What Causes AIDS?

It's an open question.

Most Americans believe they know what causes AIDS. For a decade, scientists, government officials, physicians, journalists, public-service ads, TV shows, and movies have told them that AIDS is caused by a retrovirus called HIV. This virus supposedly infects and kills the "T-cells" of the immune system, leading to an inevitably fatal immune deficiency after an asymptomatic period that averages 10 years or so. Most Americans do not know--because there has been a virtual media blackout on the subject--about a longstanding scientific controversy over the cause of AIDS, a controversy that has become increasingly heated as the official theory's predictions have turned out to be wrong.

Leading biochemical scientists, including University of California at Berkeley retrovirus expert Peter Duesberg and Nobel Prize winner Walter Gilbert, have been warning for years that there is no proof that HIV causes AIDS. The warnings were met first with silence, then with ridicule and contempt. In 1990, for example, Nature published a rare response from the HIV establishment, as represented by Robin A. Weiss of the Institute of Cancer Research in London and Harold W. Jaffe of the U.S. Centers for Disease Control. Weiss and Jaffe compared the doubters to people who think that bad air causes malaria. "We have�been told," they wrote, "that the human immuno-deficiency virus (HIV) originates from outer space, or as a genetically engineered virus for germ warfare which was tested in prisoners and spread from them. Peter H. Duesberg's proposition that HIV is not the cause of AIDS at all is, to our minds, equally absurd." Viewers of ABC's 1993 Day One special on the cause of AIDS--almost the only occasion on which network television has covered the controversy--saw Robert Gallo, the leading exponent of the HIV theory, stomp away from the microphone in a rage when asked to respond to the views of Gilbert and Duesberg.

Such displays of rage and ridicule are familiar to those who question the HIV theory of AIDS. Ever since 1984, when Gallo announced the discovery of what the newspapers call "HIV, the virus that causes AIDS," at a government press conference, the HIV theory has been the basis of all scientific work on AIDS. If the theory is mistaken, billions of dollars have been wasted--and immense harm has been done to persons who have tested positive for antibodies to HIV and therefore have been told to expect an early and painful death. The furious reactions to the suggestion that a colossal mistake may have been made are not surprising, given that the credibility of the biomedical establishment is at stake. It is time to think about the unthinkable, however, because there are at least three reasons for doubting the official theory that HIV causes AIDS.

First, after spending billions of dollars, HIV researchers are still unable to explain how HIV, a conventional retrovirus with a very simple genetic organization, damages the immune system, much less how to stop it. The present stalemate contrasts dramatically with the confidence expressed in 1984. At that time Gallo thought the virus killed cells directly by infecting them, and U.S. government officials predicted a vaccine would be available in two years. Ten years later no vaccine is in sight, and the certainty about how the virus destroys the immune system has dissolved in confusion.

Second, in the absence of any agreement about how HIV causes AIDS, the only evidence that HIV does cause AIDS is correlation. The correlation is imperfect at best, however. There are many cases of persons with all the symptoms of AIDS who do not have any HIV infection. There are also many cases of persons who have been infected by HIV for more than a decade and show no signs of illness.

Third, predictions based on the HIV theory have failed spectacularly. AIDS in the United States and Europe has not spread through the general population. Rather, it remains almost entirely confined to the original risk groups, mainly sexually promiscuous gay men and drug abusers. The number of HIV-infected Americans has remained constant for years instead of increasing rapidly as predicted, which suggests that HIV is an old virus that has been with us for centuries without causing an epidemic.

No one disputes what happens in the early stages of HIV infection. As other viruses do, HIV multiplies rapidly, and it sometimes is accompanied by a mild, flu-like illness. At this stage, while the virus is present in great quantity and causing at most mild illness in the ordinary way, it does no observable damage to the immune system. On the contrary, the immune system rallies as it is supposed to do and speedily reduces the virus to negligible levels. Once this happens, the primary infection is over. If HIV does destroy the immune system, it does so years after the immune system has virtually destroyed it. By then the virus typically infects very few of the immune system's T-cells.

Before these facts were well understood, Robert Gallo and his followers insisted that the virus does its damage by directly infecting and killing cells. In his 1991 autobiography, Gallo ridiculed HIV discoverer Luc Montagnier's view that the virus causes AIDS only in the company of as yet undiscovered "co-factors." Gallo argued that "multifactorial is multi-ignorance" and that, because being infected by HIV was "like being hit by a truck," there was no need to look for additional causes or indirect mechanisms of causation.

All that has changed. As Warner C. Greene, a professor of medicine at the University of California, San Francisco, explained in the September 1993 Scientific American, researchers are increasingly abandoning the direct cell-killing theory because HIV does not infect enough cells: "Even in patients in the late stages of HIV infection with very low blood T4 cell counts, the proportion of those cells that are producing HIV is tiny--about one in 40. In the early stages of chronic infection, fewer than one in 10,000 T4 cells in blood are doing so. If the virus were killing the cells just by directly infecting them, it would almost certainly have to infect a much larger fraction at any one time."

Gallo himself is now among those who are desperately looking for possible cofactors and exploring indirect mechanisms of causation. Perhaps the virus somehow causes other cells of the immune system to destroy T-cells or induces the T-cells to destroy themselves. Perhaps HIV can cause immune-system collapse even when it is no long present in the body. As Gallo put it at an AIDS conference last summer: "The molecular mimicry in which HIV imitates components of the immune system sets events into motion that may be able to proceed in the absence of further whole virus."

But researchers have not been able to confirm experimentally any of the increasingly exotic causal mechanisms that are being proposed, and they do not agree about which of the competing explanations is more plausible. When TheNew York Times interviewed the government's head AIDS researcher, Anthony Fauci, in February, reporter Natalie Angier summarized his view as a sort of stew of all the leading possibilities: "It [HIV] overexcites some immune signaling pathways, while eluding the detection of others. And though the main target of the virus appears to be the famed helper T-cells, or CD-4 cells, which it can infiltrate and kill, the virus also ends up stimulating the response of other immune cells so inappropriately that they eventually collapse from overwork or confusion." No other virus is credited with such a dazzling repertoire of destructive skills.

Perhaps it is the HIV scientists who are collapsing from overwork or confusion. The theory is getting ever more complicated, without getting any nearer to a solution. This is a classic sign of a deteriorating scientific paradigm. But as HIV scientists grow ever more confused about how the virus is supposed to be causing AIDS, their refusal to consider the possibility that it may not be the cause is as rigid as ever. On the rare occasions when they answer questions on the subject, they explain that "unassailable epidemiological evidence" has established HIV as the cause of AIDS. In short, they rely on correlation.

The seemingly close correlation between AIDS and HIV is largely an artifact of the misleading definition of AIDS used by the U.S. government's Centers for Disease Control. AIDS is a syndrome defined by the presence of one or more of 30 independent diseases--when accompanied by a positive result on a test that detects antibodies to HIV. The same disease conditions are not defined as AIDS when the antibody test is negative. Tuberculosis with a positive antibody test is AIDS; tuberculosis with a negative test is just TB.

The skewed definition of AIDS makes a close correlation with HIV inevitable, regardless of the facts. This situation was briefly exposed at the International AIDS Conference in Amsterdam in 1992, when the existence of dozens of suppressed "AIDS without HIV" cases first became publicly known. Instead of considering the obvious implications of these cases for the HIV theory, the authorities at the CDC, who had known about some of the cases for years but had kept the subject under wraps, quickly buried the anomaly by inventing a new disease called ICL (Idiopathic CD4+Lympho-cytopenia)--a conveniently forgettable name that means "AIDS without HIV."

There are probably thousands of cases of AIDS without HIV in the United States alone. Peter Duesberg found 4,621 cases recorded in the literature, 1,691 of them in this country. (Such cases tend to disappear from the official statistics because, once it's clear that HIV is absent, the CDC no longer counts them as AIDS.) In a 1993 article published in Bio/Technology, Duesberg documented the consistent failure of the CDC to report on the true incidence of positive HIV tests in AIDS cases. The CDC concedes that at least 40,000 "AIDS cases" were diagnosed on the basis of presumptive criteria--that is, without antibody testing, on the basis of diseases such as Kaposi's sarcoma. Yet these diseases can occur without HIV or immune deficiency. Perhaps some of the patients diagnosed as having AIDS would have tested negative, or actually did test negative, for HIV. Physicians and health departments have an incentive to diagnose patients with AIDS symptoms as AIDS cases whenever they can, because the federal government pays the medical expenses of AIDS patients under the Ryan White Act but not of persons equally sick with the same diseases who test negative for HIV antibodies.

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

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    Excellent article, apparently exposes the bias in the scientific community towards pandering to those who choose dangerous lifestyles. It seems the money flowing to these flawed help projects is more important than actually helping the sick. Abstinence again is ignored as an option for the dangers involved. A moral choice is never mentioned, as usual. Avoid pain, and have fun- is our cultures general mantra, as pseudo scientists proclaim their flawed bandaid.

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