HIV/AIDS Skepticism

The advent of antiretroviral “cocktails”, combination antiretroviral therapy, HAART, is said to have made HIV/AIDS a manageable chronic disease to the extent that “HIV-positive” individuals can lead essentially normal lives for essentially normal life-spans — at least according to official statements repeated by the media from interviews with gurus and VIPs and from press releases put out by government agencies and by drug companies.

The technical literature, on the other hand, is replete with descriptions of highly unpleasant, health-threatening “side” effects from all antiretroviral drugs and combinations. Note for instance that the Treatment Guidelines  have been revised once or twice a year for well over a decade, and revisions are made on-line even more frequently, raising suspicions as to just when the treatment became so successful as to permit normal living and why recommendations have still needed to be revised so often.
Moreover, if treatments are so successful, what need is there for patients to “understand the . . . risks of therapy” [emphasis added] and to consider deferring therapy? (Treatment Guidelines, 27 March 2012 version, introductory pages):
“Patients starting ART should be willing and able to commit to treatment and should understand the benefits and risks of therapy and the importance of adherence . . . . Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors”.

One wonders, too, at such sections in the Guidelines as “What Not to Use: Table 8. Antiretroviral Regimens or Components That Should Not Be Offered At Any Time”.
This includes not only the NRTI monotherapy and Dual-NRTI therapy that was officially lauded from the late 1980s into the mid-1990s before being suddenly superseded. “What Not to Use” also lists a goodly number of combination therapies that were earlier recommended!

There are hints everywhere in these Guidelines that what was once recommended is to be avoided; for example, Table 8 includes such rather inscrutable comments as
“Clinicians caring for patients who are clinically stable on regimens containing TDF + ddI should consider altering the NRTIs to avoid this combination”: Obviously this earlier recommended treatment isn’t all that good. Some earlier combinations are now labeled “When no other ARV options are available and potential benefits outweigh the risks”: What risks? That one might lead a normal life?

“Adherence to treatment” qualifies for quite a bit of discussion in which “adverse drug effects” and “treatment fatigue” are mentioned only toward the end of a list that includes what some people (including me) might regard as nonsense, e.g. “low levels of health literacy . . . or numeracy (ability to understand numerical-related health information)”, which presumably means not believing what they are told when they complain of the debilitating effects of the treatment.

“Adverse Effects of Antiretroviral Agents” (pp. K7-11) documents that all antiretroviral drugs have such nasty “side” effects as “Bleeding events . . . Bone marrow suppression . . . Cardiovascular disease . . . Central nervous system (CNS) effects . . . Diabetes mellitus
(DM)/insulin resistance . . . Dyslipidemia . . . Gastrointestinal (GI) effects . . . Hepatic effects . . . Hypersensitivity reaction . . . Lactic acidosis (NRTIs, especially d4T, ZDV, and ddI ) . . . Lipodystrophy . . . Myopathy/elevated creatine phosphokinase . . . Nephrotoxicity/urolithiasis . . . Osteopenia/osteoporosis . . . Peripheral neuropathy . . . Rash (All NNRTIs) . . . Stevens-Johnson syndrome (SJS)/ toxic epidermal necrosis (TEN)”.
Here’s a thought experiment: How many people treated with these medications had to develop one of these “side” effects before it was noted and acknowledged? Keeping in mind that when an HIV/AIDS patient is being treated, deterioration in health is usually ascribed at first to “HIV”?

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This blog post was stimulated by a recent press release (31 December 2012) from the Food and Drug Administration: “FDA approves first anti-diarrheal drug for HIV/AIDS patients — Fulyzaq is the second botanical drug approved by the agency . . . . [It is to be used] to relieve symptoms of diarrhea in HIV/AIDS patients taking antiretroviral therapy . . . . Diarrhea is experienced by many HIV/AIDS patients and is a common reason why patients discontinue or switch their antiretroviral therapies. . . . The median number of daily watery bowel movements was 2.5” (emphasis added; hardly the normal life claimed in official propaganda).
A minor point of interest here is that a “botanical drug” is good when recommended by an official agency, but of course not when it comes from anyone who advises an “alternative” or “complementary” medical approach (“More mainstream alternative treatment for ‘HIV/AIDS’”).

The main general point I want to make is that one learns about the real effects of antiretroviral therapy only from reading between the lines of the official statements and looking into the underlying data. In particular,

continuing praise of new improvements in therapy
means inevitably that earlier treatments
 were less than completely satisfactory,
though that is never stated outright.

For example, that AZT did nothing beneficial and actually killed some proportion of patients has to be inferred from such hints as that it was omitted from estimates of how antiretroviral drugs had decreased mortality “[c]ompared with . . . untreated HIV disease” (“The survival benefits of AIDS treatment in the United States”, Walensky et al., Journal of Infectious Diseases 194 [2006] 11-19); or from noting that when AZT monotherapy was replaced by cocktails, there was an immediate halving  in mortality,  indicating that AZT had been responsible for about 150,000  deaths (“HAART saves lives — but doesn’t prolong them!?”).

The same point applies to how HIV tests are presented to the public, as reliable ways to diagnose infection (e.g. “‘HIV’ tests are self-fulfilling prophecies”; “‘HIV’ tests are demonstrably invalid”; “The Wonderland of ‘HIV’ ‘tests’”; “Health-threatening and life-threatening tests”). By contrast, the technical literature makes plain that no HIV tests or combination of tests can diagnose infection, given the lack of a gold-standard test (S. H. Weiss and E. P. Cowan, “Laboratory detection of human retroviral infection”, Chapter 8 in AIDS and Other Manifestations of HIV Infection, ed. G. P. Wormser, 2004). Straightforward calculations based entirely on official data show that at least half of the people who test positive on HIV tests will suffer no ill health on that account (“Iatrogenic harm following ‘HIV’ testing”, Journal of American Physicians and Surgeons 15 [#2, 2010] 42-6).

After many years of paying attention to these things, I remain astonished that public pronouncements by official agencies are so stunningly at odds with what is in the technical literature. One simply cannot rely on supposedly authoritative sources. Nor is that only my conclusion:

It is simply no longer possible to believe
 much of the clinical research that is published,
or to rely on the judgment of trusted physicians
 or authoritative medical guidelines.
I take no pleasure in this conclusion,
 which I reached slowly and reluctantly
over my two decades as an editor of
 The New England Journal of Medicine
—— Marcia Angell
“Drug companies and doctors: a story of corruption,”
New York Review of Books, 56 #1, 15 January 2009.