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AidsTruth contributor and a leader of the Treatment Action Campaign, Nathan Geffen, has published a new book documenting AIDS denialism and the related quackery in South Africa titled Debunking Delusions: The Inside Story of the Treatment Action Campaign. We will publish a full review soon. More information can be found at the book's website. Below is the publisher's summary of the book.

Summary

One of the great, iconic struggles for social justice in the 21st century has been the campaign of the TAC against state-supported Aids denialism in South Africa. This struggle between activists, scientists and health workers, on the one hand, and a strange alliance of dissidents, quacks and political leaders, on the other, is here recounted in absorbing and dramatic detail for the first time by an insider. In his book Nathan Geffen, one of the TAC leaders, describes how early on in its life the organisation discovered that the greatest obstacle to AIDS treatment was in fact the South African government’s denialism. Not only did this extend to a reluctance to provide antiretroviral treatment to AIDS patients but also to support of a host of quacks and denialists who operated freely in the country to sow suspicion and confusion about the efficacy of standard medical treatment of AIDS. The most notorious of these were the German vitamin seller, Dr Matthias Rath, who along the way sued The Guardian of London and lost his case, and the Dutch nurse Tine van der Maas. It was the TAC that, as a result of a court case it brought against Rath, managed to stop his operations in South Africa; and it was the TAC, once again through legal means, that put pressure on the South African government to roll out an antiretroviral programme throughout the country. Geffen describes not only the TAC’s response to the puzzling intransigence of government and the spellbinding nonsense of dissidents, but the thought, strategy and discussion that lay behind the organisation’s major decisions. The story of the TAC’s campaign is one of the great triumphs of citizen activism for social justice and human rights. 

ScienceInsider reports:

Elizabeth M. Whelan writes in the New York Post:

The media gave big headlines to this week's stories on a prestigious British medical publication's retraction of an article that had claimed to show a causal link between standard childhood vaccinations (measles, mumps and rubella) and autism.

Yet the coverage of the Lancet affair didn't truly convey the outrageousness of the original publication or the gravity of its consequences -- consequences long festering, since the paper was published not last week but 12 years ago.

Many of us in the scientific community recognized the "study" as junk when it appeared in 1998. Even before we learned of then-unknown ethical failings by its lead author, we knew the study was based on a tiny population of only 12 children. More, it relied on a novel methodology that assumed some bizarre, previously unheard of, association between children's autism and their manifestation of intestinal problems.

Nonetheless, the media back then seized on this story from a prestigious medical source -- and the scare picked up steam when TV appearances by actress Jenny McCarthy and a Rolling Stone article by Robert Kennedy Jr. blared word of the putative dangers of vaccines.

Rahul K. Parikh, M.D. writes on Salon.com:

The media trumpeted an irresponsible study, ensuring that its nasty legacy thrives

Feb. 05, 2010

This week, Dr. Andrew Wakefield's now infamous study linking the MMR vaccine to autism was finally retracted by the prestigious Lancet medical journal. The move came days after medical officials in the United Kingdom found the doctor guilty of multiple ethics violations. For doctors, this is a victory -- but a bittersweet one.

As a pediatrician, I grapple daily with what Wakefield wrought: parents who are twisted in knots -- to the point of tears -- about whether to immunize their child. In the 12 years since the publication of Wakefield's study, 10 of his fellow co-authors have denounced him, and an unremitting series of revelations have exposed just how corrupt his motives and methods were. Most important, multiple studies verified there is no link between the MMR (or any other) vaccine and autism. Meanwhile, infectious diseases once confined to medical history have broken out in our communities. To say the retraction is criminally overdue is an understatement.

Further, even as Wakefield's research is expunged from the scientific record, what he spawned -- a well-funded, vocal, even rabid movement -- will remain. Without him, poster girl Jenny McCarthy would have been abandoned in the MTV archives instead of smugly crowing to Time magazine, "I do believe sadly it's going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it's their f___ing fault that the diseases are coming back. They're making a product that's s___ ." And anti-vaccine darling David Kirby would split his time between running a P.R. firm and writing pithy articles about art and aircraft instead of turning speculation and rumor into a Kennedy-esque vaccine-autism conspiracy theory. Finally, Wakefield himself stands to be completely unaffected by both the U.K. medical community (which could revoke his license to practice there) and the Lancet's decision. He long ago settled here in the U.S. and successfully peddles his views through his Thoughtful House autism center in Texas.

This documentary was produced by the non-profit health news agency Health-e and was recently broadcast on an independent television channel in South Africa.

View Part I:

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Download Part I in ogg/theora or in mp4.

Part II after the jump.

The anti-vaccine movement, which shares characteristics with AIDS denialism (both like to blame pharmaceutical conspiracies) and which was originally based on claims by British surgeon Andrew Wakefield, has been dealt a decisive blow by a finding against Wakefield by the General Medical Council. Caims that the MMR vaccine was linked to autism have since been shown to be baseless, but are still promoted by some, including by groups linked to AIDS denialism. The Guardian reports:

Dr Andrew Wakefield, the expert at the centre of the MMR controversy, "failed in his duties as a responsible consultant" and showed a "callous disregard" for the suffering of children involved in his research, the General Medical Council (GMC) has ruled.

Wakefield also acted dishonestly and was misleading and irresponsible in the way he described research that was later published in the Lancet medical journal, the GMC said. He had gone against the interests of children in his care, and his conduct brought the medical profession "into disrepute" after he took blood samples from youngsters at his son's birthday party in return for payments of £5.

The results from the DART trial, reported this week in The Lancet, provide important evidence for HAART programmes in resource-constrained settings. From commentary by Phillips & Oosterhout published alongside the results:

In much of sub-Saharan Africa, the scale-up of use of antiretroviral therapy has been so far achieved without routine laboratory monitoring of drug toxicity and efficacy. Until now, there has not been substantive evidence about the consequences of delivering antiretrovirals without such routine monitoring.

In The Lancet today, the DART Trial Team present the Development of AntiRetroviral Therapy in Africa (DART) trial. In DART at enrolment, all participants started triple-drug antiretroviral therapy and were randomised to clinically driven monitoring versus laboratory plus clinical monitoring for toxicity (haematology and biochemistry) and efficacy (CD4-cell counts). Over 5 years, the proportions who had one or more serious adverse events were almost identical, while there was a somewhat higher proportion in the group on clinically driven monitoring who had disease progression or death (28%, compared with 21% in the other group; hazard ratio 1·31, 95% CI 1·14—1·51). This benefit of laboratory plus clinical monitoring is probably due to the use of CD4 count rather than presence of clinical symptoms alone to decide on when to switch to a second-line regimen. This criterion for switching on the basis of CD4 count is just one of the CD4-count switch criteria recommended by WHO; the other criteria (on the basis of CD4-count change from baseline and from peak) are problematic to implement without a baseline CD4 count and frequent CD4 counts being available thereafter.

The other particularly striking result from DART is the 5-year survival in both groups: 87% for clinical monitoring and 90% for laboratory plus clinical monitoring. Such rates of survival are for people in whom the initial median CD4-cell count was 86 cells per μL. For comparison, the survival in the Entebbe cohort of untreated HIV-positive people in 5 years was below 10% (data presented in the DART report), which emphasises the huge clinical benefits of antiretroviral therapy. The DART Trial Team concluded from their results that antiretroviral therapy can be delivered safely with good-quality clinical care, which would allow treatment delivery to be decentralised, and that there is a role for CD4 testing from the second year on antiretrovirals to guide the switch to second-line therapy, which should encourage accelerated development of simpler and cheaper point-of-care CD4 tests. The DART investigators should be complimented for exceptional achievement by completing this important trial with such a low loss to follow-up (7%) in challenging circumstances, which shows that excellent trials can be done in Africa.

The results from DART are very important for antiretroviral programmes, no matter what their current level of routine laboratory monitoring. Programmes that currently deliver antiretrovirals without any laboratory monitoring can be reassured that the vast majority (but not all) of the potential survival benefit of such therapy can be realised with the use of such a simple approach (albeit with particularly intensive and high-quality clinical monitoring, which is a substantial challenge to achieve in routine settings throughout sub-Saharan Africa). Similarly, no antiretroviral programme should enhance laboratory monitoring at the expense of putting more people in need on these drugs. Those clinics that do use routine measurement of biochemistry and haematology can reduce their laboratory costs to enable spending on other aspects of the programme (which has already started in some programmes). Programmes that monitor people on antiretrovirals with CD4 counts should consider adopting the switch criterion used in DART of CD4 count below 100 cells per μL (ie, only this one of the WHO-recommended criteria, rather than all three), and apply this criterion to people who have been on therapy for at least 2 years. Such a delay should help to reduce the number of people in whom a switch is made when viral load is actually suppressed.

Read the commentary at The Lancet (open access; registration required)

Details on the main paper below:

Also see the comment piece Still Crazy After All These Years (open access) by Nicoli Nattrass that appears in the same issue of AIDS & Behavior.

Update (22/01/2010): See AIDS Denialism Under Fire From Researchers by Nora Proops in The AIDS Beacon.

AIDS & Behavior. 2010 Jan 8. [Epub ahead of print]

AIDS Denialism and Public Health Practice

Chigwedere P, Essex M.

In this paper, we respond to AIDS denialist arguments that HIV does not cause AIDS, that antiretroviral drugs are not useful, and that there is no evidence of large-scale deaths from AIDS, and discuss the key implications of the relationship between AIDS denialism and public health practice. We provide a brief history of how the cause of AIDS was investigated, of how HIV fulfills Koch's postulates and Sir Bradford Hill's criteria for causation, and of the inconsistencies in alternatives offered by denialists. We highlight clinical trials as the standard for assessing efficacy of drugs, rather than anecdotal cases or discussions of mechanism of action, and show the unanimous data demonstrating antiretroviral drug efficacy. We then show how statistics on mortality and indices such as crude death rate, life expectancy, child mortality, and population growth are consistent with the high mortality from AIDS, and expose the weakness of statistics from death notification, quoted by denialists. Last we emphasize that when denialism influences public health practice as in South Africa, the consequences are disastrous. We argue for accountability for the loss of hundreds of thousands of lives, the need to reform public health practice to include standards and accountability, and the particular need for honesty and peer review in situations that impact public health policy.

PMID: 20058063

Read the full article on SpringerLink (open access)

Fact: A small percentage of people infected with HIV do live for many years without developing AIDS. They are often known as long-term non-progressors. But such individuals are rare: without proper medical care, including antiretroviral drugs when needed, most HIV-positive people will eventually develop AIDS.

As putative evidence that HIV is harmless, some HIV/AIDS denialists point to examples of HIV-infected people who survive for many years, even decades, without receiving antiretroviral treatment. HIV denialists often claim that these people survived because they avoided antiretroviral therapy, and that diet, exercise, nutritional supplements or herbal therapies, stress reduction, hypnosis, and other interventions prevent progression to AIDS. These claims are untrue and dangerous.

Read the full bebunking.

J Acquir Immune Defic Syndr. 2010 Jan;53(1):86-94.

Brady MT, Oleske JM, Williams PL, Elgie C, Mofenson LM, Dankner WM, Van Dyke RB; for the Pediatric AIDS Clinical Trials Group219/219C Team.

CONTEXT: Introduction of highly active antiretroviral therapy has significantly decreased mortality in HIV-1-infected adults and children. Although an increase in non-HIV-related mortality has been noted in adults, data in children are limited.

OBJECTIVES:: To evaluate changes in causes and risk factors for death among HIV-1-infected children in Pediatric AIDS Clinical Trials Group 219/219C.

DESIGN, SETTING, AND PARTICIPANTS:: Multicenter, prospective cohort study designed to evaluate long-term outcomes in HIV-1-exposed and infected US children. There were 3553 HIV-1-infected children enrolled and followed up between April 1993 and December 2006, with primary cause of mortality identified in the 298 observed deaths.

MAIN OUTCOME MEASURES:: Mortality rates per 100 child-years overall and by demographic factors; survival estimates by birth cohort; and hazard ratios for mortality by various demographic, health, and antiretroviral treatment factors were determined.

RESULTS:: Among 3553 HIV-1-infected children followed up for a median of 5.3 years, 298 deaths occurred. Death rates significantly decreased between 1994 and 2000, from 7.2 to 0.8 per 100 person-years, and remained relatively stable through 2006. After adjustment for other covariates, increased risk of death was identified for those with low CD4 and AIDS-defining illness at entry. Decreased risks of mortality were identified for later birth cohorts, and for time-dependent initiation of highly active antiretroviral therapy (hazard ratio 0.54, P < 0.001). The most common causes of death were "End-stage AIDS" (N = 48, 16%) and pneumonia (N = 41, 14%). The proportion of deaths due to opportunistic infections (OIs) declined from 37% in 1994-1996 to 24% after 2000. All OI mortality declined during the study period. However, a greater decline was noted for deaths due to Mycobacterium avium complex and cryptosporidium. Deaths from "End-stage AIDS," sepsis and renal failure increased.

CONCLUSIONS:: Overall death rates declined from 1993 to 2000 but have since stabilized at rates about 30 times higher than for the general US pediatric population. Deaths due to OIs have declined, but non-AIDS-defining infections and multiorgan failure remain major causes of mortality in HIV-1-infected children.

PMID: 20035164.

Read at JAIDS.

Science 11 December 2009: Vol. 326. no. 5959, pp. 1476 - 1477

Dozens of studies have been examining people who fend off HIV despite repeated exposures in an effort to find genetic or immunologic factors that can help guide AIDS vaccine research. But all too often the leads point in contradictory directions, in part because investigators use different assays to probe their samples, and there is little coordination among them. Many labs also use wildly varying criteria to decide who qualifies as HIV-resistant, making it difficult to sort out which study subjects were truly exposed and uninfected, were exposed and have an occult infection, or were never exposed in the first place. At the first-ever meeting on natural immunity to HIV, held from 15 to 17 November, researchers attempted to hammer out these and other issues.

Read the article at Science.

doi: 10.1126/science.326.5959.1476

AIDS. 2010 Jan 2;24(1):123-37.

HIV-CAUSAL Collaboration.

OBJECTIVE: To estimate the effect of combined antiretroviral therapy (cART) on mortality among HIV-infected individuals after appropriate adjustment for time-varying confounding by indication. DESIGN: A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62 760 HIV-infected, therapy-naive individuals followed for an average of 3.3 years. Inverse probability weighting of marginal structural models was used to adjust for measured confounding by indication. RESULTS: Two thousand and thirty-nine individuals died during the follow-up. The mortality hazard ratio was 0.48 (95% confidence interval 0.41-0.57) for cART initiation versus no initiation. In analyses stratified by CD4 cell count at baseline, the corresponding hazard ratios were 0.29 (0.22-0.37) for less than 100 cells/microl, 0.33 (0.25-0.44) for 100 to less than 200 cells/microl, 0.38 (0.28-0.52) for 200 to less than 350 cells/microl, 0.55 (0.41-0.74) for 350 to less than 500 cells/microl, and 0.77 (0.58-1.01) for 500 cells/microl or more. The estimated hazard ratio varied with years since initiation of cART from 0.57 (0.49-0.67) for less than 1 year since initiation to 0.21 (0.14-0.31) for 5 years or more (P value for trend <0.001). CONCLUSION: We estimated that cART halved the average mortality rate in HIV-infected individuals. The mortality reduction was greater in those with worse prognosis at the start of follow-up.

PMID: 19770621

Mortality Rate Still Higher Than for Children without HIV

The death rates of children with HIV have decreased ninefold since doctors started prescribing cocktails of antiretroviral drugs in the mid-1990s, concludes a large-scale study of the long-term outcomes of children and adolescents with HIV in the United States. In spite of this improvement, however, young people with HIV continue to die at 30 times the rate of youth of similar age who do not have HIV, found researchers from the National Institutes of Health and other institutions.

Earlier studies have shown that adults with HIV are living longer because of improved multi-drug antiretroviral regimens known as highly active antiretroviral therapy (HAART). However, limited information has existed about the effectiveness of HAART in improving the survival of children with HIV. The current analysis, published in the Dec. 15 issue of the Journal of Acquired Immune Deficiency Syndromes, delineates the effects of HAART on the rates and causes of death for HIV-infected children and adolescents.

AIDS. 2010 Jan 2;24(1):139-46.

Yotebieng M, Van Rie A, Moultrie H, Meyers T.

OBJECTIVES: Construct percentile curves for 6-month gain in weight, height, CD4 cell count, and CD4 percentage (CD4%) in children initiating ART, and to assess the association between lower percentiles and subsequent ART responses. DESIGN: Cohort of 1394 HIV-infected children initiating ART between April 2004 and March 2008, Johannesburg, South Africa METHODS: The generalized additive model for location, scale, and shape was used to construct percentile curves for 6-month gain in weight, height, CD4 cell count, and CD4%. Cox proportional models were used to assess the association between lower percentiles of each distribution and death, virological suppression, and treatment failure between 6 to 36 months post-ART initiation. RESULTS: Lower percentiles for gain in weight, CD4, and CD4% count after 6 months of ART, but not height, were associated with poor subsequent treatment outcomes independent of baseline characteristics, with increasing strength of association as percentiles decreased. Age-specific 6-month post-ART weight gain in our cohort was substantially higher compared with 6-month weight gain in non-HIV-infected American children of the Fels Institute cohort and the attained weight-for-age at 6 months post-ART plotted on WHO weight-for-age growth charts were not associated with subsequent treatment outcomes. CONCLUSION: Gain in CD4% in the first 6 months of ART was the best predictor of poor subsequent ART outcomes. In areas with limited access to CD4%, weight gain post-ART using our newly developed reference distributions for HIV-infected children on ART is a good alternative to CD4%, and clearly superior to the commonly used 'Road-to-Health' weight-for-age charts.

PMID: 19940744

Fact: Studies in vitro, ex vivo and in vivo all support HIV's ability to deplete CD4+ T-cells.

There are some denialists that argue that HIV does exist but that it is merely a harmless passenger virus and that no evidence exists to claim otherwise. In fact, there are thousands of studies that support the cytopathic properties of HIV. While some aspects of how HIV destroys cells that are not fully understood, that it does so it beyond doubt. This is not unique to HIV, of course, as the effects of many diseases are known despite the mechanisms not being completely elucidated. Some of what is known (and supporting evidence will be cited) is the documented here. Since there are literally thousands upon thousands of papers on HIV, a representative few are cited here. This is by no means an exhaustive list.

Evidence shows us that AIDS the CD4+ T-cell depletion is due to HIV. This can be observed 1) in vitro (in cell cultures), 2) ex vivo (in tissues removed from animal models or patients), and 3) in vivo both in animal models and in infected individuals.

Read the full debunking here.

View the list of myths we debunk here.

A new study has found poorer adherence to antiretroviral therapy among African-American men with HIV who hold conspiracy beliefs, e.g. that HIV is a man-made virus designed to kill Africans.

JAIDS. 2009 Dec 09.

Conspiracy Beliefs About HIV Are Related to Antiretroviral Treatment Nonadherence Among African American Men With HIV

Bogart, Laura M PhD; Wagner, Glenn PhD; Galvan, Frank H PhD; Banks, Denedria MSW

Background: Medical mistrust is prevalent among African Americans and may influence health care behaviors such as treatment adherence. We examined whether a specific form of medical mistrust-HIV conspiracy beliefs (eg, HIV is genocide against African Americans)-was associated with antiretroviral treatment nonadherence among African American men with HIV.

Methods: On baseline surveys, 214 African American men with HIV reported their agreement with 9 conspiracy beliefs, sociodemographic characteristics, depression symptoms, substance use, disease characteristics, medical mistrust, and health care barriers. Antiretroviral medication adherence was monitored electronically for one month postbaseline among 177 men in the baseline sample.

AIDS. 2010 Jan 2;24(1):123-37.

The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals

The HIV-CAUSAL Collaboration

Abstract

Objective: To estimate the effect of combined antiretroviral therapy (cART) on mortality among HIV-infected individuals after appropriate adjustment for time-varying confounding by indication.

Design: A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62 760 HIV-infected, therapy-naive individuals followed for an average of 3.3 years. Inverse probability weighting of marginal structural models was used to adjust for measured confounding by indication.

AIDSTruth contributor Nicoli Nattrass writes in AIDS and Behavior:

In his new book, Denying AIDS, Seth Kalichman observes that people are surprised by the persistence of AIDS denialists: “Are they still around?”[1, p. 1] he is often asked. And it is a good question. Given the large body of scientific and clinical evidence on HIV disease and treatment (expertly summarized by Chigwedere and Essex in this issue of AIDS and Behavior) it is indeed strange that Peter Duesberg and his followers still claim HIV is harmless and that antiretrovirals cause rather than treat AIDS. While such dissident views were intellectually respectable in the 1980s when HIV science was new, they make little sense today. Thus Joseph Sonnabend, a doctor who treated some of the earliest AIDS cases in New York and was well known for arguing that environmental factors may be more important than a virus in driving AIDS, was quick to change his mind once antiretroviral treatment was shown to act against HIV and transform the health of his patients [2, p. 25]. Peter Duesberg, by contrast, refused to accept the evidence, thereby earning the label ‘denialist’ rather than ‘dissident’ [1, 2].

The Lancet has hailed the new approach evident in South Africa in which the government has decisively turned away from the AIDS denialism associated with former President Thabo Mbeki. 

The Lancet, Volume 374, Issue 9705, Page 1867, 5 December 2009

HIV/AIDS: a new South Africa takes responsibility

On Dec 1 the usual activities surrounding World AIDS Day will take on a special significance for South Africans. In a high-profile event in Pretoria, the South African National AIDS Council (SANAC) is bringing together people who work in HIV/AIDS, those who have been affected by HIV, and government officials, including President Jacob Zuma, Deputy President and SANAC Chair Kgalema Motlanthe, and the Minister of Health Aaron Motsoaledi. Zuma will give a televised address on HIV/AIDS to the nation. Under the motto “I am responsible, we are responsible, South Africa is taking responsibility”, a new era in the country's response to HIV/AIDS is being publicly heralded. In a key-messages booklet, SANAC calls on everyone to know their HIV status by frequent testing; on communities to stop stigma and discrimination against people living with HIV; and on itself to ensure that the government is taking responsibility for people to receive counselling, provide condoms, and give access to treatment for tuberculosis and HIV.

Already on Oct 29, in what has been widely praised as a landmark speech, Zuma left no doubt about the decisive departure from the previous government's stance of denialism and indifference: “South Africa must work harder to implement the national strategy to tackle HIV/AIDS…all South Africans need to know their HIV status and be informed of the treatment options available to them…there should be no shame, no discriminations, and no recriminations”. The non-governmental organisation Treatment Action Campaign called Zuma's speech, which came almost 10 years after Thabo Mbeki made his HIV/AIDS denial clear before the same National Council of Provinces, as “one of the most important speeches in the history of AIDS in South Africa”.

by George N. Pavlakis, Rockville, MD USA

What do you do about someone who claims to be an expert, serving up half-truths, twisting the facts in credible-sounding sentences and misleading a patient? There must be some rules that apply to someone who professes to be an expert and induces patients to stop their doctor-prescribed medication. These must be applied to prevent harm to more patients. And what if these actions lead to the patient’s death?

Such is the case of Lambros Papantoniou, a journalist living in Washington, a diplomatic correspondent for several Greek media institutions for more than 30 years and a man loved by all who met him. Even in the higher political echelons of Washington, he was affectionately known as “Mr Lambros”.

During a hospital stay approximately ten years ago, Lambros was diagnosed with AIDS and given anti-retroviral therapy. Following this, his interest in the AIDS problem skyrocketed, and he sought information on it. Although he was a diplomatic correspondent, he reported on AIDS issues several times.