Talk:HIV/AIDS denialism/points

As suggested in Talk:AIDS_denialism#.22draft_of_what_you.27d_like_this_section_to_look_like.22

According to denialists, HIV has failed to satisfy the Koch's postulates postulates. Peter Duesberg, among others, have claimed that Koch's first postulate is not adequately fulfilled because there are individual cases of AIDS in which HIV cannot be isolated.{{cite journal |author=Duesberg PH |title=Human immunodeficiency virus and acquired immunodeficiency syndrome: correlation but not causation |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=86 |issue=3 |pages=755–64 |year=1989 |month=February |pmid=2644642 |doi= |url=http://www.pnas.org/cgi/pmidlookup?view=long&pmid=2644642}} The Perth Group, led by Eleni Papadopulos-Eleopulos, has stated that scientists have failed to satisfy the second postulate; they claim that a precondition of isolation is purification of the virus and that current isolates of HIV are not "pure".{{cn}}

Scientific research concludes that HIV does fulfill Koch's postulates completely.[http://www.niaid.nih.gov/Factsheets/evidhiv.htm NIAID Fact Sheet: The Evidence that HIV Causes AIDS]. Accessed via National Institutes of Health website on 24 Oct 2006. In cases such as those cited by Duesberg, where HIV cannot be isolated, PCR shows that the virus is present.{{cite journal | author = O'Brien SJ, Goedert JJ. | title = HIV causes AIDS: Koch's postulates fulfilled.| journal = Curr Opin Immunol.| volume = 8 | issue = | pages = 613-618 | year = 2002 | id = {{PMID|8902385}}}} In any case, Koch's postulates have never been universally applicable. Even in Koch's time, it was recognized that some infectious agents were clearly responsible for disease in spite of the fact that they did not fulfill all of the postulates; Koch R. (1896) J. Hyg. Inf. 14, 319-333Koch R. (1884) Mitt Kaiser Gesundh 2, 1-88 Koch himself disregarded three postulates for cholera and typhoid fever. Currently, a number of infectious agents are accepted as the cause of disease despite not fulfilling all of Koch's postulates.{{cite journal | author = Jacomo V, Kelly P, Raoult D | title = Natural history of Bartonella infections (an exception to Koch's postulate). | journal = Clin Diagn Lab Immunol | volume = 9 | issue = 1 | pages = 8-18 | year = 2002 | id = {{PMID|11777823}}}}

Denialists note that in North America and Western Europe, AIDS is non-randomly distributed, affecting certain groups of people more than others, and moreover it is fragmented into distinct sub-epidemics with different distributions of AIDS-defining diseases.[http://www.duesberg.com/papers/chemical-bases.html The Chemical Bases of the Various AIDS Epidemics: Recreational Drugs, Anti-viral Chemotherapy and Malnutrition] According to dissidents, AIDS in Africa looks completely different from the corresponding syndrome in North America and Western Europe; one example that has been cited is that in Africa AIDS affects roughly equal numbers of men and women, while in North America and Western Europe it affects more men than women.[http://data.unaids.org/pub/GlobalReport/2006/2006_GR_ANN2_en.pdf Joint United Nations Programme on HIV/AIDS Global Report 2005 estimates and data]

The consensus view is that regional variability in the pattern and spread of HIV/AIDS results from differences in the time of introduction of the virus, the social fabric of a given community, its culture, its sexual networks, the mobility of its people and the reaction of the government in mounting an AIDS control program.{{cite journal | author = Quinn T | title = Global burden of the HIV pandemic. | journal = Lancet | volume = 348 | issue = 9020 | pages = 99-106 | year = 1996 | id = {{PMID|8676726}}}} Regional variation in infection rates and infected populations is not unique to HIV/AIDS; for example, the epidemiology of hepatitis B is very different in the U.S. as compared to Asia.{{cite journal | author = Maynard J | title = Hepatitis B: global importance and need for control. | journal = Vaccine | volume = 8 Suppl | issue = | pages = S18-20; discussion S21-3 | year = | id = {{PMID|2139281}}}}{{cite journal | author = Alter M, Hadler S, Margolis H, Alexander W, Hu P, Judson F, Mares A, Miller J, Moyer L | title = The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies. | journal = JAMA | volume = 263 | issue = 9 | pages = 1218-22 | year = 1990 | id = {{PMID|2304237}}}} Transmission via bodily fluids has been well-demonstrated and is typical of an infectious disease: HIV behaves exactly like many other viruses in terms of its transmission through blood, sexual fluids,{{cite journal | author = Vogt M, Witt D, Craven D, Byington R, Crawford D, Hutchinson M, Schooley R, Hirsch M | title = Isolation patterns of the human immunodeficiency virus from cervical secretions during the menstrual cycle of women at risk for the acquired immunodeficiency syndrome. | journal = Ann Intern Med | volume = 106 | issue = 3 | pages = 380-2 | year = 1987 | id = {{PMID|3643769}}}}{{cite journal | author = Zagury D, Bernard J, Leibowitch J, Safai B, Groopman J, Feldman M, Sarngadharan M, Gallo R | title = HTLV-III in cells cultured from semen of two patients with AIDS. | journal = Science | volume = 226 | issue = 4673 | pages = 449-51 | year = 1984 | id = {{PMID|6208607}}}}{{cite journal | author = Zagury D, Fouchard M, Cheynier R, Bernard J, Cattan A, Salahuddin S, Sarin P | title = Evidence for HTLV-III in T-cells from semen of AIDS patients: expression in primary cell culture, long-term mitogen-stimulated cell cultures, and cocultures with a permissive T-cell line. | journal = Cancer Res | volume = 45 | issue = 9 Suppl | pages = 4595s-4597s | year = 1985 | id = {{PMID|2410109}}}}{{cite journal | author = Wofsy C, Cohen J, Hauer L, Padian N, Michaelis B, Evans L, Levy J | title = Isolation of AIDS-associated retrovirus from genital secretions of women with antibodies to the virus. | journal = Lancet | volume = 1 | issue = 8480 | pages = 527-9 | year = 1986 | id = {{PMID|2869262}}}} and breast milk,[http://www.cdc.gov/hiv/resources/factsheets/transmission.htm Centers For Disease Control Fact Sheet: Transmission of HIV.] suggesting that HIV does in fact spread like an infectious disease.{{cite journal | author = Auerbach D, Darrow W, Jaffe H, Curran J | title = Cluster of cases of the acquired immune deficiency syndrome. Patients linked by sexual contact. | journal = Am J Med | volume = 76 | issue = 3 | pages = 487-92 | year = 1984 | id = {{PMID|6608269}}}}{{cite journal | author = Gazzard B, Shanson D, Farthing C, Lawrence A, Tedder R, Cheingsong-Popov R, Dalgleish A, Weiss R | title = Clinical findings and serological evidence of HTLV-III infection in homosexual contacts of patients with AIDS and persistent generalised lymphadenopathy in London. | journal = Lancet | volume = 2 | issue = 8401 | pages = 480-3 | year = 1984 | id = {{PMID|6147547}}}}{{cite journal | author = Francis D, Curran J, Essex M | title = Epidemic acquired immune deficiency syndrome: epidemiologic evidence for a transmissible agent. | journal = J Natl Cancer Inst | volume = 71 | issue = 1 | pages = 1-4 | year = 1983 | id = {{PMID|6575197}}}}{{cite journal | author = Jaffe H, Bregman D, Selik R | title = Acquired immune deficiency syndrome in the United States: the first 1,000 cases. | journal = J Infect Dis | volume = 148 | issue = 2 | pages = 339-45 | year = 1983 | id = {{PMID|6604115}}}}

In addition to the claims regarding the variations in AIDS definition between North America, Western Europe, and Africa, another fact cited as supporting the hypothesis that HIV is harmless is that a small number of HIV-positive people remain relatively healthy 15 or 20 years after testing positive for HIV.[http://www.scientificexploration.org/jse/articles/pdf/17.1_hodgkinson.pdf AIDS: Scientific or Viral Catastrophe? by Neville Hodgkinson, 2003, accessed 11 October 2006.] Conversely, some HIV-seronegative people develop what would have been considered AIDS-defining diseases had they tested positive [http://www.ncbi.nlm.nih.gov/pubmed/8023211?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum HIV-negative "AIDS" in Kentucky: a case of idiopathic CD4+ lymphopenia and cryptococcal meningitis.].

According to the mainstream perspective, the long period of HIV infection preceding AIDS manifestations is to be expected; HIV can take years to cause the immunosuppression necessary to permit opportunistic disease to occur. Extensive studies conducted before treatment was available found the mean duration between HIV infection and the development of AIDS to be eight to ten years.{{cite journal | author = Rutherford G, Lifson A, Hessol N, Darrow W, O'Malley P, Buchbinder S, Barnhart J, Bodecker T, Cannon L, Doll L | title = Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study. | journal = BMJ | volume = 301 | issue = 6762 | pages = 1183-8 | year = 1990 | id = {{PMID|2261554}}}} By this measurement, Hepatitis C would also be a "harmless" virus, as its latent stage may run longer than 20 years.[http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm NIH Consensus Statement on Hepatitis C, accessed 31 August 2006.] There are many other well-known infectious diseases that develop slowly with a long latency period between infection and disease, such as Creutzfeldt-Jakob Disease, syphilis, and leprosy; AIDS is hardly unique in this respect.

Of substantial concern to AIDS denialists is the use of HIV antibody or viral testing as part of the definition of AIDS.[http://robertogiraldo.com/eng/papers/Farber_Reply_April_2006.html Website of Roberto A. Giraldo] HIV tests cannot diagnose HIV infection, Gallo et al. 2006 Some of the approximately 30 AIDS-defining diseases, including Kaposi's Sarcoma (KS) and Pneumocystis jiroveci pneumonia (PCP, formerly Pneumocystis carinii), are considered diagnostic of AIDS only when serologic evidence of HIV is present. In the absence of such evidence, these diseases are thought to be related to other immune problems, and are not diagnostic of AIDS. In other words, according to denialists, the definition of AIDS is an example of circular logic: because a diagnosis of AIDS requires the presence of HIV antibodies, there can be no AIDS without HIV.[http://www.duesberg.com/papers/ch13.html Therefore, the perfect correlation is not a natural coincidence but a perfect artifact of the definition of AIDS by its hypothetical cause, HIV. It is one of the purest examples of circular logic.]

Two major systems of AIDS diagnosis used today are the World Health Organization system, for use in resource-limited settings (see WHO Disease Staging System for HIV Infection and Disease),{{ cite journal | author=WHO | title=Interim proposal for a WHO Staging System for HIV infection and Disease. | journal=Wkly Epidemiol Rec. | year=1990 | pages=221-224 | volume=65 | issue=29 | PMID=11809639|url=http://whqlibdoc.who.int/wer/WHO_WER_1990/WER1990_65_221-228%20(N°29).pdf}} and the CDC system used in the USA (see CDC Classification System for HIV Infection). [http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm 1993 CDC]: Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults European countries and Canada use a variation of the CDC definition that excludes CD4 counts{{Fact|date=February 2007}}. Supporters of these definitions point out that AIDS-defining diseases such as KS and PCP (and also very low CD4 counts) are exceedingly rare in people who are HIV-negative, and that it is standard practice in medicine to include a microbial test in disease diagnosis.{{cite journal | author = Martin J, Ganem D, Osmond D, Page-Shafer K, Macrae D, Kedes D | title = Sexual transmission and the natural history of human herpesvirus 8 infection. | journal = N Engl J Med | volume = 338 | issue = 14 | pages = 948-54 | year = 1998 | id = {{PMID|9521982}}}}{{cite journal | author = Rezza G, Andreoni M, Dorrucci M, Pezzotti P, Monini P, Zerboni R, Salassa B, Colangeli V, Sarmati L, Nicastri E, Barbanera M, Pristerà R, Aiuti F, Ortona L, Ensoli B | title = Human herpesvirus 8 seropositivity and risk of Kaposi's sarcoma and other acquired immunodeficiency syndrome-related diseases. | journal = J Natl Cancer Inst | volume = 91 | issue = 17 | pages = 1468-74 | year = 1999 | id = {{PMID|10469747}}}}{{cite journal | author = Sitas F, Carrara H, Beral V, Newton R, Reeves G, Bull D, Jentsch U, Pacella-Norman R, Bourboulia D, Whitby D, Boshoff C, Weiss R | title = Antibodies against human herpesvirus 8 in black South African patients with cancer. | journal = N Engl J Med | volume = 340 | issue = 24 | pages = 1863-71 | year = 1999 | id = {{PMID|10369849}}}}{{cite journal | author = Kovacs J, Gill V, Meshnick S, Masur H | title = New insights into transmission, diagnosis, and drug treatment of Pneumocystis carinii pneumonia. | journal = JAMA | volume = 286 | issue = 19 | pages = 2450-60 | year = 2001 | id = {{PMID|11712941}}}}

{{see also|HIV test}}

Denialists claim that the process of testing individuals for the presence of HIV is flawed. They assert there is a high probability of encountering a false positive, which would falsely identify someone as HIV-positive due to cross-reactivity [http://www.duesberg.com/subject/epafrica.html The presence of positive HIV serology in Africans represents no more than cross-reactivity caused by an abundance of antibodies induced by the numerous infectious and parasitic diseases which are endemic in Africa]

A detailed criticism of the Western blot test and the "gold standard" of HIV isolation was published by Eleni Papadopulos-Eleopulos et al. in Bio/technology in 1993: [http://www.reviewingaids.org/awiki/index.php/Document:Positive_WB_Proof Is a Western Blot Proof of HIV Infection?] Their arguments rest on non-specificity of antibodies and lack of standardisation and reproducibility of HIV tests. In their conclusion, the authors state, "It is axiomatic that the use of antibody tests must be verified against a gold standard. The presently available data fail to provide such a gold standard for the HIV antibody tests. The inescapable conclusion from the above discussion is that the use of HIV antibody tests as predictive, diagnostic and epidemiological tools for HIV infection needs to be carefully reappraised."

In response, virologists contend that the accuracy of serologic testing has been verified by isolation and culture of HIV and by detection of HIV RNA by PCR, which are widely accepted "gold standards" in microbiology.{{cite journal | author = Busch M, Eble B, Khayam-Bashi H, Heilbron D, Murphy E, Kwok S, Sninsky J, Perkins H, Vyas G | title = Evaluation of screened blood donations for human immunodeficiency virus type 1 infection by culture and DNA amplification of pooled cells. | journal = N Engl J Med | volume = 325 | issue = 1 | pages = 1-5 | year = 1991 | id = {{PMID|2046708}}}}{{cite journal | author = MacDonald K, Jackson J, Bowman R, Polesky H, Rhame F, Balfour H, Osterholm M | title = Performance characteristics of serologic tests for human immunodeficiency virus type 1 (HIV-1) antibody among Minnesota blood donors. Public health and clinical implications. | journal = Ann Intern Med | volume = 110 | issue = 8 | pages = 617-21 | year = 1989 | id = {{PMID|2648922}}}} The consensus view of the scientific community is that current methods of HIV antibody testing are remarkably accurate. The false-positive rate among the American public ranges from 0.0006 to 0.0007 percent.{{cite journal | author = Burke D, Brundage J, Redfield R, Damato J, Schable C, Putman P, Visintine R, Kim H | title = Measurement of the false positive rate in a screening program for human immunodeficiency virus infections. | journal = N Engl J Med | volume = 319 | issue = 15 | pages = 961-4 | year = 1988 | id = {{PMID|3419477}}}} The false-negative rate for HIV antibody testing ranges from 0.001% to 0.3%, depending on the risk factors of the tested population.{{cite journal | author = Farzadegan H, Vlahov D, Solomon L, Muñoz A, Astemborski J, Taylor E, Burnley A, Nelson K | title = Detection of human immunodeficiency virus type 1 infection by polymerase chain reaction in a cohort of seronegative intravenous drug users. | journal = J Infect Dis | volume = 168 | issue = 2 | pages = 327-31 | year = 1993 | id = {{PMID|8335969}}}}{{cite journal | author = Busch M, Eble B, Khayam-Bashi H, Heilbron D, Murphy E, Kwok S, Sninsky J, Perkins H, Vyas G | title = Evaluation of screened blood donations for human immunodeficiency virus type 1 infection by culture and DNA amplification of pooled cells. | journal = N Engl J Med | volume = 325 | issue = 1 | pages = 1-5 | year = 1991 | id = {{PMID|2046708}}}}{{cite journal | author = Van de Perre P, Simonon A, Msellati P, Hitimana D, Vaira D, Bazubagira A, Van Goethem C, Stevens A, Karita E, Sondag-Thull D | title = Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda. | journal = N Engl J Med | volume = 325 | issue = 9 | pages = 593-8 | year = 1991 | id = {{PMID|1812850}}}}

Critics assert that many AIDS denialists' claims of inaccuracy result from an incorrect or outdated understanding of how HIV antibody testing is performed and interpreted.[http://www.kaisernetwork.org/health_cast/uploaded_files/081306_ias_sat_journalism.pdf HIV Science and Responsible Journalism][http://www.aidstruth.org/howimmunoassayswork.php How Immunoassays Work: The Curious Case of AIDS Denialist Roberto Giraldo and his Ignorance of the Basics] In the USA, the standard HIV diagnostic procedure combines two methods of detecting HIV antibodies: ELISA and Western blot.{{cite journal | author = Gürtler L | title = Difficulties and strategies of HIV diagnosis. | journal = Lancet | volume = 348 | issue = 9021 | pages = 176-9 | year = 1996 | id = {{PMID|8684160}}}}

Denialists claim the antiretroviral treatments prescribed to AIDS patients often cause the very symptoms they are supposed to delay.[http://www.duesberg.com/articles/azt.html Articles on AZT hosted by Peter Duesberg] To support this claim, they cite two studies from the late 1980s whose authors said they found it difficult to distinguish adverse events possibly associated with administration of Retrovir (AZT) from underlying signs of HIV disease or intercurrent illnesses.[http://www.virusmyth.net/aids/data/pdr-azt.htm Virusmyth.net: HIV & AIDS - AZT, Zidovudine, Retrovir - Product Information]

Mainstream scientists and doctors argue that dissidents are ignoring or unjustifiably dismissing abundant evidence demonstrating the effectiveness of modern antiretroviral medication. Harmful side effects do occur, and in some cases these can be severe or even deadly. However, multiple studies — conducted in Africa as well as Western countries — have found that, overall, anti-retroviral drug treatment is associated with a greatly decreased incidence of opportunistic infections and increased survival among HIV-positive people.[http://bmj.bmjjournals.com/cgi/content/full/324/7340/757 Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15983918 Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature]{{cite journal | author = Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d'Arminio Monforte A, Knysz B, Dietrich M, Phillips A, Lundgren J | title = Decline in the AIDS and death rates in the EuroSIDA study: an observational study. | journal = Lancet | volume = 362 | issue = 9377 | pages = 22-9 | year = 2003 | id = {{PMID|12853195}}}}{{cite journal | author = Sterne J, Hernán M, Ledergerber B, Tilling K, Weber R, Sendi P, Rickenbach M, Robins J, Egger M | title = Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. | journal = Lancet | volume = 366 | issue = 9483 | pages = 378-84 | year = | id = {{PMID|16054937}}}}

{{reflist|2}}