HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

Posts Tagged ‘long-term non-progressors’

What numbers mean: 50% of “HIV-positives” are long-term non-progressors

Posted by Henry Bauer on 2010/06/04

Numbers may seem like indisputable facts, but as with other “facts”, what matters is their significance, how they are interpreted. Those who present us with numbers don’t always point to the appropriate way to interpret them, however. Indeed, manifold devices are deployed — unwittingly as well as deliberately — to help numbers insinuate unwarranted implications. Read, for example, Darrell Huff’s “How to Lie with Statistics” to be alerted to the grain of truth in the common saying that “There are lies, damned lies, and statistics”.

One does not need to be a mathematician or a statistician to think sensibly about the significance conveyed by numbers. A few general points, expressed as questions to ask of presented numbers, can be of enormous help:
→   What is the accuracy, the margin of uncertainty?
→  Was the measurement made on an appropriate sample?
→  With surveys of humans: How were the questions phrased?
→   Above all: Is this detailed report overall compatible with the accepted theory?

I’ve been puzzled a number of times as mainstream articles present numbers clearly incompatible with HIV/AIDS theory without bringing a storm of commentary let alone re-evaluation.

One occasion was what eventually made me an AIDS Rethinker. Harvey Bialy cited (at p. 184) the early finding that teenage girls and boys applying for military service from all over the United States in the mid-1980s tested “HIV-positive” at about the same rate. This was obviously quite incompatible with the orthodox view of HIV/AIDS, namely, that HIV entered the United States during the 1970s within communities of gay men and caused AIDS among them by the late 1970s and early 1980s: in no way could such a purported infection have spread by the mid-1980s throughout the country to affect teenage girls everywhere as often as teenage boys. Therefore I suspected there was something wrong with the source Bialy had cited, and I set out to confirm that suspicion. The rest is history. The source was cited correctly, and together with all other published data on HIV tests demonstrates beyond any doubt that what the “HIV” tests detect or measure is not an AIDS-causing infectious agent; see my book  about it.*

Then there’s the fact that the peak age for testing “HIV-positive” is the same as the peak age for an AIDS diagnosis and the same as the peak age for death from “HIV disease”, making obvious nonsense of the “latent period” “slow-virus” story [No HIV “latent period”: dotting i’s and crossing t’s, 21 September 2008].

That last concerns numbers that are not widely disseminated, though, I had to calculate them from other published data. So too with the fact that mortality among “people living with AIDS” is independent of age, unlike with every other ailment to which humankind is subject and incontrovertibly nonsensical [Age shall not wither them — because HIV really doesn’t kill, 4 February 2009].

But there’s an entirely straightforward, publicly disseminated numerical assertion that had been nagging at me for quite some time because, as with the paper cited by Bialy, it’s quite obviously incompatible with the official view of HIV/AIDS: the repeated assertions from official spokespeople that something like a quarter or a third of “HIV-positive” people don’t know their state of “infection”. This has become so much a shibboleth that it has recently been emphasized as support for initiatives to institute universal HIV testing and treatment [GAYnocide in San Francisco, 2010/04/04].
But if this assertion were true then the standard story about HIV/AIDS could not be true. From at least the mid-1980s, about a million Americans have been “HIV-positive” (see sources cited at pp. 1-2 & 108 in The Origin, Persistence and Failings of HIV/AIDS Theory). If 250,000-330,000 of them were not known to be “infected”, and if on average they would succumb to AIDS about a decade later (since obviously they were not being treated), then the numbers of AIDS deaths should have climbed towards ≥250,000 annually by the mid-1990s at the latest and should have remained at least that high ever since. But AIDS deaths have been nowhere near such numbers.**
Therefore, if the CDC’s assertions are correct that 25-33% of “HIV-positives” don’t know it, and yet AIDS deaths have been much lower than would correspond to this, then a large proportion of “HIV-positive” people must have been long-term non-progressors or elite controllers — apparently unbeknownst to the CDC, though they surely should have drawn this plain inference from their own statements.

The proportion of potential long-term non-progressors can in fact be calculated from available official data. CDC has published firm estimates of the annual number of new HIV “infections”. Many estimates have been published over the years of the total numbers of “HIV-positive” Americans.*** Detailed numbers are made available periodically by the Centers for Disease Control and Prevention about numbers of people “living with HIV”, “living with HIV/AIDS”, and dead from AIDS (or “HIV disease”).

It turns out that
if every American were to be HIV-tested,
something like half of them would be
potential long-term non-progressors or elite controllers

The detailed calculations can be found in the earlier cited article in the Italian Journal of Anatomy and Embryology [Medical students in Africa need not fear HIV, 2010/05/31; REPRINT of Galletti & Bauer, 2010/06/03], and also now in a different context in “Iatrogenic harm following ‘HIV’ testing”, Journal of American Physicians and Surgeons, 15 (#2, summer 2010) 42-46.  It’s gratifying that the Journal’s press release about this article was picked up quite widely, for example by Yahoo! Politics which boasts 56,825,000 visitors/day, or AOL DailyFinance
(a mere 860,000 visitors/day).

The title of that article reflects an obvious chain of reasoning. If everyone who tests “HIV-positive” were to be put on antiretroviral drugs, which is increasingly being urged irrespective of individual state of health or CD4 count, then about half of those people would be severely damaged for no good reason by the debilitating “side” effects of antiretroviral treatment.

The $2.5 million awarded to Audrey Serrano may then be just the harbinger of a huge future bonanza for trial lawyers; but perhaps they would collectively gladly forfeit such bounty if that would avoid the enormous human costs of subjecting tens of thousands of healthy Americans — and many more than that Africans — to iatrogenic harm from misguided, uncalled-for, unwarranted antiretroviral treatment.

* Please note that nothing in my book has been discredited. All the reviews by uncommitted individuals have been thoroughly favorable. The most determined critic, Kalichman, could only find fault by attacking things that are not said in my book (see “Kalichman re-writes Bauer’s book — Kalichman’s disgracefully un-Komical Kaper #10”, 2009:05:26). The most determinedly negative review of my book on was so egregiously non-substantive and ad hominem that its author — then graduate student and AIDS-truther, Kenneth Witwer — soon withdrew it.

**Actually even earlier than the mid-1990s the numbers of AIDS deaths should have been higher than they actually were, because a million Americans didn’t become “HIV-infected” suddenly in 1985, by then there must have been substantial numbers of “HIV-positive” Americans for quite a few years already.

*** Always since 1985 the number has magically remained the same at about 1 million. That in itself ought to have sufficed to raise strenuous doubts about HIV/AIDS theory.

Posted in antiretroviral drugs, experts, HIV does not cause AIDS, HIV risk groups, HIV skepticism, HIV tests, HIV/AIDS numbers, uncritical media | Tagged: , | 16 Comments »

Compounding HIV/AIDS absurdities

Posted by Henry Bauer on 2009/10/11

HIV/AIDS theory and practice have covered much ground in nearly 3 decades, without reaching a coherent understanding of where “HIV” came from, how it destroys the immune system, or how the supposed benefits of antiretroviral drugs are achieved and how those purported benefits are supposed to outweigh the drugs’ toxicity.

Instead, a host of mutually contradictory tenets are held simultaneously. A recent instance to come to my attention concerns the ability of “elite controllers” to infect others despite an absence of “virus”:

“the viral loads of elite controllers range from a scant 50 down to levels so small that even the most sensitive tests can’t detect them. Doctors know these people have the virus only because separate tests have revealed the presence of antibodies to HIV in their systems. In other words, elite controllers aren’t HIV-free; they may still be able to pass the virus to others, to whom it may be deadly” (Charles Slack, “Researchers hope ‘elite’ group holds clues for others”, Washington Post, 7 July 2009, pp. E1, 4; a longer version is in PROTO Magazine, Winter 2009, pp. 22-7; PROTO is a quarterly biomedical magazine published by Massachusetts General Hospital ).

Thus the presence of antibodies has become, in the conventional wisdom, proof of the presence of virions, even when no virions are to be found.

That virions may be transmitted even in their absence also runs directly counter to another tenet of the conventional HIV/AIDS wisdom, namely, that the likelihood of transmitting “HIV” increases with the magnitude of the “viral load”, i.e. the purported number of virions:
“blood HIV load, which is higher during the postseroconversion period and during advanced disease, is the principal predictor of heterosexual transmission [5-8]” (Wawer et al., Journal of Infectious Diseases, 191 [2005] 1403-9).

Kissing was early declared not to be a risky behavior insofar as transmitting “HIV” was concerned, because of the (relative) absence of “HIV” in saliva. Nevertheless, transmission of “HIV” has been officially recognized as having occurred from mother to child through pre-chewing food [CHEW ON THIS, 7 February 2008] as well as from child to mother through biting [HIV: IT MUST HAVE BEEN TRANSMITTED BY BITE!, 24 April 2008].

Then there’s the universally accepted HIV/AIDS “fact” that “HIV” is responsible for the disappearance of CD4 cells, even as there is no correlation between amount of “HIV” — “viral load” — and the subsequent course of CD4 counts [Rodriguez et al., JAMA 296 (2006) 1498-1506].

There is also no explanation for how “HIV” might accomplish this disappearance of CD4 cells:
“It is not clear how much of the pathology of AIDS is directly due to the virus and how much is caused by the immune system itself. There are numerous models which have been suggested to explain how HIV causes immune deficiency: Direct Cell Killing . . .  Antigenic Diversity . . . . The Superantigen Theory . . . . T-cell Anergy . . . . Apotosis [sic] . . . . TH1-TH2 Switch . . . . Virus Load and Replication Kinetics . . . .” [MicrobiologyBytes: Virology: AIDS I — Updated 8 April 2009;  see also Henry et al., JAMA 296 (2006) 1523-5].

A currently faddish shibboleth is that “AIDS” results from “chronic immune activation”, a fine example of the sort of “explanation” that, in other circumstances, is laughed at for being a “hand-waving” evasion of specifics: Exactly what sort of “activation” is it that apparently can’t deal with the activating stimulus and instead accomplishes suicidal self-destruction? When the typical reaction of the immune system to a stimulus is the very opposite?

We are also treated continually to new discoveries of where and how “HIV” originated in humans, discoveries based on careful analysis of “HIV” genomes and their change over the decades and centuries — even as in other contexts it is emphasized that “HIV” mutates at so incredible a rate that
“Within a single . . . host, HIV-1 population represents a complex mixture, or swarm, of mutant virus variants . . . [whose] prevalence . . . is changing . . . on almost a daily basis (intrahost evolution). Moreover, infected individuals within a human population harbor distinct viruses (interhost or populationwide heterogeneity). Finally, the global HIV-1 pandemic is composed of many local epidemics, which generally differ in . . . virus genotypes in circulation (global variation)” [V. V. Lukashov, J. Goudsmit, & W. A. Paxton, “The genetic diversity of HIV-1 and its implications for vaccine development”, in AIDS Vaccine Research, ed. Flossie Wong-Staal and Robert C. Gallo. Chapter 3, 93-120, Marcel Dekker, 2002].
That’s why it’s so difficult to manufacture a vaccine: “This isn’t just one virus . . . . You’re talking about tens of thousands of different viruses” [Dennis Burton, immunologist at Scripps Research Institution, cited by Charles Slack, cited above].

So “HIV” is sufficiently stable that one can trace its ancestry over many decades, yet at the same time so unstable that one cannot manufacture a vaccine. Leave aside the extraordinary ability of this chameleon to mutate and mutate and mutate and remain deadly in each of its variants.

On the one hand, it’s extraordinarily rare that “HIV-positive” people don’t progress to AIDS and remain extraordinarily healthy; that’s why they are called “elite controllers”, a term that seems to have replaced the earlier “long-term non-progressors”. There are “no more than one in every 300 cases, or perhaps 5,000 of the more than 1 million infected Americans” (Slack, cited above).
On the other hand, about 1 million Americans have been “HIV-positive” in each year since the mid-1980s at least [specific sources for an estimate of 1 million for 1986, 1987, 1988, 1989, 1993, 2003 are cited at pp. 1-2 & 108 in The Origin, Persistence and Failings of HIV/AIDS Theory]; and the Centers for Disease Control and Prevention continually urge universal testing because about one quarter (A) or perhaps one third (B) of all “HIV-positive” people don’t know that they are “HIV-positive”, in the United Kingdom (C) as well as in the United States.
[(A): “One of out of three people infected with HIV in the U.S. doesn’t know it, according to the CDC. Many of them are unknowingly spreading the disease to people they love” — Richard Sine, “Braving an HIV Test” (reviewed on 14 August 2006 by Charlotte Grayson Mathis, MD) ;
(B) MMWR 56 (2007) 1233-7;
(C) Michael Carter, “HIV testing in gay social venues is viewed as inappropriate”, 22 December 2007]

So ever since the mid-1980s there have been 250,000-333,000 “HIV-positive” Americans who didn’t know they were positive; and who therefore were also not known to the authorities to be positive. How many of those, one is allowed to wonder, are “elite controllers” who have never been tested and who have remained perfectly healthy, for as much as two decades or more?

Of course, the fact that the number of “HIV-positive” Americans has been steady at about 1 million throughout the AIDS era is in itself an obvious disproof of the notion of a spreading epidemic.

The latest estimate postulates an annual rate of about 55,000 new “HIV-positive” cases (Hall et al., JAMA 300 [2008] 520-9). There is no reason to imagine that the 1 million “HIV-positives” in 1985 generated fewer new cases than the 1 million “HIV-positives” in recent years, so 1 million have been augmented at an annual rate of 55,000 or so for more than two decades, without exceeding appreciably that steady total of about 1 million. That makes no sense.

Deaths from “AIDS” or “HIV disease” can’t be invoked as balancing out those extra 55,000 annually, because the officially reported numbers of deaths are much smaller, beginning with 430 in 1982, rising to 42,000 in 1994, and declining to 13,000-14,000 by 1996, remaining there ever since [Table 3 in HAART saves lives — but doesn’t prolong them!?, 17 September 2008].  Cumulatively through 2007, just over 583,000 “AIDS” deaths have been reported (Table 8 in HIV/AIDS Surveillance Report, 2007; vol. 19, 2009).
For more than 20 years, about 55,000 “HIV-positives” have been added to the initial 1 million, so by 2007 there should have been something like (1 + 0.055 x 20) million minus 583,000, in other words about 1.52 million living “HIV-positive” or with “AIDS”.
However, the CDC reports 264,000 “Living with HIV infection” and 469,000 “Living with AIDS” at the end of 2007 (Table 14 in cited report), a total of 733,000.
The difference between 1.52 million and 733,000, namely 787,000, represents plausibly the number of people who, at one time or another, were “HIV-positive” but have never been tested nor become ill from anything that would occasion an “HIV” test: in other words, “elite controllers”.
The number of elite controllers, then, is plausibly on the order of 800,000, comparable in magnitude to the number of those who have been diagnosed with “HIV” or “AIDS”. Half of all “HIV-positives” may well be “elite controllers”.

That last calculation illustrates not only how baseless is the asserted rarity of “long-term non-progression” or “elite controlling” but also that one can prove just about anything on the basis of official HIV/AIDS data.

Perhaps the most direct hard data on elite controllers and long-term non-progressors comes from the Armed Services, whose members are typically “HIV”-tested annually. TACC (Tri-Services AIDS Clinical Consortium) found 382 such individuals among 4574 who had been followed for up to 20 years, that is, 8.4% of all the “HIV-positives” [Okulicz J, Marconi V, Dolan M. 2008. “Characteristics of elite controllers, viremic controllers, and long-term nonprogressors in the US Military HIV cohort.” Keystone symposium on HIV pathogenesis, Banff (Alberta, Canada)].
This means that on average about 8% of “HIV-positive” people will derive only harmful “side”-effects and no benefit at all from antiretroviral treatment.


Scan the “HIV absurdities” category on this blog to relish further examples of the mutually contradicting, common-sense-insulting things that HIV/AIDS believers must stand firm on, like marriage as a risk factor for “HIV” but being a porn star as one of the surest ways to avoid “HIV”; more breast feeding producing less “transmission”; “HIV-disease” deaths not the same as “AIDS” deaths and mutually contradictory numbers from two different administrative units within CDC; prison as a hotbed of spreading “HIV” and yet no appreciable spread of “HIV” in prisons; black Americans both more affected by “HIV/AIDS” and yet surviving better; death rates from “HIV/AIDS” not varying much by age; and much, much more.

Okulicz J, Marconi V, Dolan M. Characteristics of elite controllers, viremic
controllers, and long-term nonprogressors in the US Military HIV cohort.
Keystone symposium HIV pathogenesis. Banff, Alberta, Canada; 2008.

Posted in HIV absurdities, HIV does not cause AIDS, HIV risk groups, HIV skepticism, HIV tests, HIV transmission, HIV/AIDS numbers, sexual transmission, uncritical media, vaccines | Tagged: , , , , , , , | 14 Comments »

Science Studies 102: Burden of proof, HIV/AIDS “science”, pseudo-science

Posted by Henry Bauer on 2008/07/22

For a long time, the central question in philosophy of science was to find objective, specific, and practically applicable criteria for deciding whether a claim or investigation warrants designation as “science”; without that, one cannot legitimately class anything as “not science” or “pseudo-science”. Tried and found wanting were notions of “scientific method”, falsifiability, progressiveness or regressiveness of research programs, as well as other, less well known attempts. Perhaps the definitive history and debunking of these attempts is by Larry Laudan (1).

Nevertheless, the epithet “pseudo-science” continues to be bandied about in controversies over such matters as human-caused global warming, psychic phenomena, HIV/AIDS, Loch Ness monsters—wherever dogmatists are 100% sure of their beliefs, they like to describe the opposing position as pseudo-science.

The history of such arguments teaches that they are finally settled only by evidence specific to the particular claims, not by application of abstract notions like scientific method or falsifiability (2); for no matter how plausible some abstract criterion may seem at first sight, in practice illustrations of it can be found on both sides of the imagined divide between science and pseudo-science.

Take the matter of burden of proof (3). Defenders of mainstream paradigms like to portray those who put forward unorthodox claims as saying, “Prove me wrong”, when actually the onus is on the dissenters to prove their claims right; but in practice, one can find mainstreamers themselves setting the challenge, “Prove us wrong”, instead of providing the necessary proof that the mainstream view is sound.

Immanuel Velikovsky’s “Worlds in Collision” had received great public acclaim in the 1950s, and the Velikovskian cult gained widespread support even among prominent humanists and social scientists (4), despite the huge implausibility of his claims: that a comet ejected from Jupiter had nearly collided with Earth and Mars, producing such Biblical events as the parting of the Red Sea and the fall of Jericho’s walls before settling eventually into its present position as the planet Venus.
“Throughout Velikovsky’s writing runs the subtly misleading attitude that the onus is on his critics to prove him wrong. Whenever he states — as he often does — that his case is unshaken and has not been disproved, the unwary listener or reader is led to expect that some clear disproof is called for, and that in its absence Velikovsky’s reconstruction stands as plausible or even valid. But in all fields of knowledge the onus of proof rests on the new proposition” (5).

Yet when it comes to HIV/AIDS, it is the orthodoxy that states, “Prove us wrong”, and that refuses to accept the onus of proof. Mainstream discourse is salted and peppered with statements to the effect that “the evidence that HIV causes AIDS is overwhelming” (6), yet the mainstream has never established, for example:
1. That a positive HIV-test marks the presence of active infection (7).
Whole virions of HIV have never been isolated direct from an HIV-positive individual. Indeed, a prize of $50,000 awaits anyone who uncovers a scientific publication in which such isolation has been demonstrated (8).
2. That HIV-positive portends progress to AIDS, and all AIDS patients are HIV-positive.
To the contrary: It has long been known that there are thousands (at least) of “long-term non-progressors” or “elite controllers”, HIV-positive individuals who have not become ill, some of them “positive” since the early 1980s. It has also been known since the early 1990s that there are many clinically diagnosed AIDS patients who have never tested HIV-positive, causing the mainstream to invent the new condition of “ICL” (9).
3. What mechanism it is by which HIV destroys the immune system (11).
4. What properties a vaccine needs to have to protect against infection (12).

As noted before [Science Studies 101: Why is HIV/AIDS “science” so unreliable?, 18 July 2008], the repeated publication of mainstream HIV/AIDS claims without adequate proof represents a failure of peer review that began in the late 1980s when Duesberg’s critiques were ignored. The initial claim that Gallo had discovered the “probable” viral cause of AIDS became accepted by default, it was never followed by definitive published proof; a prize of ₤50,000 awaits whoever produces proof of isolation of virions from AIDS patients (13).

By contrast, HIV/AIDS rethinkers and skeptics have accepted the onus of proof by publishing positive evidence to the effect that
1. A retrovirus cannot do what HIV is charged with doing (14).
2. Illnesses developing in “AIDS” patients who abuse drugs are specific to the particular drug; signifying that it is the drug that produces the illness and the frequently positive HIV-test in drug abusers (15).
3. Kaposi’s sarcoma in gay men in the United States results predominantly from persistent inhalation of nitrite “poppers” (16).
4. Official data show that the tendency to test HIV-positive has the characteristics of an endemic physiological property, not of a spreading infection (10).
5. Officially reported deaths from “HIV disease” since 1987 demonstrate that antiretroviral drugs have had no life-extending effect (17). AIDS patients treated by alternative modalities have lower mortality than those treated with antiretroviral drugs (18).
6. Officially reported death statistics together with officially reported data on HIV “infection” demonstrate that the 10-year latent period supposed to intervene between “infection” and illness does not exist (17).


1. Larry Laudan, “The demise of the demarcation problem”, pp. 111-27 in Physics, Philosophy and Psychoanalysis, ed. R. S. Cohen & L. Laudan, Dordrecht: D. Reidel, 1983

2. Henry H. Bauer, Science or Pseudoscience: Magnetic Healing, Psychic Phenomena, and Other Heterodoxies, University of Illinois Press, 2001

3.  pp. 220-1 in reference 2

4. Henry H. Bauer, Beyond Velikovsky, University of Illinois Press, 1984

5. P. 171 in reference 4

6. For instance, read the testimonies of the expert witnesses in the Parenzee case.

7. “The birth of antibodies equal infection”, Appendix II (pp. 333-40) in Celia Farber, Serious Adverse Events, Melville House, 2006

8. May 2007: Alive & Well $50,000 Fact Finder Award—Find one study, save countless lives

9. See “ICL” in index of reference 10 for details and sources

10. Henry H. Bauer, The Origin, Persistence and Failings of HIV/AIDS Theory, McFarland, 2007

11. Chapter 7 of Principles of Molecular Virology

12. “Is it time to give up the search for an Aids vaccine? After 25 years and billions of pounds, leading scientists are now forced to ask this question”, 24 April 2008, by Steve Connor and Chris Green,

13. The Michael Verney-Elliott Memorial Prize: £50,000 reward for the existence of ‘HIV’; letter of 29 March 2008

14. Peter H. Duesberg, Retroviruses as carcinogens and pathogens: expectations and reality, Cancer Research 47 (1987) 1199–220; Human immunodeficiency virus and acquired immunodeficiency syndrome: correlation but not causation, Proceedings of the National Academy of Sciences, 86 (1989) 755–64.

15. Duesberg, P., Koehnlein, C. and Rasnick, D. The Chemical Bases of the Various AIDS Epidemics: Recreational Drugs, Anti-viral Chemotherapy and Malnutrition, Journal of Bioscience 28 (2003) 383-412

16. John Lauritsen and Hank Wilson, Death Rush: Poppers & AIDS, Pagan Press, 1986

17. “HIV DISEASE” IS NOT AN ILLNESS, 19 March 2008; “Disproof of HIV/AIDS theory” [Society for Scientific Exploration, Annual Meeting, Boulder CO, June 2008]; at News for June 30; “Incongruous age distributions of HIV infections and deaths from HIV disease: Where is the latent period between HIV infection and AIDS?” in press, Journal of American Physicians and Surgeons

18. Only 3 of 36 (12%) of Dr. Köhnlein’s AIDS patients died under alternative treatment compared to about 63% of all AIDS patients in Germany, most of whom were treated with antiretroviral drugs; pp. 401-2, Table 8, in reference 15

Posted in antiretroviral drugs, HIV does not cause AIDS, HIV skepticism, HIV tests, HIV transmission, vaccines | Tagged: , , , , , , , , , , , | 4 Comments »


Posted by Henry Bauer on 2007/12/12

The previous post (BEST TREATMENT…, 10 December) mentioned these aspects of the official Treatment Guidelines:
—They change incessantly.
—The recommendations are based more on opinion than on scientific evidence.
—The available evidence is overwhelmingly about surrogate markers rather than patient health.
—The recommendations are so complex and change so often that physicians must suffer constant dilemmas over how to advise their patients.
Several further posts will examine aspects of these Guidelines in more detail, in particular, “side” effects of the drugs and conflicts of interest among those who draw up the Guidelines. First, however, a quick look back at how and why antiretroviral treatment began.

* * * * * *

Wainberg, in his single-minded lauding of “lifesaving” antiretrovirals (WAINBERG’S HAMMER, 5 December), suggested that “Many people had forgotten” what went on in the early days of AIDS. Wainberg himself seems to have forgotten the genesis and rationale of antiretroviral treatment.

In the early 1980s, small clusters of people were coming down, it seemed suddenly, with otherwise rare opportunistic infections, predominantly fungal ones; and death was following within months. There were two obvious possibilities as to cause: either some shared environmental exposure, activity, or lifestyle; or perhaps a previously unknown infectious agent.

The question was effectively settled by fiat rather than freely attained scientific consensus with the official announcement by the Secretary of Health and Human Services that HIV (then called HTLV-III) was the probable cause. Since that came from the prime source of research funds, those seeking grant support naturally framed their proposals in that vein. The immediate goal became to find an HIV-killer. A desperate rummage among all conceivable chemicals turned up AZT, a twenty-year old candidate for cancer chemotherapy that had never been used because it is too toxic. AZT seemed effective against HIV in the test-tube and, in brief trials, AIDS patients appeared to survive for several months on AZT treatment. Given that the prognosis for a person newly diagnosed with AIDS was death within months, an apparent extension of a few months was regarded as worthwhile. Moreover, activists were clamoring for rapid approval of anything that offered some hope, so AZT was approved without the evidence of “safety and efficacy” that was normally demanded before drugs were allowed into general use.

The situation nowadays is entirely different. Although HIV is still regarded as the agent causing AIDS, the official belief holds that there is an average period of about 10 years between infection with HIV and the first appearance of symptoms of illness. This is very different than expected death within months, and should–but apparently has not–set a very different basis for weighing possible benefits of treatment against the known risks from drug toxicity.

In point of fact, the official treatment guidelines of October 2006, introduced in the previous post (10 December), make abundantly clear the high risk of serious, indeed often fatal “side” effects of antiretroviral treatment. The risks and possible benefits are summarized in this way in the Introduction to those Guidelines (p. 10):

Potential Benefits of Deferred Therapy include:
—avoidance of treatment-related negative effects on quality of life and drug-related toxicities;
—preservation of treatment options;
—delay in development of drug resistance if there is incomplete viral suppression;
—more time for the patient to have a greater understanding of treatment demands;
—decreased total time on medication with reduced chance of treatment fatigue; and
—more time for the development of more potent, less toxic, and better studied combinations of antiretrovirals.
Potential Risks of Deferred Therapy include:
— the possibility that damage to the immune system, which might otherwise be salvaged by earlier therapy, is irreversible;
—the increased possibility of progression to AIDS; and
—the increased risk for HIV transmission to others during a longer untreated period.

A conspiracy theorist might wonder why this useful summary has been shifted in the December 2007 revision of the Guidelines to an inconspicuous place following Table 5 at the bottom of p. 58. Was it perhaps realized that having it up front is too unintentionally revealing of the grave and common risks associated with these drugs?

An analyst of rhetoric might point to a choice of words designed to play down the risks. Since the drugs supposedly do something good, the only reason not to use them is because of their harmful “side” effects; so “Potential benefits of deferred therapy” is a euphemism for “Treatment-associated risks”. Furthermore, those risks are spoken of in a rather masked way–“negative effects” on quality of life, “drug-related toxicities” instead of simply “drug toxicities”. The revealing need for “less toxic” drugs is inserted between the two hoped-for benefits of “more potent” and “better studied”. “Treatment demands” and “treatment fatigue” are euphemisms for the fact that a large proportion of patients find the “side” effects of antiretroviral treatment intolerable.

(Another common euphemism in mainstream discourse about antiretroviral drugs is “HIV lipodystrophy” or “HIV-associated lipodystrophy” for the dysfunctional distribution of body fat occasioned particularly by protease inhibitors. The drugs, not the HIV, are responsible for the lipodystrophy, but the terms in quotes are designed to give the opposite impression.)

In any case, the question nowadays is–or should be–whether the acknowledged, well known toxicity of all antiretroviral drugs calls for their use when people are not yet ill. It is highly pertinent here that the consensus in the United States asserts that “illness” warranting antiretroviral drugs can be diagnosed purely on the basis of laboratory tests, for example, CD4 cell counts below 200 (not to mention the HIV test itself!–see HIV TESTS: DANGER TO LIFE AND LIBERTY, 16 Nov ), whereas the consensus elsewhere, for instance in Canada, does not accept this as a conclusive marker of AIDS-illness.

A further, important datum not mentioned in these Treatment Guidelines is the fact that large numbers of HIV-positive people have lived healthy lives for a couple of decades or more without antiretroviral treatment. That was not known in the early days when an AIDS diagnosis presaged early death, and when HIV was first suggested as the culprit.

We cannot know, of course, how many HIV-positive people are quietly living healthy lives. People are rarely tested for HIV unless they are in high-risk groups or need medical attention for some reason. Official estimates that about one quarter or one third of HIV-positives don’t know their status implies that many of them suffer no ill effects from that condition–after all, about 1 million Americans have supposedly been HIV-positive steadily since the mid-1980s. The “long-term non-progressors” or “elite controllers” acknowledged in mainstream discourse have been estimated to number in the thousands, but this is surely an under-estimate because, again, only people with known risks tend to be tested; so these thousands represent chiefly high-risk non-progressors or controllers; there are likely to be a larger proportion of such people in low-risk groups. In addition and not usually acknowledged in mainstream discourse are those HIV-positive people who have eschewed treatment by their own decision; though many of them have joined in support groups, there is no reliable way to estimate their numbers, but it is certainly in the thousands.
Drugs too toxic for cancer chemotherapy were approved for use at a time when a few months of extra life seemed a worthy objective. Infection by HIV is believed to produce no serious symptoms for an average of 10 years. Where is the rationale for feeding highly toxic medications to asymptomatic people? When moreover the mechanism by which HIV is supposed slowly or eventually to destroy the immune system is unknown? When it turns out that people being treated with these drugs are experiencing typical drug toxicities, and cancers, within the 10-year period during which it is officially acknowledged that HIV by itself on average does no harm?

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