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
Immune Breakdown.
The Case for HIV
Koch's Postulates Unmet
Definitional Paradoxes
Little Detectable Virus
Misleading Animal Models
HIV without AIDS
Africa's Non-Epidemic
AIDS Diseases without HIV
Strange
Distribution of AIDS Diseases
Montagnier's Startling
Admission
The Risk-AIDS Hypothesis
Hemophiliac and
Pediatric Cases
Behavioral Changes in the
'70s
AZT Toxicity
Misguided Programs
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.