AIDS risk groups, and that HIVfree Kaposi's cases are diagnosed in U. S. homosexuals, arguments previously raised
by the senior author of this article (Peter Duesberg). While the basic data used in that
paper are not new, this startling admission by CDC epidemiologists marks the first
time HIV has been officially questioned as the cause of any AIDS disease, although
the CDC has still not removed Kaposi's form the disease listing in the AIDS
definition. Nevertheless, the publication of this paper may have opened the door for
more inquiry of whether HIV is responsible for other AIDS diseases, and whether
those diseases truly belong together as a single syndrome.
The Risk-AIDS Hypothesis
If a number of scientists and medical physicians do not believe HIV is likely to play
any significant role in AIDS, what do they consider the true cause to be? For the most
part, the alternative views of AIDS can be grouped together as the "risk hypothesis"
of AIDS-that the AIDS diseases are entirely separate conditions caused by a variety
of factors, most of which have in common only that they involve risk behavior. This
view does not see AIDS as being a transmissible condition at all.
Nevertheless, a risk hypothesis must explain the recent increases in the various AIDS
diseases, and why these have all been concentrated in particular risk groups. During
at least the past decade, the incidence of these 25 conventional diseases has increased
dramatically among groups in which they were previously rare.
Kaposi's sarcoma may actually be the most clearly understandable of the AIDS
conditions. As noted above, it has existed at low levels in the population for as long
as it has been recognized. Undoubtedly, various unidentified factors play roles in
bringing on this condition. But the relatively recent clustering of Kaposi's in
homosexuals may be due to their group-specific use of nitrite inhalants, or "poppers."
These aphrodisiac drugs became popular in the active homosexual community during
the 1970's. Use of these inhalants began declining after they were suggested as a
possible cause of AIDS, and that behavior change has been followed by a
corresponding decline in the incidence of Kaposi's. Early tests on animals also
implicated these inhalants in Kaposi's. In fact, this evidence of the dangers of nitrite
inhalants prompted Congress to ban the nonprescription use of these drugs in 1988.
While these nitrites were officially dropped from consideration as a cause of AIDS
because they were not associated with all the AIDS diseases, they should be strongly
reconsidered as agents specific to Kaposi's sarcoma.
Certain other diseases on the AIDS list, those not necessarily resulting from immune
problems appear to have better explanations than HIV. Dementia is most likely the
result of extensive use of psychoactive recreational drugs, and/or undiagnosed
syphilis; increased sexual activity appears to have led to renewed epidemics of
venereal diseases, including syphilis, which is difficult to test for. Wasting syndrome
found most heavily in African AIDS patients, is an endemic condition produced by
the extremes of malnutrition and the lack of sanitation on most of that continent; the
rise in recent years of wars and totalitarian regimes has served only to worsen
conditions. African sickness was included in the AIDS epidemic merely because HIV
had already been implicated in sickness in the industrial world and this same virus
could be found endemically in Africa.
Most of the AIDS diseases involve some degree of immune suppression. This is a
condition produced by many different factors. Drug use, particularly of heroin, is one.
Recreational drugs are commonly used by active homosexuals in the bath houses.
Alcohol, heroin, cocaine, marijuana, valium, and amphetamines can all be found as
part of the life histories of many AIDS patients. When combined with regular and
prolonged malnutrition, as is done with many active homosexuals and with heroin
addicts, this can lead to complete immune collapse. Antibiotics, when used heavily or
over long periods, also wear down the immune system. Active homosexuals have
been among the heaviest users, often taking large amounts of tetracycline and other
antibiotics each evening before entering the bath houses.
Joseph Sonnabend, a New York physician who founded the journal "AIDS Research"
in 1983, has pointed out that repeated, constant infections may eventually overload
the immune system, causing its failure; still worse are simultaneous infections by two
or more diseases. "Fast track" homosexuals have generally experienced repeated
bouts not only of a full spectrum of venereal diseases, but also of all forms of
hepatitis, cytomegalovirus infection, Epstein-Barr virus infection, and various
protozoan infections. They have commonly developed multiple infections, usually
repeatedly.
Procedures traumatic to the body can play a major role in weakening the immune
system. Almost exclusive to the homosexual community is the practice of fisting,
which like anal intercourse is often damaging to the rectum. This damage provides
access for many infectious agents into the bloodstream.
Many surgeries are immunosuppressive because of the trauma itself, or due to the
anesthesia, or from immunosuppressive chemotherapy, or even from the transfused
blood itself. In fact, immune suppression is proportional to the volume of transfused
blood. These problems may explain the occurrence of AIDS diseases among blood
transfusion recipients; with or without HIV infection, half of all such recipients do
not survive their first year after transfusion.
Hemophiliac and Pediatric Cases
The question naturally arises as to why people outside these behavioral health-risk
groups, including hemophiliacs and children, would develop some of the AIDS
diseases. The answers lie in the risk factors too rarely reported to the public.
Hemophilia has always been a fatal condition. This has only been partly alleviated by
recent medical advances. Not only are blood transfusions still frequently needed, but
blood clotting factors used by hemophiliacs today are somewhat immunosuppressive
themselves. Interestingly, the controlled epidemiological study of hemophiliacs, cited
above, found evidence to support the idea that hemophilia may be an inherently
immune-deficient condition on its own. In the case of Ryan White, now often cited as
an example of an AIDS death, the Hemophilia Foundation of Indiana has confirmed
that his death was due to such complications as liver failure and internal bleeding,
conditions that typically result from hemophilia itself. Indeed, White already had a
severe case of hemophilia, ultimately requiring clotting factor therapy every day. He
also underwent daily AZT therapy, the dangers of which are reviewed below.
Infants diagnosed as having AIDS have developed their conditions due to
combinations of most of the above risk factors. Published CDC data shows that some
95 percent of these babies are born to mothers who are confirmed drug addicts and/or
sexual partners of IV drug users (frequently a code word for prostitutes), or the babies
are themselves hemophiliacs or recipients of blood transfusions. The risk behavior of
many of their mothers has reached these victims, but their conditions are renamed
AIDS when in the presence of antibodies against HIV.
Finally, those few AIDS cases in which no risk factors exist are due to the clinical
definition of AIDS. Having contracted, for whatever reason, one or more diseases on
the AIDS list in the presence of antibodies against HIV, these people are diagnosed as
having this syndrome. In many instances, this means the patients are not given
sufficient conventional therapies for the conventional disease, but are instead treated
with the drug AZT.
Behavioral Changes in the '70s
Both the AIDS diseases and the risk factors causing them have increased before and
during the same period that AIDS has been officially defined. Although
homosexuality is older than recorded history, the "gay liberation" movement in 1969
began a wave of increasing activity by many homosexuals. Bath houses were opened
in major cities, where both sexual promiscuity and drug use exploded. The number of
sexual contacts per individual jumped to hundreds or thousands over only a few
years, and the diseases discussed above exploded in frequency a the same time.
Chronic disease epidemics actually became the medical hallmark of homosexuals in
New York and San Francisco. The practice of fisting appears to have begun in the
early 1970's, along with the use of nitrite inhalants.
Drug use among other groups also exploded beginning in the 1960s, with the use of
such substances as heroin and cocaine having multiplied several times since then; the
National Narcotics Intelligence Consumers Committee reports that the consumption
of cocaine alone increased five-fold from 1978 to 1988. During this same period,
continually greater volumes of blood have been used for increasingly complex
surgical operations. Given the dramatic increases in these risk factors in precisely the
groups developing AIDS, the appearance of young male homosexuals with multiple
diseases in 1980 add 1981 should never have been a surprise; indeed, the first five
homosexuals diagnosed with this syndrome in 1981 were all heavy uses of nitrite
inhalants, an indicator of the risk behavior practiced by all of the early AIDS cases.
The risk hypothesis explains the many paradoxes of AIDS and HIV. By considering
AIDS not a single infectious disease or syndrome, but rather a set of separate
conditions with different risk factors contributing to each case, it resolves the
difficulties of the HIV hypotheses:
•
why Koch's postulates cannot be met for HIV;
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•
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•
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the long and inconsistent latent periods between HIV infection and AIDS;
why HIV would be able to devastate the immune system while never infecting
more than a tiny fraction of its cells;
the fact that HIV is to different enough from other retroviruses to account for
its supposedly different behavior;
the predominance of males in AIDS cases in the U.S., which is consistent with
the predominance of males among heavy drug abusers;
the presence of AIDS-like diseases without HIV;
the saturation of the number of AIDS cases at levels far below the number of
HIV infections;
the enormous diversity, and risk-group specificity, of the different AIDS
diseases; and
why controlled studies, though few and incomplete, show no difference in
sickness between people with HIV and people without.
Instead the risk hypothesis suggests that AIDS diseases can be attributed to the
explosion in drug use and multiple infections associated with sexual promiscuity
among certain sectors of the population. Hemophilia is a separate risk factor.
The risk hypothesis also accounts for the rough correlation between HIV infection
and the development of various diseases; because HIV is difficult to transmit, it has
naturally become a surrogate marker for risk behavior. Those people with the most
risks are often the ones most likely to spread such an inactive microbe.
AZT Toxicity
If the virus-AIDS hypothesis is wrong and the risk hypothesis correct, several
important conclusions follow. The most urgent of these concerns the current therapy
officially approved for AIDS, the drug zidovudine (AZT). The hope is that AZT, by
preventing the copying of DNA within cells, will prevent the multiplication of HIV in
the host. However, by doing this the drug also kills all actively growing cells in the
patient; chief among these are the cells of the immune system. This becomes deadly
in light of the risk-AIDS hypothesis; inhibiting HIV would accomplish nothing, while
AZT actually produces the very immune suppression it is supposed to prevent. The
effectiveness of AZT at this task is demonstrated by the fact that it was first designed
in the 1960s for the purpose of fighting immune system cancers, by killing the rapidly
multiplying, cancerous immune cells; AZT was finally shelved because treated
leukemic mice in laboratory studies died as quickly as those not given AZT. Some
symptoms of AZT toxicity, such as muscle disease and anemia, resemble those of
full-blown AIDS cases.
Two clinical studies have been published claiming effectiveness of AZT in slowing
the progression of AIDS, but the studies were both terminated as soon as different
results could be found between the treated and untreated groups. Some medical
researchers have become skeptical of these studies, in part because the double-blind
protocol had broken down: partly due to the immediate toxicity of AZT, both the
patients and the doctors had already found out who was getting AZT and who was
receiving the placebo. Despite these invalidating faults, the studies have been
published anyway and AZT was quickly approved by the Food and Drug
Administration after the first of these. Interestingly, a recent study by the Veterans
Administration, cited in the March 23/30, 1990, issue of the "Journal of the American
Medical Association," has found no difference in longer-term death rates between
patients treated with AZT and those given a placebo. Some British and French
researchers have also expressed doubt about AZT's effectiveness, as mentioned in the
same JAMA article.
Despite its toxicity, most medical doctors currently using the drug believe it to have
some short-term benefits in alleviating symptoms of AIDS diseases. This may be for
two reasons. Because AZT is a non-specific killer of dividing cells, it is likely to kill
cancer cells and parasitic bacteria at the same time that it kills the immune system
cells of the host; however, while AZT may temporarily fight the opportunistic
diseases, its depletion of the immune system and other crucial cells makes it more
difficult for the patient to fight off disease later. The other reason for an apparent
benefit of AZT lies in the observation that many patients on this drug experience
short-term increases in their immune system cells. This, however, is a temporary
pseudo-benefit; when the body is initially exposed to any toxin that depletes its blood
cells, a compensatory reaction begins to produce large quantities of new blood cells
to replace the poisoned ones. The temporary increase in all blood cells, including
immune cells, is likely to be the result of the body's reaction to AZT, which later
proves futile in the continued presence of the drug.
Federal agencies are not promoting and even financing the application of this drug
not only for patients with full-blown AIDS, but now even for people without
symptoms, including pregnant mothers and children; some 50,000 patients worldwide
are now undergoing treatment. Many other AIDS therapies now under consideration,
such as the new drug ddI (dideoxyinosine), operate in the same basic way. Even if the
HIV hypothesis were correct, this approach would be irrational, since HIV is inactive
by the time AZT is administered.
Misguided Programs
The risk-AIDS hypothesis also calls into question the direction of current AIDS
education programs. Condoms and sterile needles may limit the transmission of
hepatitis and other infectious diseases, but they do not guard against he
immunosuppressive effects of heroine, cocaine and overuse of antibiotics. Therefore
education programs that promote condoms and sterile needles without emphasizing
the danger of the risk behavior itself-particularly drug-taking-may inadvertently
encourage spread of the disease.
With respect to AIDS itself, the risk hypothesis should reduce the fear of HIV
infection. Those people not practicing risk behavior nor subject to severe medical
problems need not worry about AIDS. There is no need to trace the sexual partners of
HIV positive, nor to exclude from the country those who have been infected by the
virus. Neither policemen nor health workers nor school classmates need to be
concerned about contracting HIV from antibody-positive people. Legitimate concerns
will still remain about tuberculosis, hepatitis, and other contagious diseases often
associated with AIDS. But infection by HIV would not be significant in itself.
For those people who do develop AIDS-like diseases, regardless of infection by HIV,
several steps would be advisable. The use of AZT and similar antiviral-specific drugs
should be avoided, while conventional therapies directed against the specific diseases
might be considered. Such therapies have previously included drugs for each illness,
such as pentamidine for P. carinii pneumonia, as well as limited use of antibiotics and
vaccinations; but none of these particular approaches is necessarily endorsed by the
authors of this article. Doctors should treat each condition separately, and should seek
to determine the underlying causes in each individual's case; patients should insist on
this approach from their doctors. But perhaps the most useful action for any such
patient to take would be the ending of any risk behavior. Unfortunately, no studies
have been done, but anecdotal case descriptions exist of AIDS patients who recover
after ending drug use, sexual promiscuity, and prophylactic antibiotic use, and who
improve their nutritional status.
Significantly, a June 10, 1990, "Parade" magazine survey of 13 AIDS survivors who
have lived more than five years since their diagnosis showed a majority rejecting
AZT. "It's incredible, isn't it," said one survivor, Mike Leonard, "that the drug
designed to save you can also kill you."
Public policy questions raised by the risk hypothesis mostly concern federal funding
patterns. The HIV hypothesis has not yet saved a single life, despite federal spending
of $3 billion per year. In place of the current research funding policy, which
exclusively fiances HIV-related AIDS research, studies on the causes of the separate
AIDS-diseases and their appropriate therapies might be conducted. The rest of the $3
billion that will be spent on the virus-AIDS hypothesis in the next fiscal year might
then be saved and returned to the taxpayers, before it can do more harm. *
DEPARTMENT OF HEALTH & HUMAN SERVICES
Office of the Secretary Washington D.C.
April 28, 1987
MEDIA ALERT
An NCI grantee scientist, Dr. Peter Duesberg of California/Berkeley, has published a
paper in a scientific journal which concludes that the HTLV-III/HIV virus identified
by Dr. Gallo and Dr. Montagnier is not the cause of AIDS and that the disease is
caused by "a still unidentified agent" which may not even be a virus.
Inexplicably, the paper was published in the March 1 addition of Cancer Research,
and gives a non-specific credit to Dr. Robert Gallo and others, but nobody within the
Department or the news media seems to have been aware of it until it was disclosed
Monday, 4/27, by a gay publication in New York City.
Dr. Duesberg has been an NCI grantee doing research in retroviruses and oncogenes
for 17 years and is highly regarded. He is the recipient of an "outstanding researcher"
award from the Department. The article apparently went through the normal prepublication process and should have been flagged at NIH. Failing that, it should have
caused a splash on publication nearly two months ago.
Playwright, gay activist and Department critic Larry Kramer is currently bringing it
to the attention of the media, but it really hasn't taken off yet. I know for instance he
has talked to Tom Brokaw about it. There has been one call to CDC from Newsday
and none to the press office so far.
This obviously has the potential to raise a lot of controversy (if this isn't the virus,
how do we know the blood supply is safe? How do we know anything about
transmission? How could you all be so stupid and why should we ever believe you
again?) and we need to be prepared to respond. I have already asked NIH public
affairs to start digging into this.
Chuck Kline
cc:
The Secretary
The Under Secretary
Chief of Staff
Assistant Secretary for Health
Surgeon General
Assistant Secretary for Public Affairs
The White House