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Answering the AIDS Denialists: Is AIDS Real?

AIDS TREATMENT NEWS Issue #356, December 1, 2000
Bruce Mirken

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[Note: AIDS TREATMENT NEWS has published a series of articles looking in
depth at some of the bizarre ideas about AIDS, theories which are being used
to persuade people to change or completely stop their medical treatment, or
to ignore precautions for preventing HIV infection. One of the most bizarre
is that the epidemic does not exist but is just a new name for a collection
of old diseases. AIDS writer Bruce Mirken analyzes this claim and similar
theories that have also been widely promoted. JSJ]
The AIDS denialists, who dispute not only the role of HIV in AIDS but nearly
all scientific knowledge about the epidemic, regularly claim that the very
notion of AIDS as a distinct medical condition is a mistake. What medicine
has identified as a major epidemic, they insist, is nothing of the sort.

A number of variations on this theme have been put forth. Some have argued
that AIDS is nothing but a "group fantasy" or "epidemic hysteria."(1) Others
claim that several separate but real medical problems have been wrongly
lumped together. ACT UP San Francisco has repeatedly claimed that "AIDS is
over," suggesting that it did exist at one time but has somehow come to an
end.

While most in the denialist camp accept some physical cause or causes for
the illness we call AIDS, they claim science has fundamentally misunderstood
what is going on, leading to faulty conclusions about causation.

"AIDS by definition is not new and is not a disease," the web site of HEAL
Toronto declares. "AIDS is a new name for 29 old illnesses and conditions,
including yeast infections, diarrhea, pneumonia, cancer and
tuberculosis."(2)Christine Maggiore of the Los Angeles group Alive and Well
adds that "every AIDS indicator disease occurs among people who test HIV
negative," existed prior to AIDS, and has "medically proven causes that do
not involve HIV."(3)

AIDS, in this view, is just a new name given these old diseases when they
occur in people who test positive for HIV antibodies. Furthermore, it is
claimed that inclusion of a positive HIV test in the criteria for an AIDS
diagnosis has created a phony connection between these illnesses and HIV:
"Pneumonia + positive HIV test = AIDS," Maggiore writes, but "Pneumonia +
negative HIV test = pneumonia," thus creating "the illusion of a perfect
correlation."(4)

Though factually wrong, such statements appear regularly in denialist
literature.

Another complaint is that the number of AIDS cases has been artificially
increased by repeated changes in the official AIDS definition. Adding more
conditions to the definition, it is argued, pumps up the number of cases
even though those new cases may not even be ill.(2,4)

What Was New in 1981?

The notion that AIDS is simply "a new name for old diseases" requires
ignoring years of history and reams of published medical data.

The official start of the AIDS epidemic dates from mid- 1981, when the U.S.
Centers for Disease Control and Prevention's MORBIDITY AND MORTALITY WEEKLY
REPORT described cases of Kaposi's sarcoma (KS) and Pneumocystis carinii
pneumonia (PCP) in young, previously healthy gay men.(5,6) Detailed reports
of these and other cases, a few involving heterosexual drug injectors, were
published in several medical journals later that year.

Prior to 1980 KS and PCP were extraordinarily rare in the U.S. Annual
incidence of KS ranged from 2.1 to 6.1 cases for every 10 million people,(7)
usually occurring in older men of European descent. The disease generally
progressed slowly, with an average survival time of 8-13 years.(7,8)

PCP was nearly as rare, and the drug used to treat it, pentamidine
isothionate, could only be obtained through the CDC's Parasitic Disease Drug
Service, which kept detailed statistics. Strictly a disease of people with
weakened immunity due to disease, cancer chemotherapy or immune- suppressive
treatment for organ transplantation, PCP had "never been convincingly
demonstrated to occur in an immunologically normal adult."(9)In one study 98
percent of patients had known immune defects, and the others were all
seriously ill infants. Even though most were quite sick even before their
PCP, the disease often responded well to treatment and relapses were
rare.(10)

These new PCP and KS cases shattered the pattern. Most patients were young
men, often in their 20s and 30s, with no identifiable reason for weakened
immunity. Their KS was "fulminant, malignant"(8) and rapidly progressing.
Some had both PCP and KS, and most had a cluster of other problems including
persistent fever, weight loss, swollen lymph nodes, and other infections
usually associated with weakened immunity, including cytomegalovirus and
toxoplasmosis. This unremitting barrage set victims on a downward spiral
that commonly ended in death within a year.(5,6,8,9,11,12,13,14)

This onslaught of infections in people with no known reason for being sick
was so unusual that the usually reserved British journal THE LANCET called
it "bizarre" twice in one brief commentary.(15)Patients also showed
unexplained weakness in their immune responses, with a consistent pattern of
defects in their cellular immunity.(5,6,8,9,11,12)

The physicians treating these patients had no doubt they were seeing a new
clinical syndrome ("syndrome" is the medical term for a group of signs or
symptoms that appear together and indicate a particular condition). And
these doctors weren't babes in the woods. Several treated large numbers of
gay men living a "fast lane" existence including multiple sex partners and
recreational drugs, while others worked at urban hospitals treating many
drug addicts, yet none of them had seen anything like this.(16)

The Evolving Definition of AIDS

As with any new syndrome, scientists' understanding of AIDS evolved
gradually, with the most obvious and severe manifestations noticed first and
rarer or subtler ones recognized later. A careful review of how the CDC has
defined a case of AIDS contradicts the cartoon version presented by the
denialists and shows that the definition has evolved cautiously--perhaps too
cautiously at times.

(For simplicity this analysis will focus on the CDC's AIDS case definition.
While not followed universally, health authorities in other industrialized
countries often use the CDC's work as a starting point. The enormous subject
of AIDS in Africa and other third world areas requires a separate article.)

The CDC first published an AIDS case definition in September, 1982. AIDS was
simply defined as "a disease, at least moderately predictive of a defect in
cell-mediated immunity, occurring in a person with no known cause for
diminished resistance to that disease." 13 specific diseases were
listed.(17)

HIV (then known as HTLV-III or LAV) was discovered in 1984, but the CDC
waited a full year, until after a discussion at the Conference of State and
Territorial Epidemiologists, before revising the AIDS definition. This new
definition added a small number of conditions which would be considered
AIDS-defining if they occurred in a person with a positive HIV test. But the
original list of infections still triggered an AIDS diagnosis without an HIV
test if they occurred in a person with depleted CD4 (T-helper) cells and no
known reason for immune dysfunction.(18)

It was soon clear that patients commonly experienced a much broader array of
illnesses than the indicator diseases listed by the CDC. In 1987 the agency
noted, "It became apparent that some progressive, seriously disabling, even
fatal conditions (e.g. encephalopathy, wasting syndrome) affecting a
substantial number of HIV-infected patients were not subject to
epidemiological surveillance, as they were not included in the AIDS case
definition." So the agency made another cautious revision, with
encephalopathy (dementia) and wasting syndrome being the most notable
additions to the list of indicator conditions.(19)

But the CDC's AIDS definition was still capturing only a narrow piece of the
picture, and not always the most severe piece. "There are very many people
who are very ill who don't have AIDS by the CDC definition," said Los
Angeles AIDS specialist Scott Hitt, M.D. (who went on to head President
Clinton's AIDS Council) in 1990. "There are also people with one KS lesion
(qualifying them for an AIDS diagnosis) who are doing very well."(20)

Part of the problem was that the only opportunistic infections that made it
into the CDC's database were whatever conditions triggered a patient's
initial diagnosis. CDC spokespeople acknowledged they simply didn't have the
means to track the rest.(20)

Pressure mounted on the agency to adopt a definition that was more
reflective of the real-world clinical experience of the most seriously ill
patients, and after a lengthy period of discussion and debate, the current
definition went into effect in January, 1993. For the first time it allowed
an AIDS diagnosis based purely on an immune system measure: a CD4 cell count
below 200 or a CD4 percentage below 14. Based on strong epidemiological
evidence, three conditions were also added as AIDS indicator diseases in
people with HIV: invasive cervical cancer, pulmonary tuberculosis and
recurrent pneumonia (defined as two or more episodes within one year).(21)

One thing did not change: The core list of 12 opportunistic infections--PCP,
toxoplasmosis, etc.--that dated from the mid-1980s would still trigger an
AIDS diagnosis even without a positive HIV test.(21,22) In other words--and
contrary to the denialists' claims--a positive HIV test has never been
required to diagnose AIDS in people with these otherwise rare illnesses.

At this point it is useful to refer again to Maggiore's version of the AIDS
definition, variations of which appear throughout denialist literature:
"Pneumonia + positive HIV test = AIDS," but "pneumonia + negative HIV test =
pneumonia." In fact, pneumocystis pneumonia triggers an AIDS diagnosis
regardless of HIV status, and in HIV- positive persons, more conventional
bacterial and viral pneumonias do not automatically trigger an AIDS
diagnosis. To qualify as AIDS they must happen at least twice within a year,
because only such multiple episodes are strongly associated with immune
suppression.(21) Simply put, the "illusory correlation" so harped on by the
denialists is an illusion of their own invention.

Another favorite denialist complaint is that some of the toxicities of
certain AIDS drugs match items in the list of AIDS-defining conditions. As
with the assertions discussed above, this claim is based on a skewed and
often blatantly inaccurate reading of the case definition. In any case, the
list of toxicities often cited as "AIDS by prescription"(23) consists
entirely of conditions whose association with HIV was well established
before AZT and other antiretrovirals came into widespread use.

Duesberg's Epidemiology and Other Mysteries

A related but distinct thesis has been advanced by University of California
Berkeley Prof. Peter Duesberg: AIDS is in fact several separate epidemics
lumped together. Proof, he and colleague David Rasnick suggest, lies in the
fact that members of different risk groups get different diseases. KS, he
notes, is seen mostly in gay men, while "weight loss and tuberculosis
predominate in intravenous drug users, and pneumonia and candidiasis are
almost the only two of the 30 AIDS-defining diseases that are diagnosed in
hemophiliacs."(24)

These "distinct, subepidemic-specific diseases," Duesberg and Rasnick argue,
rule out a common cause, infectious or otherwise. They further insist that
AIDS indicator conditions can be divided into those that are immune
deficiency-related, like PCP, and those that aren't, such as KS. A
significant proportion of AIDS cases, they note, are diagnosed based on
these "non immune deficiency diseases."(24)

Duesberg's reading of the literature is, to put it gently, selective. For
one thing, despite his repeated assertions to the contrary, an association
between KS and weakened immunity had been well established in the medical
literature prior to AIDS.(7)

As for his claims about differing opportunistic infections in different risk
groups, it is hardly a surprise that populations with widely varying
behaviors, lifestyles and health risks would experience severe immune
deficiency somewhat differently, and such differences have indeed been
noted. But even a cursory glance at the medical literature quickly dynamites
Duesberg's claim that these differences are so dramatic as to constitute
separate epidemics. For example, five years before Duesberg and Rasnick's
assertion that pneumonia and candidiasis are "almost the only two"
AIDS-defining conditions seen in hemophiliacs, a European hemophiliac cohort
found that of 37 diagnosed with AIDS, 6 had toxoplasmosis, 3 had wasting
syndrome, 3 had dementia, 2 had MAC, 1 had CMV and 1 had lymphoma as their
AIDS- diagnosing illness.(25)

The same Duesberg/Rasnick article touts both the "drug-AIDS hypothesis" and
the "new name for old diseases" theory with an impressive list of references
purportedly showing that AIDS-defining illnesses had been widely identified
in drug users prior to and without AIDS. Duesberg's chart has at times been
borrowed by other denialists.(24,26)

But again his "evidence" wilts under close examination. For example, one
reference he cites repeatedly--as evidence that immune deficiency,
candidiasis, lymphadenopathy and weight loss had been documented in heroin
addicts pre-AIDS- -is 1973 article by Pillari and Narus from the AMERICAN
JOURNAL OF NURSING. But the article, it turns out, isn't a study but simply
an anecdotal description of patients seen in one treatment program. It gives
neither numbers of cases nor occurrence rates for any of the conditions
described.(27)

In fact, Pillari and Narus specifically mention just one of the four
conditions Duesberg attributes to them, lymphadenopathy. Candidiasis is
perhaps implied by nonspecific references to "fungal infections," while
immune deficiency and weight loss are implied even more vaguely and
indirectly. And although Duesberg's chart lists all four conditions as "AIDS
defining," nothing in the article comes remotely close to describing an
illness that would meet the criteria for an AIDS diagnosis.(27)

Finally, a different spin has been put out by ACT UP San Francisco. Some of
their materials echo the general denialist notion that the whole epidemic is
a scam, but their most-repeated phrase in recent years has been, "AIDS is
over." Such statements often refer to declining numbers of AIDS cases and
deaths.(28)

But extensive evidence links those declines to improved anti-HIV treatment
(for more on this see AIDS TREATMENT NEWS' special issue, "Treatment and
Survival," Sept. 8, 2000). And for the families of the 10,198 people who
died of AIDS during 1999 according to the most recent CDC figures,(29) AIDS
is certainly not over.

References

1. Schmidt, Casper G., "The group-fantasy origins of AIDS," in THE AIDS
CULT, edited by John Lauritsen and Ian Young, Asklepios USA, 1997.

2. MacDonald, Robert, "Healthy skepticism about HIV," HEAL Toronto web site,
http://www.harmsen.net/heal/healthy_skeptic.html

3. Maggiore, Christine, WHAT IF EVERYTHING YOU KNEW ABOUT AIDS WAS WRONG?
American Foundation For AIDS Alternatives, p. 51.

4. Maggiore, p. 1.

5. Gottlieb, MS, and others, "Pneumocystis pneumonia--Los Angeles,"
MORBIDITY AND MORTALITY WEEKLY REPORT, 1981: 30: 250-52.

6. Friedman-Kien, A and others, "Kaposi's sarcoma and pneumocystis pneumonia
among homosexual Men--New York City and California," MORBIDITY AND MORTALITY
WEEKLY REPORT, 1981: 30: 305-08.

7. Safai, B. and Good, R., "Kaposi's sarcoma, a review and recent
developments," CLINICAL BULLETIN, 1980: 10: 62-69.

8. Friedman-Kien, A., "Disseminated Kaposi's sarcoma syndrome in young
homosexual men," JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY. 1981: 5(4)
468-71.

9. Masur, H. and others, "An outbreak of community-acquired pneumocystis
carinii pneumonia," NEW ENGLAND JOURNAL OF MEDICINE, 1981: 305: 1431-8.

10. Walzer, Peter D. and others, "Pneumocystis carinii pneumonia in the
United States," ANNALS OF INTERNAL MEDICINE, 1974: 80: 83-93.

11. Gottlieb, Michael and others, "Pneumocystis carinii pneumonia and
mucosal candidiasis in previously healthy homosexual men," NEW ENGLAND
JOURNAL OF MEDICINE, 1981: 305: 1425-31.

12. Siegal, Frederick and others, "Severe acquired immunodeficiencies in
male homosexuals, manifested by chronic perianal ulcerative herpes simplex
lesions," NEW ENGLAND JOURNAL OF MEDICINE, 1981: 305: 1439-44

13. Durack, David, "Opportunistic infections and Kaposi's sarcoma in
homosexual men," NEW ENGLAND JOURNAL OF MEDICINE, 1981: 305: 1465-7.

14. Hymes, Kenneth and others, "Kaposi's sarcoma in homosexual men--a report
of eight cases," THE LANCET, 1981; ii: 598-600.

15. "Immunocompromised homosexuals," THE LANCET, 1981, ii: 1325-6.

16. Shilts, Randy, AND THE BAND PLAYED ON, updated edition, Penguin Books,
1988, chapters 2-8.

17. "Current trends update on acquired immune deficiency syndrome
(AIDS)--United States," MORBIDITY AND MORTALITY WEEKLY REPORT, 1982: 31:
508-08.

18. "Current trends revision of the case definition of Acquired
Immunodeficiency Syndrome for National Reporting-- United States," MORBIDITY
AND MORTALITY WEEKLY REPORT, 1985: 34: 373-5.

19. "Revision of the CDC Surveillance Case Definition for Acquired
Immunodeficiency Syndrome," MORBIDITY AND MORTALITY WEEKLY REPORT, 1987:
36(supplement no. 1S).

20. Mirken, Bruce, "AIDS Name Game: Help or Misery Turns on Obsolete
Definition," LOS ANGELES READER, May 25, 1990, p. 3-4.

21. "1993 revised classification system for HIV infection and expanded
surveillance case definition for AIDS among adolescents and adults,"
MORBIDITY AND MORTALITY WEEKLY REPORT, 1992: 41: RR-17.

22. Kitty Bina and Dr. Richard Selick, CDC, personal communication.

23. Maggiore, p. 30.

24. Duesberg, P. and Rasnick, D., "The AIDS dilemma: Drug diseases blamed on
a passenger virus," GENETICA, 104:85- 132, 1998.

25. Aronstan, A. and others, "HIV infection in haemophilia- -a European
cohort," ARCHIVES OF DISEASE IN CHILDHOOD, 1993: 68: 521-24.

26. Maggiore, p. 56.

27. Pillari, George, and Narus, June, "Physical effects of heroin
addiction," American Journal of Nursing, 1973, 73: 2105-8.

28. ACT UP San Francisco press release, "ACT UP San Francisco launches
survive AIDS campaign," March 27, 2000.

29. U.S. HIV and AIDS Cases Reported through December 1999, year-end
edition, Vol. 11, no. 2.
001201
ATN35606

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provider of the content. comments@aegis.org.

I ran your recent postings listing names of dissidents through a
sort program.  Here are some representative excerpts from the output:

*    Annemarie Colbin (New York, NY)
*    Annemarie Colbin (New York, NY)
*    Arnold W. Giddens (Shingle Springs, CA)
*    Arnold W. Giddens (Shingle Springs, CA)
*    Arnold W. Giddens (Shingle Springs, CA)
*    Arnold W. Giddens (Shingle Springs, CA)
*    Asit K. Chakraborty, Ph.D. (Omaha, NE)
*    Asit K. Chakraborty, Ph.D. (Omaha, NE)
*    Barry A. Liebling, Ph.D. (New York, NY)
*    Barry A. Liebling, Ph.D. (New York, NY)
*    Barry R. Alexavich (Cell Biologist, Bristol, CT)
*    Barry R. Alexavich (Cell Biologist, Bristol, CT)
*    Bernard K. Forscher, Ph.D (Ret. Editor Proc. Nat. Acad. Sci., Santa Fe,
*    Bernard K. Forscher, Ph.D (Ret. Editor Proc. Nat. Acad. Sci., Santa Fe,
*    Beverly E. Griffin, Ph.D. (Dir. Dept. Virology, Royal Postgrad. Med.
*    Beverly E. Griffin, Ph.D. (Dir. Dept. Virology, Royal Postgrad. Med.
*    Bob Guccione, Jr. (Editor Spin Magazine, New York, NY)
*    Bob Guccione, Jr. (Editor Spin Magazine, New York, NY)

Alberti Mirco, Naturopathic Physician, Bologna, Italy
Alberti Mirco, Naturopathic Physician, Bologna, Italy
Alexavich Barry R. (Cell Biologist, Bristol, Connecticut)
Alexavich Barry R. (Cell Biologist, Bristol, Connecticut)
Almeida Ricardo, Visiting Professor, Ecological issues, Southern New
Almeida Ricardo, Visiting Professor, Ecological issues, Southern New
Almendro Manuel, PhD in Psychology, (Spain)
Almendro Manuel, PhD in Psychology, (Spain)
Also MPH, completing a PhD in Public Health at New York University
Also MPH, completing a PhD in Public Health at New York University
Ambiel Roger, Nurse teacher, Zurich, Switzerland
Ambiel Roger, Nurse teacher, Zurich, Switzerland
Amoroso Serafino, N.D., PhD, DAHom, New Jersey Center for the Healing
Amoroso Serafino, N.D., PhD, DAHom, New Jersey Center for the Healing
Anastasopoulos Emmanuel MD, PhD, Athens, Greece
Anastasopoulos Emmanuel MD, PhD, Athens, Greece

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