Surveillance data have been useful in developing prevention and control programs for persons at risk of HIV infection. AIDS prevention programs continue to be based on our understanding of scientifically defined HIV transmission modes because prevention of AIDS is prevention of HIV. To deviate from or ignore this concept would result in an unconscionable tragedy.
Brenda W. Garza
D. Peter Drotman, M.D., M.P.H.
Harold W. Jaffe, M.D.
Division of HIV/AIDS
National Center for Infectious Disease
Centers for Disease Control and Prevention
Atlanta, GA
"What Causes AIDS?" contains misleading and incorrect information questioning the contagious nature of HIV infection and its causal role for AIDS. This has serious consequences, as this infection almost invariably results in long, painful, terminal illnesses and death. The authors are distinguished in fields far removed from the epidemiology of HIV and AIDS about which they pontificate. Would any of your readers hire an electrician to repair a faulty toilet?
The authors assert, "The only evidence that HIV does cause AIDS is correlation." Correlation has established the causes of many diseases: smoking and lung cancer, Staphylococcus aureus infection and toxic shock syndrome, and ionizing radiation and leukemia, to name a few. They state, "There are many cases of persons with all the symptoms of AIDS who do not have any HIV infection." This is not surprising as immune suppression, the underlying cause of AIDS, may result from defective genetic mechanisms, toxic chemical exposures, medicinal treatments, and infections other than HIV. They also assert, "There are also many cases of persons who have been infected by HIV-and show no signs of illness." About half of all HIV-infected persons develop AIDS within 10 years and of these, 90 percent are dead within two years. In studies observing HIV-infected persons for more than 10 years, over 85 percent have developed AIDS.
The authors claim that the San Francisco Men's Health Study, for which I am "principal investigator," was "designed not to test the HIV theory but to measure the rate at which HIV-positive gay men develop AIDS. They did not compare otherwise similar persons who differ only in HIV status, did not control effectively for drug use, and did not fully report the incidence of AIDS-defining conditions in the HIV-negative men." These assertions are misleading or just plain false.
The San Francisco Men's Health Study is an epidemiological investigation of the cause or causes of AIDS, its transmission, and the natural history of the disease. Participants were a random sample of 1,000 single men living in AIDS-affected areas of San Francisco in 1984. When a serological test for HIV infection became available in late 1984, the participants were tested to determine HIV-infection status. This allowed the investigators to conduct a large number of important analytic studies of causal factors, modes of transmission, and the natural history of HIV infection and AIDS.
An analysis of drug use, AIDS incidence, and progressive immune deficiency, using appropriate statistical techniques and proper controls, was published in 1993. No relationship between drug use and AIDS incidence or immune deficiency progression was found. The advocates of the drug etiology of AIDS have never accepted these findings nor the findings from several other rigorous studies of the drug hypothesis.
Because an AIDS diagnosis is almost invariably followed by death within two years, deaths may be substituted for AIDS diagnoses to evaluate the occurrence of cases among the uninfected. In the San Francisco Men's Health Study, 581 participants, who were uninfected by the HIV on entry, remained uninfected for over eight years. Among them, eight deaths occurred, for a cumulative rate of 1.4 percent. Of the 400 men infected by the HIV, 169 deaths occurred, for a cumulative rate of 42.3 percent. These data are inconsistent with the contention that there were AIDS cases among the uninfected.
Space precludes a complete refutation of the other misstatements which burden the article. The readers of REASON magazine should not be misled about the consequences of HIV infection. As indicated above, these consequences are very serious. Regardless of whether or not HIV infection causes AIDS, it is a strong predictor of premature death.
Warren Winkelstein Jr., M.D., M.P.H.
Professor of Epidemiology (emeritus)
School of Public Health
University of California
Berkeley, CA
It has now been over three years since I first challenged Peter Duesberg and a co-writer that if they really don't believe HIV causes AIDS they should publicly inject themselves with the virus. It would hardly be the first time a doubter of a pathogen-disease hypothesis has intentionally exposed himself. Nevertheless, Duesberg and fellow have steadfastly refused to do so and neither have any of Duesberg's vocal followers volunteered to take their place. They won't shoot up, but as their article "What Causes AIDS? It's An Open Question," shows, they won't shut up, either.
To address just a few major points:
They write that "after spending billions of dollars, HIV researchers are still unable to explain how HIV, a conventional retrovirus with very simple genetic organization, damages the immune system, much less how to stop it."
Only three retroviruses have been discovered, the first barely over a decade ago. How does one become "conventional"? The authors want us to believe that because it is "conventional" and simple genetically it should have been cured by now, but all viruses are genetically simple and we have cures for none of them. What will make curing HIV all the harder is that it is so very unconventional in that unlike any other human virus we know about, it attacks the very immune system and to date our disease-fighting tools have always relied on the immune system as an ally.
As to how it damages the immune system, there are numerous medical journal articles on the subject, the latest in the June 2 issue of Nature. This doesn't mean we understand how HIV works in the same way that we understand, say, internal combustion in a piston engine. Human physiology is infinitely more complicated than a motor. Still, we certainly know more about the actions of HIV than we do about most viruses simply because HIV has been so heavily studied. Finally on this point, knowing the cause and knowing the cure may have little or no relationship. For hundreds of years, people knew that cigarette smoking caused lung cancer, yet the cure rate for lung cancer even today is dismal.
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