Among the charming — so to speak — aspects of HIV/AIDS theory and practice is the periodic changing of definitions and categories, for example, altering the age ranges for which numbers are reported, so that making comparisons becomes fraught with trying to disentangle the effects of those changes [for example, Living with HIV; Dying from What?, 10 December 2008].
Since “HIV is the virus that causes AIDS”, and CDC numbers (or rather, estimates from the Division of HIV/AIDS) are increasingly given in terms of “HIV/AIDS” cases, one might be forgiven for thinking that deaths from “HIV disease” might be the same as deaths from “AIDS”. Not so:
“Deaths due to HIV disease, as reported on death certificates, are not exactly the same as deaths of persons with acquired immunodeficiency syndrome (AIDS) reported to the HIV/AIDS surveillance systems of health departments.
The AIDS case definition requires documentation of a low CD4 T-lymphocyte count or diagnosis of one of the approximately two dozen AIDS-defining illnesses. (The exact number of possible AIDS-defining illnesses depends on how they are split or grouped together). If information on the CD4 count is missing and no AIDS-defining illness was diagnosed, these persons cannot be counted as AIDS cases despite the fact that their deaths were attributed to HIV disease on their death certificates.”
Is there some good reason for this? Why shouldn’t exact, immediate, manifest, ACTUAL causes of death be reported to the HIV/AIDS surveillance systems? If “HIV-positive” people die from something that isn’t in the “AIDS” definition, surely it shouldn’t be reported as from “HIV disease”! Yet evidently it is.
“The crescent shape on the right includes the deaths of persons with AIDS attributed to causes unrelated to HIV infection (such as lung cancer or motor vehicle accidents).”
In her excellent book, Rebecca Culshaw pointed to this remarkable practice for which, again, it’s difficult to envisage a really good reason.
“Because of improved treatment, survival after a diagnosis of AIDS has become longer, allowing a greater proportion (up to about 25%) of deaths of persons with AIDS to result from such other causes.”
. . . “such other cause” including, to a notable extent, the “side” effects of antiretroviral drugs:
“In the era of combination antiretroviral therapy, . . . the risk of several non-AIDS-defining conditions, including cardiovascular diseases, liver-related events, renal disease, and certain non-AIDS malignancies . . . is greater than the risk for AIDS . . . .” (p. 13, January 2008; p. 21, November 2008 NIH Treatment Guidelines). And these Treatment Guidelines are saying that “non-AIDS” causes of “AIDS” deaths are >50%, not up to 25%.
“The crescent shape on the left represents deaths attributed to HIV disease among persons whose conditions did not meet the surveillance case definition for AIDS.”
What sleight of definitions and evidence is this? Just as with “HIV-associated lipodystrophy”, it has become increasingly popular among HIV/AIDS gurus to ascribe the death of every “HIV-positive” person to some influence exerted by “HIV”. Consider the insupportably irrational and vicious circularity: “AIDS” appeared and was defined as a collection of opportunistic infections said to be found in people whose immune systems had been ravaged by “HIV”. Up to 1987, those included almost no manifest illnesses other than Pneumocystis carinii pneumonia or candidiasis or Kaposi’s sarcoma. Following the presumption that these “AIDS” cases were caused by “HIV”, however, an increasing number of other disease were classed as “HIV-caused” just because the affected individual tested “HIV-positive” — which might happen for a large variety of reasons, for example, having TB. It was this type of utterly unfounded inference that led to the invention of conditions like “HIV encephalopathy” and “HIV wasting syndrome” (CDC report for 1988) and eventually the catastrophic use of CD4 counts as a supposed measure of immune deficiency. So nowadays, we have this set of deaths attributed to “HIV” only because a person is “HIV-positive” when he dies!
The relative areas in this figure (measured by counting squares on a grid) are: left crescent ~65, right crescent ~210, common area ~495; total area (common plus both crescents) ~770
In other words, the common area represents ~495/770 = 65% of deaths being reported as either owing to AIDS or to “HIV disease”. But surely, if one talks of “HIV/AIDS”, that should apply to the common area only, shouldn’t it?
The right crescent plus common area, ~705, represents all “AIDS” cases; so of the deaths reported as “AIDS” , ~210/705 = ~30% are actually from non-AIDS causes! (Though, as I said earlier, the NIH Treatment Guidelines suggest >50% rather than ~30%.)
Of course, the Figure shown aboveis purely schematic, but it’s worth noting these numbers to realize just what the implications are of what the CDC is confessing here: that official data about deaths from “HIV disease” or from “AIDS” cannot be taken at face value. This explains, at least in part, why “AIDS” deaths reported by CDC’s Division of HIV/AIDS for 2004 were 20% greater than those reported by the CDC’s Center for Health Statistics, ranging from 40% less for those under 13 to 40 % greater for those aged 55-64 [CDC versus CDC: Which data to believe?, 15 August 2008].
Best of luck to you, as you try to make sense of the press releases from CDC; or, for that matter, of their “Surveillance” Reports.