A New Twist On HIV/AIDS Research
Joe Gandelman
Since Dean's World has become the Internet's hub for detailed discussion of HIV and AIDS we offer for your always-lively and candid discussion this new story that's getting lots of attention:
A previously unknown strain of HIV that is highly resistant to virtually all known drugs and appears to lead to the rapid onset of AIDS was detected in a man last week, New York health officials said Friday.
While the extent of the spread of the disease is unknown, officials said the situation was alarming.
"We consider this a major potential problem," said Dr. Thomas Frieden, commissioner of the New York City Department of Health and Mental Hygiene. The department issued an alert to all hospitals and doctors in the city to be on the lookout for the new strain.
The virus was found in a New York City man in his mid-40s who engaged in unprotected anal sex with other men on multiple occasions while he was using crystal methamphetamine.
While HIV strains that are resistant to some drug treatments have been on the rise in recent years throughout the United States, city officials said this case was unique and worrisome for several reasons.
First, they said, the strain of the disease was resistant to three of the four classes of drugs used to treat HIV from the moment the patient got sick. Typically, drug resistance comes after a patient is treated with retroviral drugs, often because they go off the prescribed course. And, more often than not, a person is only resistant to one or two classes of drugs.
But the resistance comes in combination with its rapid transformation into AIDS. Each of those things has been seen before, but never together.
In this case, the patient developed AIDS from 2 to 10 months after being infected. Usually, it takes 10 years for the average person infected with HIV to develop AIDS.
At a news conference at New York's health department, where Frieden was joined by nearly a dozen doctors and community leaders, several people recalled having that same worried feeling they had more than two decades ago, when AIDS first started appearing.
The city has been in close contact with the Centers for Disease Control in Atlanta.
More tests need to be completed before it is clear if any combination of drugs can work on this strain of the virus. But given what they know now, Frieden said treatment would be extremely difficult.
From the moment the health department learned about this case a week ago, they have been studying complex laboratory tests to figure out what exactly they had on their hands as well as trying to figure out the man's sexual history.
Health officials would not go into detail about how many people the man may have had sex with, but they have several investigators trying to track down partners. The man took an HIV test in May 2003 and was negative, health officials said.
The article goes on to say investigators believe he contracted HIV in Oct. 2004 due to unprotected sex with various people whil on crystal meth.
The man found some of his partners on the Internet, officials said. Frieden said that the most likely scenario was that the man had sex with someone who had AIDS and had already developed a resistance to drugs. "Whoever gave it to him most likely did not have sex only with him," Frieden said.
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On the subject of this story though, I find it odd that we would see this level of publicity and alarm bells for ONE case. Statistically, a sample size of 1 tells you exactly nothing. However, if more and more of these start showing up, the increased timetable might very well demonstrate that HIV does in fact cause AIDS.
Until that happens however, I think a single isolated case, while interesting, doesn't really tell us anything at all.
This connection is far too complex for the simplistic "HIV+ = AIDS" or "HIV+ does not cause AIDS" arguments that I have seen here.
It is completely possible and plausible that some forms of drug-resistant forms of HIV result in *some people* in AIDS, and it is also possible that in other people it does not result in AIDS.
You would think the lesson of Typhoid Mary would not have been forgotten so soon, but unfortunately, it appears to have completely fallen off the radar of BOTH sides of this issue.
Why am I not surprised. We have successfully polarized everything else...
My own view has gone from moderate on this matter--thinking there's problems with the HIV theory, suspecting it doesn't cause AIDS--to outright scorn. The notion that HIV causes AIDS is in my view simply a farce. Those who defend it give every sign of people who know they've latched onto a bullshit theory: they defend it with a mouth-foaming fury, a viciousness, and an ad hominem manner so fierce they look exactly like religious fanatics. Not only did I see that here in my own discussions with a little tinpot fascist by the name of Christopher J. Noble, but we've seen it elsewhere: Marc Weinberg has, for example, proposed that anyone who questions whether HIV causes AIDS should be jailed, and has compared people like Duesberg to sociopaths and nazis. No lie: he proposes that anyone who questions the HIV/AIDS theory actually wants to see millions of people dead.
I've not found practitioners in any scientific or medical field so wildly defensive when confronted with disagreement or skepticism. You don't, for example, see oncologists foaming at the mouth and calling people murderers if they question the efficacy of chemotherapy or question whether oncogenes really are a major cause of cancer.
I hate to break it to you Jack, but your notion that HIV might require cofactors is still considered heresy all by itself in much of the medical establishment. Small wonder: if you accept that premise, it means that tens of thousands of people have been unnecessarily medicated. It would also mean that countless children have been ripped away from their parents and forcibly medicated for no good reason.
In other words, Jack, just accepting your moderate view of the matter would mean there's a screaming problem here.
Saying that won't get you yelled at by anyone in the "establishment".
Still: let's go ahead and accept that genes are the cofactor. We will not insult people for believing there's a genetic cofactor. Still, you've opened up a can of worms now: if there's one possible cofactor, what's the justification for rejecting any other possible cofactors?
Root-Bernstein believes there are multiple possible cofactors, such as drug use, frequent practice of unprotected anal sex with multiple anonymous partners, heavy use of antibiotics (almost all the early AIDS patients had had multiple cases of gonorrhea, syphilis, hepatitis, etc. and been treated for those before AIDS), and so on. These are all chemical and biological insults that could have long-term negative effects on the immune system--and they would probably help explain why we have a growing number of HIV+ people who are living careful lives, monogamous, drug free, etc. and utterly refusing medical advice.
Christine Maggiore was first diagnosed HIV+ in 1992 and for two or three years she spouted the party line although she never took meds. By '95 she decided she didn't believe, began saying so, and was vilified for it. Eventually she wrote pamphlets about it, with people saying she was "in denial" and would soon die. When she got pregnant no OB/GYN would see her because she refused AZT, so she wound up being forced to give birth at home with a midwife.
Her kids are now both quite healthy, and the eldest will be entering High School soon. There are other kids wandering around just like hers, some of them already in High School.
By amazing coincidence she just happens to turn out to be one of the lucky ones?
I mean, do you not get it yet? At bare minimum--at bare minimum--standing medical advice on HIV has been overaggressive. People, including children, have been unnecessarily medicated. What's the percentage? We'd like to believe it's a tiny sliver, but do we really know?
More to the point: do we want to know?
If that were the case, this guy may have gotten the really bad version of HIV directly, instead of having to wait for it to mutate.
Of course, I'm already a religious fanatic, so Dean's scorn counts for naught against me. :-)
He's also right that you cannot avoid politicizing AIDS. Researchers and drug companies receive literally tens of billions of dollars in tax money every year for AIDS research and treatment. Receiving tax funds automatically makes it political. So where's the oversight, and where's the accountability? And why are those who are recieving all this money to automatically trusted when they say we shouldn't bother funding research on any alternative theories? (There are other alternative theories besides Duesberg's. I can name at least three off the top of my head.)
I can tell you of a case of a man who was HIV+ for over ten years and refused drugs. His doctors thought he was insane. Several years after being diagnosed HIV+, he developed a terrible case of pneumonia and his doctors said "aha!" and thought now surely he'd stop being "in denial" and would go on the drugs.
He didn't. He recovered from his pneumonia and he's just fine now. If he'd listened to his doctors he'd have gone on a cocktail regimen.
Which brings us to the question I've asked many times and never gotten an answer for: if we admit that some HIV+ will never develop AIDS, and we also admit that the disease can have a latency period of over 20 years in some people--in short, if we simply accept what they're telling students today in medical school--then what is the medical justification for giving someone an AIDS diagnosis? How do you know the patient is not immune? Or if he is NOT immune, how do you know the virus is not still latent if he comes down with, say, pneumonia?
In short, what is the justification for medicating a patient? How do you know this patient isn't going to get better from his toxoplasmosis or pneumonia without the expensive (and quite toxic--NO ONE disputes that these drugs are toxic) cocktail drugs
Furthermore, is there any justification for not at least TELLING the patient that he has a CHANCE of being immune, or a CHANCE of the latency period lasting for decades, and letting THE PATIENT decide what level of risk he's willing to take?
We do it for cancer patients all the time. Why don't we do it for HIV+ patients?
And is there any justification whatsoever for taking children away from parents who decide they don't want to risk the drugs? Because we're still doing that to parents RIGHT NOW.
What I notice is that there are a lot of people who would very much like to see these questions not even asked.
Your theory that only certain varieties of HIV are truly dangerous is a little wobbly for some reasons I'd rather not get into because we'll be here all day. Let's just say that it's not a stupid theory, because it's not. So let's accept it at face value. Let's pretend it's right, just for the sake of the argument.
It would again indicate that we have been giving at least some people AIDS drugs who don't need them. And it would open the horrible question: how many?
Because all of these drugs are toxic. Every single one of them.
So how many people who would never actually contract AIDS were killed by well-meaning doctors? 10? 100? 1,000? 10,000? 100,000....?
As Pournelle notes, those who back the theory that HIV and only HIV causes AIDS receive literally tens of billions of dollars a year in tax money. Those receiving all this money vigorously assure us that there is no need for any funding whatsoever for any alternative theories.
You don't have to believe they are corrupt, and you do not have to believe there is any conspiracy, in order to see a problem there, do you?
For the sake of argument...lets say Genes are the only cofactor. And that we're not sure what role that plays yet--but we know it plays some role.
How do you treat your patients when you don't know...for sure...what sort of genes they have and what role HIV plays in them??
Well...you play the odds--just like all the other diseases and surgeries etc. You can't be right every time can you? I know that sucks...but that's life and that's medicine. No medicine is 100% right all the time. Doctors take in all the info they have and try to make a rational decision.
So what do you do to deal with the idea that some may not develop AIDS within 10 years? Well...you wait until:
a. viral load skyrockets AND CD4 drops
b. They get sick from an AIDS defining infection (this doesn't mean a basic case of pneumonia--it means MAC or recurrent pneumonia, PCP---these diseases are rare without a compromised immune system)
It's not like doctors are running around treating anyone that's HIV positive anymore. Those are not the guidelines--I linked to the guidelines elsewhere.
So...we've created a system that attempts to wait essentially until CD4 level drops and viral load gooes up and the get sick with any number of AIDS illnesses. Viral load is fairly indicative of disease course.
Does this not seem like a good way to deal with the cofactor issue in the genetic sense? If they posess the genes capable of preventing HIV turning into AIDS then they won't fall into the treatment category--and they won't receive the toxic drugs.
Fair enough?
Now...as for this taking kids away from their parents--can you point me to the articles that talk about that, I'd like to read them (this isn't a snarky comment--it's the honest truth)--you may have linked them before--I'll look
New York's HIV Experiment
I'm sure there's more, but that's the only link I had handy.
Here's a link, I remember The Valerie Emerson case here in Maine. The local news had it on quite a bit.
Scientists Transform HIV into Cancer-Seeking Missile
I'm surprised by this story because it suggests a far greater understanding of HIV than I was aware existed. There's talk of using "a version of HIV from which the viral pieces that cause AIDS had been removed" and stripping "off HIV's viral coat and redress[ing] it in the outer suit of the Sindbis virus, which normally infects insects and birds."
I have no other comment on the story at this point. I just thought it relevant to the conversation.
http://www.poz.com/index.cfm?p=article&art_id=35
Seriously dude: that's worth a lot. I'm not being in the LEAST bit, not AT ALL, condescending.
Now, you ask me what I would do if I were a physician (which I am not) when presented with a patient with certain symptoms: I'd follow the conventional wisdom. I would. The only thing I'd do is try to communicate to my patients what the uncertainties were. Which would in many cases make them unhappy. But I'd do it anyway.
But here's the big thing: if a patient of mine questioned the prevailing medical wisdom, I'd do my best to tell them why they might be foolish, but I'd otherwise go out of my way to say, "Okay, you have this dissenting notion, and I respect your right to make your choices. I'll still try to work with you as my patient and try to help you. And if your particular case seems to fly in the face of the wisdom of my profession, I'll try to let others know about it."
Reasonable, yes?
Now...as for this taking kids away from their parents--can you point me to the articles that talk about that, I'd like to read them (this isn't a snarky comment--it's the honest truth)--you may have linked them before--I'll look.
Next comment.
Medicating HIV+ Children
I went back and saw the children articles almost immediately after I posted. For someone that believes HIV causes AIDS--I still think the gov't steps out of bounds. So you won't hear me argue to much over that.
At any rate, you're right about your previous post--the key to all of this is informed consent...and damned if they don't beat us over the head with that in class (and they should).
Informed consent, informed consent, informed consent.......
Informed consent is all very well but there is a big difference between cancer and AIDS. The latter is an infectious, sexually transmitted disease. If an HIV positive individual chooses to avoid treatment but still practices safe sex and informs potential partners of HIV status, he or she has a right to any opinion they care to hold vis a vie HIV and AIDS.
But as far as I'm concerned an individual's right to an opinion stops where their opinion causes them to endanger the health of others.
Right. They are exactly opposite. Leukemia (cancer of white blood cells) results in an increase of malignant t-cells.*
Whereas, AIDS is characterized by a decrease of healthy t-cells.
The latter is an infectious, sexually transmitted disease.
Truly, one of the most ironic statements on the topic, since HIV was originally called, "Human T-Cell Leukemia Virus III" -- implying that Leukemia was an infectious disease, caused by said virus.
Hank Barnes
* Of course, there as many types of leukemia as there are white blood cells. So, not all leukemias relate specifically to t-cells.
The simplest answer to your comment is no.
No, leukemia and AIDS are not exactly opposite. Apart from one being sexually transmitted and the other not, they have features in common; the most notable being that both lead to immune suppression.
No, HIV was never believed to be responsible for leukemia; it was named based on its superficial similarity to another virus HTLV-1 that is associated with leukemia.
Sometimes I wonder whether you're just parroting stuff. You'd make a good bureacrat:)
Let me walk this through for you.
1. HIV was previously called Human T-Cell Leukemia virus, correct?
2. Leukemia means cancer of the white blood cells, correct?
3. Cancer of the white blood cells, means a proliferation of malignant white blood cells, correct?
4. A proliferation of malignant white blood cells is dangerous for 3 reasons: (1) malignant white blood cells lose their function to fight antigens, (2) their mere presence and circulation interferes with other white blood cells trying to fight antigens and (3) they metastasize to other cells. Correct?
5. While Leukemia characterizes an increase in bad white blood cells, AIDS characterizes a decrease of good white blood cells, specifically, the t-cells, correct?
6. True, both Leukemia and AIDS impair the immune system — but they do so in completely opposite fashion.
I want a categorical "Yes" to each of these 6 simple questions.
Any questions?
Call 1-800-Hank
HIV was previously called HTLV-III. The L stands for leukemia but the name was never meant to imply that HIV was believed to be a virus associated with leukemia.
I'll stipulate that your description of leukemia while grossly oversimplified is more correct than not.
And you've agreed to my point that both AIDS and leukemia lead to immunosuppression.
I don't suppose you want to further agree that HIV/AIDS is a sexually transmitted disease?
Didn't think so.
Dale
Well, we're getting closer:) In all serious, I appreciate your response. You're a smart fellow.
A few comments:
The L stands for leukemia but the name was never meant to imply that HIV was believed to be a virus associated with leukemia.
You cannot mean this. Dr. Robert Gallo spent his entire life trying to find the cause/cure of leukemia, and supposedly "found" a virus, in fact, the first human retrovirus that caused any disease --leukemia. He then "found" 3 types. But to deny that Gallo's "Human T-Cell Leukemia Virus" implies (your word) that the virus causes leukemia is totally nonsensical. If it doesn't, why is it in the name? It's like saying the polio virus doesn't cause polio:)
I'll stipulate that your description of leukemia while grossly oversimplified is more correct than not.
Well, thanks! I prefer clear and easy to understand, than "grossly oversimplified," but that's ok:)
And you've agreed to my point that both AIDS and leukemia lead to immunosuppression.
Real close, but slightly off. They both lead to immunosuppression for different reasons . You're having trouble with the "reasons" part.
I don't suppose you want to further agree that HIV/AIDS is a sexually transmitted disease?
Well, I don't want to beat a dead horse, but Padian, Am. J. of Epidemiology, 1997) found otherwise:
"We followed 175 HIV discordant couples over time for a total of approximately 282 couple-years of follow-up."
"We observed no seroconversions after entry into the the study." (Padian, pg 354.)
With all this dangerous sex (282 couple-years), wouldn't you have expected that at least 1 person became HIV+?
Cheers,
Hank Barnes
Well at least you no longer cite Padian as studying 175 couples for ten years. I too see progress.
Nor do we disagree that leukemia and AIDS result in immunosupression from different underlying causes. I agree to different, I disagreed to "opposite".
As far as HIV and leukemia goes; if Dr. Gallo was looking for a virus that caused leukemia why would he look in AIDS patients, most of whom do not suffer from leukemia? The name was as I said based on similarity.
Does the name catfish imply the fish is related to a cat?
Dale
No, the name catfish does not imply that the fish is a cat - that suffers from the logical fallacy known as "faulty translocation of terms":)
But, you keep skillfully dodging these issues -- were you a fan of President Clinton? -- you are very adept.
1. Padian found NO seroconversions. So, NO, HIV is not a sexually transmitted disease. She did study 175 HIV discordant couples (pg 354) and she studied them over 10 years (pg 355, Table 3, 1985-1996). Obviously, some folks dropped out of the study, but so damn what?
2. I disagreed to "opposite".
Well, that's petty and trivial.
AIDS= Decrease in healthy T-Cells
Leukemia=Increase in unhealthy T-cells.
Perfect logic and scientific geometry.
3. As far as HIV and leukemia goes; if Dr. Gallo was looking for a virus that caused leukemia why would he look in AIDS patients, most of whom do not suffer from leukemia?
You do understand that the world of medicine and science pre-dated AIDS, for God's Sake?
1970's: War on Cancer, Hey, maybe these non-cytotoxic retroviruses cause cancer. Gallo "discovers" the dreaded Human T-Cell Leukemia Virus.
1984: War on AIDS, Hey, maybe these non-cytotoxic retrovirus cause AIDS. Gallo discovers the really dreaded Human T-Cell Leukemia Virus III -- later renamed HIV.
Cancer, virology, infectious disease, immune deficiency -- all came decades before AIDS. Surely you know this!
Barnes, Hank
I posted to you previously all the problems with interpreting Padian in the manner in which you want to. I won't repeat myself. Except to say Padian is one study. Look at the upstate New York HIV cluster and tell me how you would explain it if not by sexual transmission. Even Duesberg, in his response to my question referred to it as an exception.
I didn't say Gallo wasn't looking for viruses responsible for leukemia. I said that's not what he was looking for in AIDS patients.
D
Hank says HTLV-III was being looked at by Gallo, Montagnier, et. al. as a possible leukemia virus before claiming to have isolated it in AIDS patients.
Dale says HTLV-III was never seriously looked at as a leukemia virus, it just happened to look like a couple of other viruses and got labeled that almost by accident.
Would that sum it up, gentlemen?
Dale
This is hardly unique to HIV/AIDS. In Germany, you CAN be thrown in jail for claiming that the holocaust never happened. And let's not forget about Buzz Aldrin getting so worked up by a man why believed we never went to the moon that he punched the guy.
I would hardly call the moon landing and the holocaust "bullshit theories," yet there have been even stronger reactions against those denialists than the reactions you have encountered.
-Brad
2) I don't quite agree although you make a point.
Let's unravel some of this--Buzz Aldrin punched a guy who he felt was calling him a liar. That's a personal thing I'd say, although I don't blame him. I don't think that's a comparable situation.
In the case of the holocaust denialists, they're attempting to assert that 11 million people that died in the camps just plain didn't exist. That of course is horribly offensive. I don't agree that they should be put in jail, although I understand that in Germany they do make Nazi imagery and politics crimes.
Those who question a scientific theory do not deserve to be considered criminals. Especially a scientific theory that has not been verified by double-blind studies--which this one hasn't--and which still has serious holes that no other virus theory has.
One of the cheapest rhetorical tricks is to call people who question this theory "AIDS Denialists." That's an obvious and scurrilous attempt to compare us (and yes, I am one now) to Holocaust Denialists. That's incredibly offensive. If someone called me an "AIDS Denialist" to my face I'd punch him in the face. In fact, I promise to do just that if I should ever meet Dr. Christopher J. Noble in person.
This is a question of science, and medical treatment of a horrible disease. Those of us who think HIV does not cause AIDS do not deserve to be treated like garbage--especially since a lot of us are HIV+ individuals. Wrong we may be, but scum?
Science is supposed to be about empirical questions about truth and falsehood.
Funding for scientific research is extremely competitive, and as long as the established medical community is satisfied with the current evidence that HIV is an important causal factor leading to AIDS, researchers are not going to propose a study which probably would never make it past the ethics review board in the first place (not to mention the lawsuits that would come from study participants if the "HIV leads to AIDS" hypothesis turned out to be true). Double-blind studies are not the only type of research that leads to reliable conclusions.
Personally, I do not think proponents of any theory should be placed in jail, short of those that are the equivalent of shouting "Fire" in a crowded theater.
But I am proposing that HIV be subjected to the same standards that, say, the polio virus was. It hasn't been. It hasn't been. Indeed, it gives the impression of being the same disaster that the "swine flu" and "legionnaire's disease" fiascos were: a bunch of sloppy assumptions backed up by sloppy data.
I note for you what I have noted in other places:
When it was announced that HIV was the cause of AIDS, it was done in a political setting, not a scientific one. Robert Gallo never filed papers to confirm his claim. When he made his claim he and others said we should have a vaccine soon--and 20 years later, we're nowhere near one.
We were told that this virus was 100% lethal. This was false. We were told that anybody who contracted HIV would contract AIDS. This was false. We were told that AZT was a safe drug. This was false. We were told that "everybody is in danger of contracting AIDS." This was false.
We went from being told that anybody diagnosed HIV+ would die within 1-2 years to being told that this is a disease with a latency period of "up to 10 years" to being told that it's a disease with an average latency of 10 years.
We now have a large and growing number of HIV+ individuals who are refusing medication--and not dying. We also have HIV+ individuals--and in some cases even HIV- individuals!--being forced onto medication by court order. We have drugs that are being released for treatment of this virus that do not undergo the normally-required FDA testing before being used in live patients.
You see no problem here? None at all?
No problem here, nope, none at all, if you test HIV+ the courts should order you and your children on the drugs... nope, no problem with that at all...
I do not see how the method of public announcement has any bearing on the validity of the theory.
Yes, initial assumptions were proven false. I do not see how that affects the validity of the current conventional view of HIV/AIDS (And I don't know that AZT was ever considered a "safe drug"... simply that with the thousands of people dying of AIDS it was seen as worth the risky side effects). As our understanding of the disease has changed, so has the message. Medical science is not an absolute, and will always carry with it a degree of uncertainty.
Jeremy has already addressed the issue of informed consent. I agree that patients of sound mind should have the right to refuse treatment... but I don't see what this ethical issue has to do with the hypothesis that HIV does not lead to AIDS.
Perhaps there is a need for better diagnostic tools, but this is not unique to HIV. With Alzheimer's disease, the only reliable diagnosis is an autopsy, but that doesn't mean that Alzheimer's disease should be taken any less seriously
Finally, I haven't seen this article linked to in any of the discussion here so far, and so I wanted to give you the chance to read this:
The AIDS Heresies
From Skeptic vol. 3, no. 2, 1995, pp. 42-58
Not to spoil the ending, but Skeptic magazine calls questioning the HIV/AIDS hypothesis "A Case Study in Skepticism Taken Too Far"
I wonder why Skeptic magazine isn't supporting AIDS skeptics? Nope, no problem here.
Other than that, let me drill down to this:
Jeremy has already addressed the issue of informed consent. I agree that patients of sound mind should have the right to refuse treatment... but I don't see what this ethical issue has to do with the hypothesis that HIV does not lead to AIDS.
It's wonderful that you take this position. Too bad that the U.S. government continues to this day to force people onto medications whether they or their parents like it or not, eh?
I didn't recognize any instances of ad hominem fallicies being used to support the assertion that HIV leads to AIDS. Are you referring to the places where Harris disputes assertions made by AIDS dissidents and backs up his argument with evidence? That does not constitute an ad hominem fallicy.
But perhaps I'm missing something. If so, feel free to point out specific places where Harris makes fallacious arguments.
It's also got empirically false data in it, including the claim that chimps injected with HIV get AIDS (they don't) and then gives us handwaving about different viruses on different species as if that's huge proof.
Furthermore, if you read enough of the literature put out by the scientists who question the HIV hypothesis, you can see how often Harris mischaracterizes their remarks. I note that Skeptic allowed scientists who question the HIV theory to publish a rebuttal in their magazine, but they have not chosen to make that rebuttal available on the internet, only Harris' rather disingenuous attack piece on them. Why is that do you suppose?