Duesberg hypothesis

Template:Short description Template:Use dmy dates Template:Alternative medicine sidebar The Duesberg hypothesis is the claim that AIDS is not caused by HIV, but instead that AIDS is caused by noninfectious factors such as recreational and pharmaceutical drug use and that HIV is merely a harmless passenger virus.<ref name="DuesbergJBiosci"/> The hypothesis was popularized by Peter Duesberg, a professor of biology at University of California, Berkeley, from whom the hypothesis gets its name. The scientific consensus is that the Duesberg hypothesis is incorrect and that HIV is the cause of AIDS.<ref name="niaid">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>World Health Organization HIV and AIDS Programme, from the World Health Organization website. Retrieved 9 March 2007.</ref> The most prominent supporters of the hypothesis are Duesberg himself, biochemist and vitamin proponent David Rasnick, and journalist Celia Farber. The scientific community generally contends that Duesberg's arguments in favor of the hypothesis are the result of cherry-picking predominantly outdated scientific data<ref>Template:Cite journal</ref> and selectively ignoring evidence that demonstrates HIV's role in causing AIDS.<ref name="phenom">Template:Cite journal</ref>

Role of legal and illegal drug use

Duesberg argues that there is a statistical correlation between trends in recreational drug use and trends in AIDS cases.<ref>Template:Cite journal</ref> He argues that the epidemic of AIDS cases in the 1980s corresponds to a supposed epidemic of recreational drug use in the United States and Europe during the same time frame.

These claims are not supported by epidemiologic data. The average yearly increase in opioid-related deaths from 1990 to 2002 was nearly three times the yearly increase from 1979 to 1990, with the greatest increase in 2000–2002, yet AIDS cases and deaths fell dramatically during the mid-to-late-1990s.<ref name="drugusepharmaco">Template:Cite journal</ref> Duesberg's claim that recreational drug use, rather than HIV, was the cause of AIDS has been specifically examined and found to be false. Cohort studies have found that only HIV-positive drug users develop opportunistic infections; HIV-negative drug users do not develop such infections, indicating that HIV rather than drug use is the cause of AIDS.<ref name="niaid"/><ref name="drugusenature">Template:Cite journal</ref>

Duesberg has also argued that nitrite inhalants were the cause of the epidemic of Kaposi sarcoma (KS) in gay men. However, this argument has been described as an example of the fallacy of a statistical confounding effect;<ref>Template:Cite journal</ref> it is now known that a herpesvirus, potentiated by HIV, is responsible for AIDS-associated KS.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Moreover, in addition to recreational drugs, Duesberg argues that anti-HIV drugs such as zidovudine (AZT) can cause AIDS. Duesberg's claim that antiviral medication causes AIDS is regarded as disproven within the scientific community. Placebo-controlled studies have found that AZT as a single agent produces modest and short-lived improvements in survival and delays the development of opportunistic infections; it certainly did not cause AIDS, which develops in both treated and untreated study patients. With the subsequent development of protease inhibitors and highly active antiretroviral therapy, numerous studies have documented the fact that anti-HIV drugs prevent the development of AIDS and substantially prolong survival, further disproving the claim that these drugs "cause" AIDS.<ref name="niaid"/>

Scientific study and rejection of Duesberg's risk-AIDS hypothesis

Several studies have specifically addressed Duesberg's claim that recreational drug abuse or sexual promiscuity were responsible for the manifestations of AIDS. An early study of his claims, published in Nature in 1993, found Duesberg's drug abuse-AIDS hypothesis to have "no basis in fact."<ref name="drugusenature"/>

A large prospective study followed a group of 715 homosexual men in the Vancouver, Canada, area; approximately half were HIV-seropositive or became so during the follow-up period, and the remainder were HIV-seronegative. After more than eight years of follow-up, despite similar rates of drug use, sexual contact, and other supposed risk factors in both groups, only the HIV-positive group suffered from opportunistic infections. Similarly, CD4 counts dropped in the patients who were HIV-infected, but remained stable in the HIV-negative patients, despite similar rates of risk behavior.<ref name="lancet1993"/> The authors concluded that "the risk-AIDS hypothesis ... is clearly rejected by our data," and that "the evidence supports the hypothesis that HIV-1 has an integral role in the CD4 depletion and progressive immune dysfunction that characterise AIDS."<ref name="lancet1993">Template:Cite journal</ref>

Similarly, the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS)—which between them observed more than 8,000 Americans—demonstrated that "the presence of HIV infection is the only factor that is strongly and consistently associated with the conditions that define AIDS."<ref name="macs">MACS and WIHS Studies Provide Overwhelming Evidence That HIV Causes AIDS Template:Webarchive. From the National Institute of Allergy and Infectious Diseases. Retrieved 9 March 2007.</ref> A 2008 study found that recreational drug use (including cannabis, cocaine, poppers, and amphetamines) had no effect on CD4 or CD8 T-cell counts, providing further evidence against a role of recreational drugs as a cause of AIDS.<ref>Template:Cite journal</ref>

Current AIDS definitions

Duesberg argued in 1989 that a significant number of AIDS victims had died without proof of HIV infection.<ref>Template:Cite journal</ref> However, with the use of modern culture techniques and polymerase chain reaction testing, HIV can be demonstrated in virtually all patients with AIDS.<ref name="niaid"/> Since AIDS is now defined partially by the presence of HIV, Duesberg claims it is impossible by definition to offer evidence that AIDS does not require HIV. However, the first definitions of AIDS mentioned no cause and the first AIDS diagnoses were made before HIV was discovered. The addition of HIV positivity to surveillance criteria as an absolutely necessary condition for case reporting occurred only in 1993, after a scientific consensus was established that HIV caused AIDS.<ref>[Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 31(37), 24 Sep 1982] Update on Acquired Immunodeficiency Syndrome (AIDS), United States.</ref><ref>[Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 34(25), 28 June 1985] Revision of the CDC Surveillance Case Definition of Acquired Immunodeficiency Syndrome for National Reporting, United States.</ref><ref>[Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 36(S1), 14 August 1987] Revision of the CDC Surveillance Case Definition for Acquired Immunodeficiency Syndrome.</ref><ref>[Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 41(RR-17), 18 December 1992] 1993 Revised Classification System for HIV Infection and Expanded Surveillance Definition for AIDS Among Adolescents and Adults.</ref>

AIDS in Africa

According to the Duesberg hypothesis, AIDS is not found in Africa. What Duesberg calls "the myth of an African AIDS epidemic,"<ref name = "uirhmj">[Duesberg P "Inventing the AIDS Virus" Regnery, 1997. Template:ISBN] Page 291.</ref> among people"<ref>Discover Magazine feature on Duesberg. Jeanne Linzer, Discover, 15 May 2008, AIDS "Dissident" Seeks Redemption...and a Cure for Cancer. Retrieved 16 May 2008.</ref> exists for several reasons, including:

• The need, according to Duesberg, of the CDC, the WHO, and other health organizations to justify their existences, resulting in their "manufacturing contagious plagues out of noninfectious medical conditions."<ref>[Duesberg P "Inventing the AIDS Virus" Regnery, 1997. Template:ISBN] Page 137.</ref>
• Media sensationalism, with stories that "helped shape the Western impression of an AIDS problem out of control," resulting in high levels of funding.<ref name = "uirhmj"/>
• Willing participation in deception by local doctors who wish to take advantage of this aid money: "African doctors themselves participate in building the myth of the AIDS pandemic."<ref>[Duesberg P "Inventing the AIDS Virus" Regnery, 1997. Template:ISBN] Pages 290-1.</ref>
• Confusion or incompetence on the part of African doctors: "Many common Third World diseases are confused with AIDS even if they are not part of its official definition."<ref>[Duesberg P "Inventing the AIDS Virus" Regnery, 1997. Template:ISBN] Page 293.</ref>

Duesberg states that African AIDS cases are "a collection of long-established, indigenous diseases, such as chronic fevers, weight loss, alias "slim disease," diarrhea, and tuberculosis"<ref name="DuesbergJBiosci">Template:Cite journal</ref> that result from malnutrition and poor sanitation. African AIDS cases, though, have increased in the last three decades as HIV's prevalence has increased<ref>Template:Cite journal</ref> but as malnutrition percentages<ref>Figure of malnutrition percentage decreasesTemplate:Dead link. Retrieved 2 May 2008.</ref> and poor sanitation have declined in many African regions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In addition, while HIV and AIDS are more prevalent in urban than in rural settings in Africa,<ref>"HIV prevalence (%) by gender and urban/rural residence, selected sub-Saharan African countries, 2001-2005 From UNAIDS Joint United Nations Programme on HIV/AIDS. Retrieved 2 May 2008.</ref> malnutrition and poor sanitation are found more commonly in rural than in urban settings.<ref>Template:Cite journal</ref>

According to Duesberg, common diseases are easily misdiagnosed as AIDS in Africa because "the diagnosis of African AIDS is arbitrary" and does not include HIV testing.<ref name="DuesbergJBiosci"/> A definition of AIDS agreed upon in 1985 by the World Health Organization in Bangui did not require a positive HIV test, but since 1985, many African countries have added positive HIV tests to the Bangui criteria for AIDS or changed their definitions to match those of the U.S. Centers for Disease Control.<ref>[1] From the World Health Organization. Retrieved 1 May 2008.</ref> One of the reasons for using more HIV tests despite their expense is that, rather than overestimating AIDS as Duesberg suggests, the Bangui definition alone excluded nearly half of African AIDS patients."<ref>Template:Cite journal</ref>

Duesberg notes that diseases associated with AIDS differ between African and Western populations, concluding that the causes of immunodeficiency must be different. Tuberculosis is much more commonly diagnosed among AIDS patients in Africa than in Western countries, while PCP conforms to the opposite pattern.<ref>Template:Cite journal</ref> Tuberculosis, though, had higher prevalence in Africa than in the West before the spread of HIV. In Africa and the United States, HIV has spurred a similar percentage increase in tuberculosis cases.<ref>Template:Cite journal</ref> PCP may be underestimated in Africa: since machinery "required for accurate testing is relatively rare in many resource-poor areas, including large parts of Africa, PCP is likely to be underdiagnosed in Africa. Consistent with this hypothesis, studies that report the highest rates of PCP in Africa are those that use the most advanced diagnostic methods"<ref>Science Outsold? Correcting the Falsehoods of "Science Sold Out: Does HIV Really Cause AIDS?" Page 15. Retrieved 1 May 2008.</ref> Duesberg also claims that Kaposi's sarcoma is "exclusively diagnosed in male homosexual risk groups using nitrite inhalants and other psychoactive drugs as aphrodisiacs",<ref name="DuesbergJBiosci"/> but the cancer is fairly common among heterosexuals in some parts of Africa,<ref>Template:Cite journal</ref> and is found in heterosexuals in the United States as well.<ref>Template:Cite journal</ref>

Because reported AIDS cases in Africa and other parts of the developing world include a larger proportion of people who do not belong to Duesberg's preferred risk groups of drug addicts and male homosexuals,<ref>Sub-Saharan Africa Template:Webarchive From HIV InSite at the University of California, San Francisco. Retrieved 2 May 2008.</ref> Duesberg writes on his website that "There are no risk groups in Africa, like drug addicts and homosexuals." However, many studies have addressed the issue of risk groups in Africa and concluded that the risk of AIDS is not equally distributed.<ref>Template:Cite journal One recent article on AIDS and men who have sex with men (MSM).</ref><ref>Template:Cite journal A recent article on various risk groups and risk factors in Africa.</ref> In addition, AIDS in Africa largely kills sexually active working-age adults.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

South African president Thabo Mbeki accepted Duesberg's hypothesis and, through the mid-2000s, rejected offers of medical assistance to fight HIV infection, a policy of inaction that cost over 300,000 lives.<ref>Template:Cite book</ref>

Duesberg claims that retroviruses like HIV must be harmless to survive

Duesberg argues that retroviruses like HIV must be harmless to survive: they do not kill cells and they do not cause cancer, he maintains. Duesberg writes, "retroviruses do not kill cells because they depend on viable cells for the replication of their RNA from viral DNA integrated into cellular DNA."<ref name="DuesbergJBiosci"/> Duesberg elsewhere states that "the typical virus reproduces by entering a living cell and commandeering the cell's resources in order to make new virus particles, a process that ends with the disintegration of the dead cell."<ref>[Duesberg P "Inventing the AIDS Virus" Regnery, 1997. Template:ISBN] Page 90.</ref>

Duesberg also rejects the involvement of retroviruses and other viruses in cancer. To him, virus-associated cancers are "freak accidents of nature" that do not warrant research programs such as the war on cancer. Duesberg rejects a role in cancer for numerous viruses, including leukemia viruses, Epstein–Barr virus, human papilloma virus, hepatitis B, feline leukemia virus, and human T-lymphotropic virus.<ref name="inventing">Duesberg P "Inventing the AIDS Virus" Regnery, 1997. Template:ISBN</ref>

Duesberg claims that the supposedly innocuous nature of all retroviruses is supported by what he considers to be their normal mode of proliferation: infection from mother to child in utero. Duesberg does not suggest that HIV is an endogenous retrovirus, a virus integrated into the germline and genetically heritable:

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Scientific response to the Duesberg hypothesis

The consensus in the scientific community is that the Duesberg hypothesis has been refuted by a large and growing mass of evidence showing that HIV causes AIDS, that the amount of virus in the blood correlates with disease progression, that a plausible mechanism for HIV's action has been proposed, and that anti-HIV medication decreases mortality and opportunistic infection in people with AIDS.<ref name="niaid"/>

In Template:Nat issue of Science (Vol. 266, No. 5191),<ref name="phenom" /> Duesberg's methods and claims were evaluated in a group of articles. The authors concluded that

• It is abundantly evident that HIV causes disease and death in hemophiliacs, a group generally lacking Duesberg's proposed risk factors.<ref name="niaid"/><ref>Template:Cite journal</ref>
• HIV fulfills Koch's postulates, which are one set of criteria for demonstrating a causal relationship between a microbe and a disease.<ref>Template:Cite journal</ref><ref>Template:Cite journal Full text available Template:Webarchive from National Institutes of Health website.</ref> (Subsequently, additional data further demonstrated the fulfillment of Koch's postulates.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>)
• the AIDS epidemic in Thailand cited by Duesberg as confirmation of his hypothesis is in fact evidence of the role of HIV in AIDS.<ref>Template:Cite journal</ref>
• According to researchers who conducted large-scale studies of AZT, the drug does not cause AIDS. Furthermore, researchers acknowledged that recreational drugs do cause immune abnormalities, though not the type of immunodeficiency seen in AIDS.<ref>Template:Cite journal</ref>

Effectiveness of antiretroviral medication

The vast majority of people with AIDS have never received antiretroviral drugs, including those in developed countries prior to the licensure of AZT (zidovudine) in 1987, and people in developing countries today where very few individuals have access to these medications.<ref>UNAIDS, 2003 Template:Webarchive.</ref>

The NIAID reports that

in the mid-1980s, clinical trials enrolling patients with AIDS found that AZT given as single-drug therapy conferred a modest survival advantage compared [with] placebo. Among HIV-infected patients who had not yet developed AIDS, placebo-controlled trials found that AZT given as single-drug therapy delayed, for a year or two, the onset of AIDS-related illnesses. Significantly, long-term follow-up of these trials did not show a prolonged benefit of AZT, but also did not indicate that the drug increased disease progression or mortality. The lack of excess AIDS cases and death in the AZT arms of these placebo-controlled trials in effect counters the argument that AZT causes AIDS. Subsequent clinical trials found that patients receiving two-drug combinations had up to 50 percent improvements in time to progression to AIDS and in survival when compared with people receiving single-drug therapy. In more recent years, three-drug combination therapies have produced another 50 to 80 percent improvement in progression to AIDS and in survival when compared with two-drug regimens in clinical trials.<ref>{{#invoke:citation/CS1|citation

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Opponents claim that nearly all HIV-positive people will develop AIDS

Duesberg claims as support for his idea that many drug-free HIV-positive people have not yet developed AIDS; HIV/AIDS scientists note that many drug-free HIV-positive people have developed AIDS, and that, in the absence of medical treatment or rare genetic factors postulated to delay disease progression, it is very likely that nearly all HIV-positive people will eventually develop AIDS. Scientists also note that HIV-negative drug users do not suffer from immune system collapse.<ref name="drugusenature"/>

See also

• HIV/AIDS denialism
• Inventing the AIDS Virus

External links

• Peter Duesberg's website
• The Evidence That HIV Causes AIDS Template:Webarchive: from the National Institute of Allergy and Infectious Diseases
• How HIV Causes AIDS: National Institutes of Health fact sheet.
• Koch's Postulates and the Etiology of AIDS: An Historical Perspective Template:Webarchive.