Is It Possible That ... HIV Does Not Cause AIDS?
Like the word "fire" in a crowded building, news that a virus caused an incurable, terminal disease called Acquired Immune Deficiency Syndrome (AIDS) has resounded since the 1980s with all the moral force of gospel. After the introduction of a test believed to predict AIDS, the phrase "HIV, the virus that causes AIDS" became boilerplate news copy.But while a set of orthodox beliefs about the virological cause of AIDS has evolved and spread like wildfire, universal consensus about the cause and implications of AIDS is far from a worldwide understanding of what has happened in the lives -- and deaths -- of people with AIDS.Many physicians and medical educators agree with the conclusions of U.S. health officials that the infectious human immunodeficiency virus (HIV) causes AIDS. Meanwhile, scientists who first proposed a viral cause of the disease have struggled to explain their conclusions,while non believers refute official dogma with a passion. If HIV does not cause AIDS, critics say, such proposals as mandatory testing and incarceration of people who might spread HIV are akin to witch hunting.Most U.S. news outlets act with the unified faith of a panicked crowd and ignore claims that the fear of AIDS is more dangerous than the retrovirus (half a virus, with a single RNA strand, not a full DNA spiral that behaves quite differently from viruses) that supposedly causes AIDS. News producers explore experimental drug treatments without mentioning claims from some quarters that AIDS drugs are a probable cause of AIDS.In an environment where the search for a cure is driven by the yearning for a profitable patent, it seems less likely that critics will soon find widespread recognition of what they call the greatest medical scandal of our time.HIV causes AIDS?Health educators and journalists warn that a single incidence of unprotected sex might start an unstoppable viral infection. An accidental needle stick or a prisoner's bite supposedly can lead to inevitable premature death.How does the human immunodeficiency virus (HIV) cause AIDS? How can one microbe cause so many very different diseases? How does a retrovirus kill immune cells when most of those cells show no evidence of viral activity?The answer to those questions is that a retrovirus does not cause AIDS, according to the growing chorus of skeptics of the HIV-equals-AIDS orthodoxy.Berkeley microbiologist Peter H. Duesberg leads the charge. Since 1984, when the U.S. Secretary of Health and Human Services Margaret M. Heckler called a press conference to announce that HIV causes AIDS, he has asked for positive proof of the assertion.Duesberg has published critiques in several scientific journals including Cancer Research, Lancet and the Proceedings of the National Academy of Sciences. In Pharmaceutical Therapeutics, he offered several questions a correct AIDS hypothesis should answer -- questions he claims the present HIV-causes-AIDS premise can't.Why does AIDS include so many different diseases? Why are African AIDS diseases so different from American AIDS diseases? Why does AIDS risk vary so much among high risk groups? How does immunodeficiency cause diseases that are not affected by immunity, such as lymphoma, sarcoma and dementia?"The virus-AIDS hypothesis, which holds that HIV, the AIDS virus, is a new cause of thirty-year-old diseases," Duesberg writes in his controversial tome, Inventing the AIDS Virus, published in 1996 by the conservative-bent Regnery Publishing, Inc. "If any of these previously known diseases now occurs in a patient who has antibodies against HIV (but rarely any HIV), then his or her disease is diagnosed as AIDS and is blamed on HIV."Duesberg claims to be shunned by colleagues and losing out at peer reviews because contemporaries refuse to see the logic in what he is saying. They have their own professional territory staked out and rely on present thinking -- and the government funds that support research along virological lines -- for their livelihoods. HIV research absorbed National Institute of Health (NIH) grant funds, he maintains, while the few scientists who challenged the new orthodoxy lost funding and status.With a NIH Outstanding Investigator Grant he received in 1985, Duesberg explored why the HIV virus appears inactive in the bodies of people with severe AIDS symptoms. Peer reviewers told Duesberg they would not endorse another seven-year grant. They acknowledged he was a pioneer of retrovirology, but said he was sidetracked by nonscientific issues, apparently referring to his maverick AIDS research.Duesberg maintains the whirlpool sinking conventional HIV theory is the circular logic that defines AIDS as HIV infection then presumes HIV causes AIDS because everyone with AIDS has HIV. Without HIV, AIDS related diseases are diagnosed as pneumonia, sarcoma, immunodeficiency, tuberculosis or cervical cancer. With a positive HIV test, each of those or a couple dozen other symptoms is called AIDS.For the lengthy and detailed effort Inventing the AIDS Virus and his other articles represents, Duesberg's publication in the scientific press has made hardly a ripple in HIV orthodoxy. Part of the reason may be because of where he publishes.Duesberg, says nationally recognized HIV specialist and Prairie Village, KS, doctor Patrick Nemechek, "has been published in non-peer review journals. Anyone can get anything published when they push it around enough."Duesberg also lost the professional support of original coauthor of Inventing the AIDS Virus, Bryan Ellison, over disagreements arising over documentation of scientific evidence. The book also took Duesberg three years to publish, being passed from Addison Wesley publishers to St. Martin's Press and finally Regnery Publishing in 1995.Duesberg's book's arrival on the market was outflanked by Time magazine's choice of David Ho as "the man of the year" in 1996 for his explanation of how HIV slowly wears down the immune system without leaving clues of an active virus.But the inventor of the Polymerase Chain Reaction for analyzing any process that included nucleic acids, Nobel laureate Kary B. Mullis, concurs with Duesberg. In the forward to Inventing the AIDS Virus, Mullis writes that Duesberg "explained exactly why I was having so much trouble finding the references that linked HIV to AIDS. There weren't any (author's emphasis). No one ever proved that HIV causes AIDS."Nemechek disputes this claim. HIV has been isolated in laboratory conditions and transferred to other animals. "Coch's Postulate stipulates that if you can find a disease agent, remove the disease and pass that into another similar organism, creating a similar disease, there is a very good chance that the agent is causing the disease. This has been the cornerstone of medical research for some 200 years."Nemechek says, "I read a lot of Duesberg's stuff in late 1980s when I was doing the studies he was referencing. When you knew the studies and read some of these diatribes he would weave together from pieces of the research, you could see he was plucking bits out of context -- two halves of the sentence were right, but the whole was wrong. It sounds plausible, but if you look closer, you can see that it is pseudoscientific and very frightening -- especially when this is the guy who gets the press."I don't pay much attention to him anymore. Knowing the technical elements of the HIV disease, I don't find any credibility in what he was saying."Dr. Donald Dall, chief oncologist at the Harry S. Truman Memorial Veterans Hospital in Columbia, MO, is familiar with Duesberg's theories. "I think he is wrong," says Dall, who attends about 40 patients with various AIDS symptoms. "There is scientific evidence that HIV causes AIDS. They have isolated it in cultures."Dr. Max Brinkman of Overland Park, KS, however, also never agreed with the official view of AIDS. Brinkman has a doctoral degree in physical chemistry and a professional background in medical recruiting and biotechnology contracting. Familiar with scientific processes, he says scientists had no time to critique the HIV theory before a federal official announced it as a fact."It offends me as a scientist that the Secretary of Health and Human Services can come out and say that is the cause," Brinkman states. "That is not how science is done. It is political science."Brinkman wants to persuade the public of something medical practitioners are reluctant to accept -- that certain high-risk behaviors might cause AIDS diseases without the help of HIV.Inventing the AIDS Virus has attracted the attention of conservative thinkers who seem to want to begin a healthy HIV/AIDS debate. But Nemechek believes many are more comfortable with focusing on individual morality than public health."When I started treating patients with HIV, it was not uncommon to find people of high education and those without education who were so afraid of the infection and people with it, that it would make them act in the most irrational and inhumane manner," he says.Misunderstanding the numbersMeanwhile, scientists exploring the gray areas of the HIV/AIDS debate have been making some strong arguments. Michigan University physiology professor Robert Root-Bernstein wrote in the Wall Street Journal that 1993 AIDS statistics released by the Centers for Disease Control (CDC) were "so odd as to be virtually indecipherable." In October of that year, the CDC announced that AIDS had become the top killer of U.S. males age 25 to 44, and the fourth leading killer of women in the same age group.The CDC explained most of the statistical increase was due to the expansion of the definition of AIDS. Without the newly defined cases the agency reported a 5 percent increase in the number of people who were diagnosed with AIDS for the first time. Root Bernstein calculated from the same numbers a 30 percent drop in reported new cases.Later, in 1994, the CDC indicated that the epidemic had reached a plateau. By 1997, statistics showed a first-time decrease in reported AIDS deaths. Most news reports coupled the statistic with speculation of the benefits of a new category of drugs used to stop growth of HIV. Few mentioned the growing chorus of dissent against HIV orthodoxy or warning cries about the danger of anti-HIV drugs.The failure of science reporters, AIDS activists and researchers to notice flawed statistics reflects a deep-seated societal trend toward misunderstanding the statistics, Root-Bernstein wrote. The professor suggested that the CDC might be masking evidence the AIDS epidemic had passed its peak.As Root-Bernstein launched his Wall Street Journal attack on CDC statistics, he published his take on the AIDS phenomenon in Rethinking AIDS (Free Press, 1993). His book asks why some people eliminate HIV from their systems, and why some people who are exposed to HIV do not become infected. Why is HIV so rare in the reproductive fluids of people with advanced AIDS symptoms? And why does HIV not appear at all among some people with AIDS?"The good news is that there are people who are infected with HIV who get rid of it," Root-Bernstein said in an interview with PitchWeekly. "We should be spending hundreds of millions of dollars to find out what these people are doing."Root-Bernstein developed a scientific skepticism of popular AIDS theories even before he read Duesberg's critiques. Along with former Harvard biochemistry professor Charles Thomas (who has rallied 70 working scientists since 1991 to demand an independent reappraisal of the hypothesis that HIV causes AIDS) and other scientists, he helped start the Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis. His approach in Rethinking AIDS is to raise questions about conventional AIDS science. He offers possible answers, but is reluctant to draw conclusions."The issue that HIV has nothing to do with AIDS, I just can't agree," he says. Root-Bernstein, a physiology professor and winner of a McArthur prize -- a genius award -- downplays his understanding of the workings of HIV. He readily admits not knowing how much evidence there is that HIV kills immune cells or how many laboratories culture HIV for study or how the microscopic view of HIV's life cycle compares to the view of better known viruses."I can say almost nothing about HIV. When I say that there is not direct evidence (of HIV killing immune cells) that comes from David Ho and Bob Gallo and those guys," Root-Bernstein says."Those guys" include the man who patented the widely-used HIV anti-body test. Gallo's test could detect anti-bodies of a virus some researchers associated with AIDS, but he deflected charges he commercialized tests for the virus after borrowing cultures from the Pasteur Institute's Luc Montagnier. Since Montagnier first isolated HTLV III, which was later renamed HIV, he has since questioned whether HIV is the sole cause of AIDS.Again, Nemechek questions Duesberg and Root-Bernstein's assertions that some AIDS patients do not have HIV. "Every single person who has AIDS who I have treated, 100 percent, have a presence of virus. We also know that 99.99 percent of people who have virus move toward AIDS. We don't see a clinical diagnosis of the disease without the virus. It all makes you wonder what is going on (with the skeptics)."Everyone recognizes the initial wave of the epidemic is over. The tools and the resources for treatment are in place and the next step is the development of a vaccine."Practicing without a netRoot-Bernstein and others suggest that drugs, foreign proteins and multiple repeated infections, including HIV infection, could work together to destroy the immune system.Doctors who think HIV retreats to lymph nodes and brain tissue prescribe drugs indefinitely to keep the virus from reinfecting blood cells, even when blood tests show no active HIV. "There is no data showing when to stop it. You keep doing it. That is the consensus opinion," says Dall from Veterans Hospital in Columbia.Some doctors encourage people exposed to HIV with no AIDS symptoms to take preventive doses of cell-killing drugs in hopes of knocking the virus out before it digs in. Some doctors feel obligated to use the drugs to keep HIV from developing into AIDS, especially for children or transfusion recipients exposed to HIV. Duesberg and others warn that the drugs' well-known side effects will become symptoms of AIDS.Dr. Robert E. Willner says the "perpetrators" of the "AIDS fraud" are guilty of murder for administering drugs that are more dangerous than the diseases they are supposed to treat. In Deadly Deception (1994, Peltec Publishing), he argues that AZT causes AIDS symptoms.In 1993, Willner publicly pricked his finger with a needle coated in HIV positive blood. Dall was aghast to learn of Willner's brazen demonstration, but he seemed humored by the suggestion that current AIDS treatments are unethical. AIDS medications are risky, Dall acknowledged, but "most patients ask for them.""I have been treating AIDS patients 1981 and none of them have died of AZT," he says. "We are doing the best we can with what we know at this time."Cancer specialists like Dall work with some of the most dangerous medicines available. For most of this century doctors have relied on the U.S. Food and Drug Administration (FDA) to establish which drugs provide benefits that outweigh their risks. When AIDS exploded into crisis proportions, patients and activists pressured the FDA to expedite approval of drugs with well-know risks. Physicians began to administer drugs without the safety net of the full FDA review process."Maybe they streamlined approval of the drugs," Dall says. "A lot of the drugs did not go through the full process. In 16 years after the syndrome was first noticed, AIDS research might have become the fastest growing new field of study in human history. New ideas about the cause of AIDS were rushed into medical schools and put into practice before they were thoroughly reviewed or tested."I would agree that they got ahead of themselves. They should go back to the basic science of the virus. Maybe it is semantics. They are not sure the exact mechanism. Personally, I think it is some direct or indirect effect. Maybe HIV produces some cytosine -- some toxic substance in the blood.""I have as much trouble with the anti-HIV people as I do with the HIV people," Root-Bernstein says. "Look at the legal liability issue. That is a bunch of buncos." If a person is terminally ill, he says, "You have a choice between definite death and possible death. You would be condemning them to death, to deny access to medications that might prolong their lives."In the meantime, Duesberg remains the patron saint of the other AIDS gospel -- the belief that people with AIDS are people who were exposed to the highest lifetime dose of immunosuppressive drugs. While health officials cite a correlation between AIDS and HIV as proof of cause and effect, Duesberg cites a correlation between AIDS and cocaine use, and between AIDS and the spread of other sexually transmitted diseases among gay men who then treat themselves with antibiotics.Duesberg claims that doctors, who are convinced that HIV causes AIDS, maintain the appearance of an epidemic with perpetual prescriptions of toxic new anti-viral drugs. AZT is a prescription for death, according to Inventing the AIDS Virus.Duesberg's drugs-cause-AIDS dogma has been a lighting rod for thunderous defense of HIV orthodoxy. "I am offended that he is given the credibility that he is," said Gary Johnson, director of the Kansas City AIDS Research Consortium. "I think he is misguided."Nemechek maintains that because of his ability to obtain and administer any AIDS treatment in his practice, "many of my guys will live regular lives. There will be some inconvenience because some people have to take pills 3 times a day for the rest of their lives. There is also no doubt that when the disease first came on and we did not have tools on molecular level, we were treating people for symptoms and side effects related to the initial drugs."But that has changed. For instance, we now only give doses of AZT at half the levels we used to and are able to use different drugs and to adjust drugs if someone is having bad side effects."Also, Nemechek says, because of AIDS research, medical science has been able for the first time to develop medications for specific purposes, called protease inhibitors. All pharmacopoeia before "were found to have an impact on symptoms or a disease, and then modified. In this instance, the basic researcher said, 'We have found an Achilles's heel to this disease.' They then gave their findings to drug chemists who designed the molecule to attack the weakness. In turn, they gave the formulas to others to mass produce and deliver it."But some researchers believe protease inhibitors might make people feel better because they seem to keep other drugs, like AZT, from getting into their blood, according to a report in December 1996 Reappraising AIDS. The new drugs reportedly block AZT and other drugs in the liver.Continued doses of anti-viral drugs might be also affecting the growth of other persistent viruses that resist conventional treatments. "There is evidence that 3TC (an anti-HIV drug) directly kills herpes virus and hepatitis virus," said Root-Bernstein, citing a study reported by The New York Times.Like Root-Bernstein, Dall -- a well-read specialist -- could not say what types of cells were viable hosts for HIV cultures. AIDS practitioners work with anti-body tests, and with a polymerase chain reaction used to estimate "viral load," but they do not culture HIV from patients' blood in petri dishes, nor do they look through microscopes at HIV samples from their patients. Scientific publications provide the bridge between medical research, where HIV is isolated and cultured, and practice, where HIV is the target of search-and-destroy drugs.Among the thousands of papers and books published each year about AIDS, Dall had not yet read Root-Bernstein's book, though he recognized suggestions that auto-immune syndromes could contribute to AIDS. Duesberg and the fundamentalist anti-HIV people seem more widely recognized than the analysts who wander into the vast grey area where multiple causes and related co-factors make it difficult to predict who will get AIDS and to know what should be done to stop it.Right cure, wrong disease"There is little doubt that AIDS is caused by HIV, a human retrovirus," states a text book in use at MU's medical school. Robbins' Pathological Basis for Disease (1994 Saunders) states HIV invades specific immune cells, multiplies and causes the cells to burst open. Then the textbook asks the same question that Duesberg poses: Why are so few T-cells infected with HIV yet their numbers slowly decline over a period of years? The medical text concludes that it is obvious that the things that lead to growth of normal T-cells lead to the death of HIV infected T cells."HIV reproduces when immune cells are revved up," explains Root Bernstein. He says the opportunistic infections associated with AIDS stimulate growth of the same immune cells that produce HIV. Opportunistic infections occur when immune function is already suppressed. In Rethinking AIDS he wrote, "Immune suppression may predispose people to HIV infection rather than resulting from such an infection." HIV might be the product of the convulsions of an exhausted immune system. "Every AIDS patient has multiple causes of immune suppression other than HIV," Root-Bernstein wrote.Assumptions about "every AIDS patient" offend some people. Some consider criticisms of HIV theory to be dangerous, insensitive and homophobic."Not all gay men are equally at risk," Root-Bernstein says. "To understand how to protect yourself, you have to know what practices put you at risk."The spread of AIDS followed a dramatic increase in U.S. drug consumption. Cocaine seizures reportedly increased 100-fold between 1980 and 1990. Hospitals reported a surge of drug-related admissions. Duesberg maintains, along with cocaine and poppers (amyl nitrate inhalants), antibiotics or incompatible protein cells can destroy immune function and promote the symptoms recognized as AIDS.The AIDS epidemic followed a few years after the commercialization of poppers -- long enough for the first users to get a lethal dose, according to Duesberg, who says Kaposi's sarcoma labeled as AIDS is seen exclusively on the upper bodies of amyl nitrate users. The epidemic also followed the widespread availability of plastic syringes, which extended the culture of needle use and the opportunity for people to give themselves repeated unsanitary injections.The more often drug users inject themselves, the greater their risk of exposure to hepatitis, staphylococcus, Escherichia coli (E. coli) and infections that attack the heart. The longer a person treats infections with antibiotics, the more likely they are to degrade their immune system.Root-Bernstein suggests the most promiscuous gay men have been more often affected by AIDS because of other risks of frequent sexual liaisons with multiple partners. Some gay men with lifetime sexual histories involving hundreds, or even thousands of partners, suffer from several recurrent sexually transmitted diseases.Other health problems of gay men have gone unnoticed while discussion of AIDS has dominated public discourse. Cell-killing antibodies respond to foreign proteins such as semen in the intestines. The intestinal lining is more permeable than vaginal or oral membranes, allowing the immune system to react directly to foreign proteins there. The resulting anti-bodies can attack their host, killing cells in the testes and in the nervous system."This is like blowing me away. I have never heard anything like this," said Mike Hyde, a former director of a Columbia, MO. AIDS service organization, Center For Living. "It does seem odd that all the HIV negative gay men I know did not practice anal sex."Parallel epidemicsThe AIDS epidemic occurred at a time when the gay community was celebrating a newfound freedom to come out and identify themselves. With that freedom came a wave of extremely promiscuous sexual expression. Gay bath houses and bars provided a setting where carefree, often anonymous sex with multiple partners was accepted. Gay men found a forum in the media to depict themselves as effeminate, campy, as drag queens or as ordinary people, but they did not find as wide a forum for open discussion of more intimate aspects of their lifestyle.While the AIDS epidemic has commanded headlines, studies have also shown dramatic increases in syphilis, gonorrhea, herpes, giardiasis, shigellosis and hepatitis. Like the AIDS epidemic, sexually transmitted diseases have spread disproportionally among gay men.Duesberg says it is not an old virus, like HIV, but a new set of behaviors that led to the AIDS crisis. For people who have been tested HIV positive, but do not buy the HIV orthodoxy, a change of behaviors is often the preferred strategy for living with HIV.Nemechek says, however, that while a lifestyle and diet changes are helpful in keeping HIV and AIDS patients healthy, "A vast number of the people I treat never took part in life-threatening behavior or took any drugs outside of normal medication. They happened to get into a relationship with a person who has been exposed, that is all."But of those who undertake risky behavior, some people with AIDS do not have the resources to improve their diet and lack a network of supportive allies to help steer them from high-risk behavior. At least one support group is helping people confront AIDS and the HIV diagnosis with the belief that neither mean certain death. HEAL, Health Education AIDS Liaison, is an international network that challenges the validity of AIDS treatments that target HIV."Most of our beliefs about HIV and AIDS are actually based on popular ideas that have little or no basis in scientific fact," writes Christine Maggiore in HEAL's 41-page book What If Everything You Thought You Knew About AIDS Was Wrong? (1996)Maggiore joined the ranks of AIDS activists after she tested HIV positive. A year later, another HIV test was indeterminate. The next test was positive. A month later, she tested negative. After learning more about the argument against HIV's role in AIDS, she changed the direction of her AIDS activism. She now tells people the HIV anti-body test is sensitive to common colds, flu shots, arthritis and to the antibodies for hepatitis, tuberculosis and malaria.HIV critics are encouraging researchers and people with AIDS to look beyond the battle between HIV and the body to consider immune function as a complex set of relationships that can be easily disturbed. Sexual hygiene, respectful partnerships and general health awareness can prevent problems other than AIDS. Skeptical critiques of popular AIDS beliefs might lead to understandings that extend beyond the battlefields of the war against AIDS.Patrick Dobson also contributed to this article.