AIDS TREATMENT NEWS Issue #356, December 1, 2000
phone 800-TREAT-1-2, or 415-255-0588

Contents

** Structured Treatment Interruption: Important Controlled
Trial in Monkeys
The first randomized controlled test of structured
treatment interruption found that certain immune responses
helped maintain an undetectable viral load during the
interruptions--at least in this study with monkeys. Later,
when treatment was permanently discontinued, the animals
with intermittent drug treatment did better than those that
had been on continuous antiretrovirals.

** Superinfection (Reinfection): New Study in San Francisco
Offers Free Resistance and Viral Load Testing
No one knows if a person who already has HIV can be
infected with a different strain. It is important to find
out, for many reasons, and a new research project is
looking for couples (of any sexual orientation) where both
partners are HIV-positive.

** New Report on World AIDS Epidemic
The United Nations released its annual AIDS report shortly
before World AIDS Day (December 1). It is the best
information anywhere on what is happening with the epidemic
around the world.

** Global Treatment Access: Call for 95% Price Reduction;
New GTAC Organization, Web Site
Doctors Without Borders and other health activists are
calling for large reductions in the prices for essential
drugs in poor countries.

** California: MediCal Income Eligibility Level Raised for
Disabled, Aged
New rules starting January 1 will allow more disabled
Californians to qualify for MediCal (Medicaid).

** Answering the AIDS Denialists: Is AIDS Real?
This article looks at theories that say AIDS does not
exist, or is not a new disease but only a collection of old
ones--and explains some of the history behind earlier
changes in the official definition of AIDS in the U.S.,
changes which caused some public confusion.


***** Structured Treatment Interruption: Important
Controlled Trial in Monkeys

by John S. James

The first randomized, controlled study of structured
treatment interruption (STI) found that monkeys on a three
week on, three week off treatment schedule controlled the
virus about as well as those which were on continuous
therapy (and therefore received twice as much of the
drugs). Also, those in the intermittent-treatment group
became able to control virus without treatment for a six-
month followup period when the drugs were stopped
permanently (after 21 weeks treatment in this study), while
those on continuous therapy usually could not.(1)

These results are not automatically applicable to patients,
for several reasons:

* This treatment was in macaque monkeys infected with
simian immunodeficiency virus (SIV), and treated with an
antiretroviral combination which includes an experimental
drug (PMPA) currently in human use only in clinical trials,
and

* This study began treatment early in infection (six weeks
after exposure), shortly after seroconversion had occurred.
Most patients are not diagnosed until much later, and it is
not known if this strategy would have worked in the animals
if treatment had been started late.

On the other hand, the animal test allowed genetically
similar individuals to all be infected with the same virus
at the same time--making it much easier to see differences
in treatment strategy that otherwise would have been hidden
by large, unknown variations in disease course caused by
these variables.

The researchers also used a new test for HIV-specific
immune function--counting the proportion of virus-specific
CD8 cells by using flow cytometry to measure which of the
cells produce gamma interferon in response to killed virus.
This test (called VIR, for virus-specific immune responses)
did distinguish the animals that could control the virus
from those that could not, while the more common test for
HIV-specific immunity (virus-specific CD4 stimulation
index) did not distinguish between the groups in this
study. (In addition, the new test would appear to be
relatively easy to develop for clinical practice, while the
stimulation-index test of immune function requires highly
trained laboratory staff and would be difficult to make
generally available.)

In this controlled trial three groups of animals were
compared: five which received no treatment, six which
received continuous antiretroviral treatment for 21 weeks,
and six which received four cycles of treatment for three
weeks, separated by three-week periods without the drugs.
The antiretroviral combination used was PMPA, ddI, and
hydroxyurea.

This study was done primarily by the RIGHT Institute
(Research Institute for Genetic and Human Therapy) in
Washington D.C. Franco Lori, M.D., and Julianna Lisziewicz,
Ph.D., are the principal authors.

Comment

Human studies of intermittent antiretroviral treatment are
happening now. If this approach proves successful in
certain identifiable patients, it could at least reduce the
cost and toxicity of antiretroviral therapy--and be a
significant step toward treatment strategies to assist the
immune system to control the virus instead of relying
entirely on antiretroviral drugs.

One hopeful sign was a late-breaker report at the Durban
AIDS conference by Shoshank R. Joshi, M.D., D.M, Retroviral
Physician at MGM hospital in Mumbai, India.(2) Twenty six
of his patients took antiretroviral combination therapy
(AZT or d4T, plus 3TC, plus saquinavir) on alternate
months, because they could not afford continuous treatment.
All of these patients had been recently diagnosed, were
asymptomatic, and had a CD4 count of over 300 but a viral
load over 20,000 when they started the intermittent
therapy. At the end of a year, all of them had undetectable
viral loads, and had remained asymptomatic and without side
effects from the treatment.

References

1. Lori F, Lewis MG, Xu J, and others. Control of SIV
rebound through structured treatment interruption during
early infection. SCIENCE. November 24, 2000; volume 290,
pages 1591-1593.

2. Joshi S, Joshi SS, Vergara PT, and others. Structured
interrupted therapy (SIT): Mumbai cohort. XIII
International AIDS Conference, Durban, South Africa, July
9-14, 2000 [abstract LbOr10].


***** Superinfection (Reinfection): New Study in San
Francisco Offers Free Resistance and Viral Load Testing

by John S. James

A new study in San Francisco will try to find out if
someone who already has HIV can be additionally infected
with a different strain of HIV. Some experts doubt that
such "superinfection" can occur--but no one knows because
cases would not be found by the tests used in standard
medical care.

The answer is very important, for at least three reasons:

(1) If two people who both have HIV have unprotected sex
with each other, are they at risk of additional infection
with a new strain (which might be more virulent, or might
already have resistance to certain antiretrovirals, or
could worsen the illness or complicate treatment in other
ways)?

(2) Whether or not superinfection occurs is very important
for vaccine research. If infection with one strain cannot
prevent infection with another, it would probably be
difficult (although not impossible) for a vaccine to do so.

(3) If superinfection does not occur it would be good news
for HIV-positive patients who need organ transplantation
for any reason, since it would suggest that organs from
HIV-positive donors could be used (instead of being thrown
away, as happens now).

This study, called Positive Partners, will initially enroll
20 sexually active HIV-positive couples. Here is a
description from the researchers, including an explanation
of who can participate, and contacts for more information.
Note that this study requires only two visits to the
research site in San Francisco, for interviews and blood
draws. It does not provide drugs nor require any changes in
one's treatment.

Can drug-resistant HIV be transmitted to someone already
HIV-positive? The Positive Partners Study will try to find
out!

Who is conducting this study and why?

The Positive Partners Study (P2) is a collaboration between
Dr. Robert Grant of the Gladstone Institute of Virology and
Immunology and Dr. Greg Greenwood at the Center for AIDS
Prevention Studies to study superinfection. P2 is a new and
unique study to demonstrate that it is feasible to recruit,
interview, and follow seroconcordant HIV-positive partners.
P2 is designed to examine whether new drug resistant
strains of HIV-1 can be sexually transmitted between
partners who are already both HIV-positive
(superinfection). This project is one key element in Dr.
Grant's broader virological research involving
reexamination of data from several other UCSF studies for
evidence of superinfection.

Who can participate?

Positive Partners will initially enroll 20 sexually active,
HIV-positive partners (M/M, M/F, & M/TG) who are both
taking HIV medications. Participants must be 18 years old
or older. Recruitment is on going so please share this
information with people who might be interested.

What will participants have to do?

Positive Partners will conduct two one-on-one confidential
interviews with each participant. We pay $25 in cash for
each interview completed. In addition, we offer FREE drug
resistance genotyping and phenotyping tests. These tests
determine the genetic structure of the present HIV strain
and how the strain stands up to medications being taken by
persons living with HIV. The tests are fairly new to the
market and are not covered by many insurance plans. They
can cost a patient upwards of $2000. We provide this
testing free of charge and will make the results available
to each participant and their physician, if the participant
chooses to release this information. We will also test for
the participant's T-cell count and viral load. In case
where participants experience a one-log increase in viral
load during the study year we ask them to come in for an
additional interview and specimen collection to see if the
increase is a result of a superinfection. In a case like
this where there has been a large increase in viral load
the drug resistance tests we provide can help participants
and their providers make medical decisions.

Laboratory assays will identify similarities and
differences in partners' viruses that will indicate if
superinfection has occurred (at baseline and 1-year follow-
up).

If I am interested and would like to screen or get more
information, where do I call?

If you or a patient, friend, or partner is interested in
participating or hearing about the study, Positive Partners
can be reached at 415-597-9292.

Where is Positive Partners located?

Positive Partners is located at 74 New Montgomery, Suite
600. This is downtown San Francisco between Market and
Mission Street, just off the BART/MUNI Montgomery Street
station.

For more information, call the Positive Partners
recruitment line, 415-597-9292. Or contact Jeff McConnell,
Project Director, Positive Partners Study, Center for AIDS
Prevention Studies, University of California San Francisco,
74 New Montgomery Street, Suite 700, San Francisco, CA
94105, phone 415-597-9394, fax: 415-597-9240,
jmcconnell@....

***** New Report on World AIDS Epidemic

by John S. James

On November 28 UNAIDS (the Joint United Nations Programme
on HIV/AIDS) and the World Health Organization issued their
annual report on the status of the global epidemic--an
authoritative though not infallible report that provides a
worldwide common basis for discussion. The 30-page AIDS
EPIDEMIC UPDATE: DECEMBER 2000 is difficult to summarize,
but here are some of the highlights:

* In 2000, the best estimates predict that 3 million people
will die of AIDS, and 5.3 million will become newly
infected with HIV. There have been over 21 million AIDS
deaths since the epidemic began.

* A major trouble spot is Eastern Europe. For example, the
Russian Federation will have more new HIV infections in
2000 than in all previous years combined.

* In Africa, new infections are down slightly (3.8 million
last year vs. 4 million the year before)--partly due to a
smaller pool of people at risk since so many have been
infected already, and partly due to prevention efforts in
some countries. Deaths are up slightly. An estimated 8.8%
of all adults (ages 15-49 years in these statistics) in
sub-Saharan Africa as a whole now have HIV, and over 25
million adults and children in this region are now living
with HIV. No one knows if the epidemic will explode in
Nigeria and other countries, as it has in southern Africa.

* In the U.S. and Western Europe, "prevention efforts are
stalled," with about 45,000 adults and children being
infected with HIV in North America.

* Australia and New Zealand hardly appear in the report,
with only 500 new HIV infections in 2000. (Australia has
long had effective prevention programs which the U.S. and
many other countries could have implemented but did not.)

* There are many success stories in certain areas; these
can be models for wider use. For example, in Belarus, a
harm-reduction program for drug users prevented 2,000 cases
of infection by its second year of operation, at a cost of
about $29 per infection prevented. And in Zimbabwe, church
groups have recruited community members to assist
households keeping orphans in homes where they live,
helping over 2700 households at a cost of about $10 per
family supported, vs. several hundred dollars a year to
keep a child in an orphanage in Africa. And in one study,
factory workers were trained to provide prevention
information to their colleagues--cutting new infections by
a third compared to factories that did not provide the
information, at a cost of about $6 per worker.

"At least U.S. $1.5 billion a year could make it possible
to achieve massively higher levels of implementation of all
the major components of successful prevention programmes
for the whole of sub-Saharan Africa. These would cover
sexual, mother-to-child and transfusion-related HIV
transmission, and would involve approaches ranging from
awareness campaigns through the media to voluntary HIV
counseling and testing, and the promotion and supply of
condoms." Another $1.5 billion would provide basic care for
many of the orphans and AIDS patients who need it, although
"making a start on coverage with combination antiretroviral
therapy would add several billion dollars annually to the
bill."


***** Global Treatment Access: Call for 95% Price
Reduction; New GTAC Organization, Web Site

Shortly before World AIDS Day (December 1), a coalition of
AIDS and health groups including MSF (Médecins Sans
Frontièrs, or Doctors Without Borders) called on
pharmaceutical companies to reduce prices of AIDS drugs 95%
in poor countries--reductions comparable to those already
in use for vaccines and contraceptives. MSF has carefully
compiled information from generic drug manufacturers and
other sources which indicates that the drugs could be sold
profitably at that price. Price reductions up to 85% have
already been offered by some companies, but even then drug
costs approach $1,000 to treat each patient for one year--
much too expensive for most individuals and governments in
poor countries.

The changing standard of care in rich countries (with
doctors now waiting longer to begin antiretroviral
treatment, reducing the number of patients who need to be
treated), and possibly structured treatment interruption
(see "Structured Treatment Interruption: Important
Controlled Trial in Monkeys" in this issue) may also help
to reduce costs, making top-quality treatment available for
many patients who would otherwise have none. (These factors
may not have been taken into account in the UNAIDS estimate
of several billion dollars annually for "making a start" on
antiretroviral therapy for sub-Saharan Africa.)

For recent information on international treatment-access
activism, see the new Web site of the Global Treatment
Access Campaign (GTAC),
http://www.globaltreatmentaccess.org

Note: While this issue is dated December 1, it went to
press too early to include announcements and other news
released on that day.


***** California: MediCal Income Eligibility Level Raised
for Disabled, Aged

Starting January 1 more disabled and elderly people will
become eligible for MediCal (Medicaid) in California.
Benefits expert Tom McCormack circulated the following
email explaining the change:

Effective January 1, 2001, California will raise its
MediCal (Medicaid) income eligibility level for single aged
and disabled persons to $926 monthly. That level had
previously been fixed at $692 (which remains the income
level for SSI and the state supplement to SSI).

The state will use the same income-counting methodology and
income disregards as are used in the SSI program:

* $20 of any income is disregarded;

*$65 and half the rest of earnings are disregarded;

*Impairment Related Work Expenses (IRWEs, cash out-of-
pocket medical costs, including transportation to medical
care) of the disabled are disregarded;

*One third of received child support is disregarded;

* Part of earnings of students under age 21 are
disregarded;

*Other miscellaneous disregards [see Section 1612 of the
Social Security Act.]; and

*Regular MediCal asset exemptions will continue to include
one lived-in home of any value, one vehicle of any value,
and limited amounts of liquid assets and funds designated
for burial.

Applications will be taken by county social services
offices--NOT by SSA.


***** Answering the AIDS Denialists: Is AIDS Real?

by Bruce Mirken

[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.


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