Have we
been misled?
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; antibody-positive 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 HIV-positive, 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 HIV-free
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;
- 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. *
The editor of Policy Review got a lot of letters. Some were published in the
next issue, together with a respons by Duesberg and Ellison. They can all be found here.
Have we
been misled?
Federal Court Declares AIDS Book Illegal