Perinatal AIDS Death: Success In Canada Versus Disaster In Kenya

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By David M. Burd

Canada:
Beginning in the early 1980s and through 1988, some 60 percent of Canadian infants born HIV-positive
died of AIDS at an early age. These infants were born to mothers not receiving prophylaxis treatment
with antiviral drugs to prevent transmission of HIV to their fetuses, as became recommended practice
in the late-1990s. When such mothers are not treated with drugs, they are called "naïve" study
subjects. However, from 1988 to 1996, the death rate among HIV-positive infants born to naïve
mothers fell to 25 percent on average. The data for three subset years - 1991 to 1993 - is typically
noteworthy, as seen eight and 11 years later, in Canada's HIV/AIDS surveillance charts of 1999 and
2002. The 1999 chart of these growing children registers 28 cumulative AIDS deaths and five others
for a total of 33; the 2002 chart registers 27 cumulative AIDS deaths and six other deaths for a
total of 33. Thus, it is apparent that this subset's AIDS mortality (and total mortality) had ceased
by 1999, as the 2002 totals remained the same.

It has been commonly stated by American health institutions such as the National Institute of
Allergy and Infectious Diseases (NIAID) and the Centers for Disease Control and Prevention (CDC)
that AIDS-defining conditions will manifest on average 10 years after infection for adults. For
infants born HIV-positive, however, disease is forecast much sooner, usually around two years.
Hence, the justification to put infants just out of the womb on intravenous AZT at dose strengths
equivalent to 582 milligrams a day for a 160-pound adult, and to treat for six weeks with this
dosage. How this dosage was derived warrants comment.

Beginning in 1984, when HIV was labeled a threat to newborns, drugs intended to attack retrovirus
replication became instituted to infants (not their mothers). They typically had severely
compromised health being born of heroin- or crack-cocaine- or alcohol-addicted mothers. Dangerous
drugs, such as pentamidine, were employed as they had been for adults to combat pneumonia and fungal
pathogens, and infant mortality began to be expected - and listed as AIDS deaths caused by HIV.

The most controversial drug of all for HIV-positive people is called AZT, and this drug is
particularly relevant (along with Bactrim, to be addressed later) in analyzing Canada's record on
conquering perinatal AIDS. AZT (azidothymidine, ZDV, zidovudine, retrovir) is a chemotherapy
invented 40 years ago for cancer treatment, but never employed due to its lethal toxicity to bone
marrow and gut-lining cells, and for its own propensity to cause such cancers as lymphoma.
Nevertheless, in early 1985, HIV-positive adults began taking typically 1,200 to 1,800 milligrams of
AZT daily, with death coming soon thereafter - but with the blessing of the medical establishment
because at least these people had a "higher quality of life" during their last year or two.

In 1987, two years after its actual widespread use (as noted above) through black market channels
and at the National Cancer Institute (NCI) itself, the FDA officially sanctioned AZT for
HIV-positive patients, including infants. Never permitted for cancer patients due to its lethality,
AZT's chemistry was to stop DNA from producing new human cells. Essentially, a chemotherapy too
toxic for adults for even brief, intermittent doses was now given to adults and fragile infants
indefinitely. In fact, long before the official FDA approval, Wall Street Journal writer Marilyn
Chase, documented in an article published Aug. 5, 1985 that AZT had been readily employed in early
1985 in patient trials at the NCI's Bethesda campus. Known as Compound S, it was supplied by
Burroughs Wellcome, along with many other toxic antivirals - such as ribavirin and suramin, also
cited by Chase's article. These experiments were championed by NCI chief Sam Broder, who became
known as Mr. AZT.

It is pertinent to note here that all people taking these amounts of AZT, even those healthy and in
the prime of life, would soon die a miserable death from this chemotherapy given non-stop as
demanded (called compliance). However, beginning in 1990, several published papers - including one
on Oct. 11, 1990 by A. C. Collier, MD, et al. in The New England Journal of Medicine - stated that
AZT in reduced doses of 300 to 600 milligrams a day was as effective at thwarting HIV as the higher
doses, and the toxic effects of the lower doses were substantially less (wonder of wonders). This
news was further published by AIDS.ORG, and read widely on the Internet and in print by AIDS
caregivers. Perhaps coincidentally, after these publications, Canadian caregivers may have begun
dosing HIV-positive infants to the 300 milligram equivalent (for babies, 24 milligrams a day) - an
80 percent reduction of a terribly toxic chemotherapy - now officially recommended by the Canadian
Pediatric Society. Drug-induced mortality immediately fell, and this can be seen in the surveillance
charts.

In 1996, a wild card was dealt to the perinatal world of AIDS. It became common to treat Canadian
HIV-positive mothers with the chemotherapy drug AZT (ZDV) during pregnancy, as transmission to the
developing fetus was reportedly lowered. A 1994 study (known as ACTG 076) claimed a two-thirds
reduction in HIV-positive infants if their mothers were given AZT. However, it must be noted that
since taking this chemotherapy frequently causes life-threatening anemia, likely severe nausea, and
leukopenia (great diminishment of white blood cells), it was a discretionary choice of the mother,
after she was counseled on its dire effects. The surveillance charts do not indicate how many
mothers accepted or declined AZT (see below). However, it is important to note that the reason that
AZT was recommended to mothers is that it easily crosses through the placenta into the developing
fetus, which of course was its justification, as AZT might possibly stop the fetus from being
"infected" with the mother's HIV.

It is an understatement to say that there are legions of scientists and practicing doctors who argue
against exposing a fetus to a mutagenic drug such as AZT, but they remain unheeded by NIAID and the
pharmaceutical companies, which essentially establish dosing protocols. Scores of studies assessing
the toxicity of AZT, and whether the ACTG 076 study has merit, are analyzed and referenced in Mother
to Child Transmission of HIV and Its Prevention with AZT and Nevirapine - A Critical Analysis of the
Evidence, published in October 2001 by The Perth Group of Australia. Comprising a group of
distinguished medical scientists and practicing doctors, The Perth Group has immensely documented
the many mistaken premises of AIDS, and further how ubiquitous HIV antigens, HIV proteins, and HIV
antibodies are present in virtually everybody. Unfortunately for infants deemed HIV-positive, all
evidence points to the Perth Group's publications remaining unread in the offices of American health
institutions such as NIAID and CDC.

As to Canadian HIV-positive infants, their mortality fell again to four percent for the six
reporting years ending 2002, with an HIV-positive group totaling 50, and had reached zero for the
last three years ending 2002. Another dominant drug is relevant to this analysis, and it is the
anti-pneumonia drug Bactrim (aka Septra). Canada's protocols as per the Canadian Pediatric Society
guidelines direct HIV-positive infants to have prophylaxis treatment with Bactrim relatively soon
after birth, beginning at two months, but with cautions as to longevity of this drug administration,
notorious for its serious, possibly lethal side effects. Bactrim may be the most important factor
common to both Canada and Kenya and is discussed below.

Complementary data as to HIV-positive naïve mothers with babies born HIV-positive is worth noting,
and clearly shown by the charts. In the early years up to 1988, faulty protocols dictated that 76
percent of these mothers' infants were deemed HIV-positive. (Recent years show 25 percent of babies
born to Canada's naïve mothers are testing HIV-positive and studies have emerged citing one-half
this rate.) Unfortunately, the label HIV-positive then dictated treatments with strong drugs
(including AZT) not remotely considered for normal infants, and thus it is plausible that
considerable mortality came from the side effects of drug treatments themselves - that were
essentially brought about in the first place by faulty non-specific antibody testing. In fact, HIV
antibody testing for infants has now been shelved due to its gross inaccuracies, and PCR and p24
antigen testing have become the mainstays for infants (despite their flaws). This realization came
too late, however, for thousands of babies in Canada and the U.S., as perinatal mortality testifies.

Two singular points can be further made as to Canada's success: First, the 1999 and 2002 charts of
mothers not taking antivirals (naïve) during pregnancy, compared to each other, reveal a notable
result as to the continuing status of their HIV-positive babies. For the three years prior to 2002,
the total of AIDS deaths, for all the infants born HIV-positive since 1985, did not rise by a single
death, as shown by the two separate cumulative mortality totals for 1999 and 2002. Thus, AIDS
mortality has clearly come to a complete stop as these children grow toward their latter teens, and
this pertains to children born HIV-positive going back to 1985 (and who survived possible minimal
AZT dosing). By itself, this survival, or actual flourishing as the case may be, condemns the use of
the mutagenic drug AZT now given to mothers-to-be, and the extreme risks of their fetuses being
congenitally damaged by this chemotherapeutic drug.

The second point: All the HIV-positive infants analyzed here are from antiviral-naïve mothers, but
it cannot be inferred from the charts whether the babies themselves were treated with AZT during
their first weeks. However, as only those infants in the charts turning out to be indeed
HIV-positive (that neonatal AZT is supposed to ward off but, in fact, failed to as per their
continued, registered HIV positivity) are the subject of this analysis, despite whether or not they
were AZT treated. Thus, it becomes a moot point if some were subjected to the now-smaller AZT dosing
(if given), as their exceedingly high survival rates speak for themselves as to surviving HIV. This
lack of mortality clearly indicates the heretofore vaunted lethality of HIV to be false, with HIV
proteins most probably being artifacts of many possible origins (see The Perth Group noted above).

Nairobi, Kenya - Bactrim Dosing Disparity:
For three years ending 2002, a controlled study (Obimbo et al.) in a major hospital setting in
Nairobi, Kenya - at the University of Nairobi teaching hospital, Kenyetta National Hospital - a
study group of 62 HIV-positive infants experienced a stupefying 52 percent mortality by the age of
two years ("Predictors of Early Mortality in a Cohort of Human Immunodeficiency Virus Type
1-Infected African Children" published in The Pediatric Infectious Disease Journal: Vol 23(6) June
2004 pp 536-543). However, Obimbo's infants were born to mothers distinctly different from the
Canadian mothers: all Obimbo mothers were given antiviral prophylactic drugs, particularly AZT,
during their pregnancy for preventing HIV-transmission to their fetuses, with mothers unable to
tolerate AZT's toxicities given nevirapine as a substitute. Additionally, mothers not tolerating AZT
therapy had nevirapine administered to their newborns within 72 hours.

As to Bactrim, Obimbo's HIV-positive infants were given this anti-bacterial PCP prophylaxis drug, at
an earlier age of four to six weeks, compared to Canada's initiation at two months, with Obimbo's
dose strength almost four times that of Canada.

The median age of death by two years age of 52 percent of Obimbo's infants, ascribed to HIV, was 6.2
months.

Bactrim:
Two powerful drugs specifically predominate for infants born HIV-positive. The first is AZT as
already noted. The second powerful drug indicated for HIV-positive infants in both Nairobi and
Canada is Bactrim, also known as Septra or Cotrimoxazole. Bactrim's two drugs (trimethoprim and
sulfamethoxazole) synergistically interfere with the metabolization of folic acid, and are claimed
to preferentially affect their toxic chemistry against bacterial folic acid over that of humans.
However, there are abundant papers documenting the fierce toxicity of Bactrim in humans, and
particularly many papers cite that the great majority of AIDS patients have severe reactions to
Bactrim. Nevertheless, Bactrim is universally given to all HIV-positive infants in Canada at age two
months for a limited time as prophylaxis against a fungal pneumonia called pneumocystis carinii
pneumonia (PCP), and at much stronger doses in Nairobi as cited below. Why an anti-bacterial such as
Bactrim is given to prevent a fungal pneumonia is a mystery, but not to be addressed here. What can
be said is that folic acid's absolutely vital function in synthesizing nucleic acids necessary for
new life is badly, at times lethally, compromised by Bactrim interfering with folic acid
metabolization, so vital to a fast-growing newborn.

Some 75 percent of the mothers of Obimbo's infants were subjected to AZT for an average three weeks
(while Canada's mothers were not), and the remaining 25 percent, unable to tolerate AZT due to
"severe anemia," received nevirapine. Both of these drugs had the clear potential to be harmful to
the fetus (see above reference by The Perth Group as to the toxicities of AZT and nevirapine).

The sharply different dose protocols of Bactrim used by Canada and Obimbo cannot be insignificant:
Both use widely published, but greatly different, provincial protocols promoting use of Bactrim for
newborn HIV-positive infants for warding off pneumocystis carinii pneumonia (PCP). Canada's dosing
per week starts at two months, and is 45 milligrams per week, with cautions as to extended use;
comparatively, Obimbo, using World Health Organization (WHO) protocols published for locales such as
Kenya, would have used 168 milligrams per week, starting as early as four weeks, for the same
three-kilogram infant. Further, Obimbo comments that Bactrim was given indefinitely (though up to
only 6.2 months for many). This dosing factor of almost four is striking, and calls for attention as
to its continued use by WHO doctors.

The mortality of Obimbo's infants cannot plausibly be ascribed to HIV, as the study infants were
given care in a modern hospital in Nairobi. Other than the two distinct toxic drug differences noted
by this article, there may of course be additional factors that are of importance; at least one
being the perception by healthcare givers and infants' mothers as to the expectations of a
successful outcome. Whereas in Canada expectation of success would predominate by now, as evidenced
by the charts, and thus all care humanly possible is given, it could be the opposite attitude of
those caring for Obimbo's babies - and with a downward spiral self-feeding on itself that HIV will
kill the infant, and do so quickly. Nothing could be further from this perceived fatal outcome.

Conclusions:
The author's career has been analyzing complex technology problems, and he realizes that analysis
from afar is profoundly difficult. Nevertheless, a case can be made that the vast amount of
literature and papers on HIV/AIDS can best be evaluated in a neutral setting, and not from the
biases of interviewed authors themselves; in essence, that of an historian. With regard to pointing
out the differences of Canada and Obimbo outcomes, and to mortal effects of the greatly different
treatment protocols, others may greatly criticize. It is indeed hoped that this criticism is
generated, and correct answers, whatever they be, may be reached as to the vast variance of
mortalities addressed here.

Lastly, a call of alarm: Currently published WHO/UNICEF/UNAIDS protocols for treating newborns
weighing three kilos (6.6 pounds) with AZT (Zidovudine, ZDV), result in the equivalent of more than
1,604 milligrams/day for a 140-pound adult. This protocol is Annex 10. Summary of Paediatric Drug
Formulations and Doses, referenced by Guidelines For A Public Health Approach, June, 2002, Scaling
Up Antiviral Therapy In Resource-Limited Settings, and cites for ZDV dosing four weeks to 13 years
of age to be 180mg/m2, twice daily. There can be only one outcome for this ZDV dosing: For infants
given this dose, the median death at 6.2 months registered by Obimbo will assuredly go even lower.

David Burd is a science and medical technology consultant based in Alexandria, Virginia. He is a
former high-tech innovator and former U.S. patent examiner in medical/surgical arts.