Talk:HIV/AIDS/Archive 7

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Merge request

I have requested a merge from AIDS reappraisal because we ought not to have two pages, one presenting the "mainstream" POV and another presenting the "dissenting" POV. We should strive to make all our articles NPOV. Problems exist in both articles presently, and both are in need of cleanup and balance. I think at least a partial merge will bring more attention to the real controversies that exist while putting more scrutiny on the claims that ought to be given less weight (and the evidence which makes them less believable, etc.). Whig 04:37, 12 Jun 2005 (UTC)

Rather than sharing your general philosophical bent, do you have a concrete suggestion on what you find of value in the reappraisal article that this article would benefit from incorporating. Rather than sticking a template on top of the article, perhaps you could make an actual suggestion of what merits merging? In general, articles about controversies suck, and the reappraisal article is no exception. Moving suckiness here isn't going to improve here. Until the recent tinkering, there was more than adequate coverage of revisionism here. - Nunh-huh 04:45, 12 Jun 2005 (UTC)

The term "revisionism" is pretty weighted. Do you think there are any meritous facts in the AIDS reappraisal article at all? Whig 05:27, 12 Jun 2005 (UTC)

Let's consider this section:

Although HIV cannot be found in the blood of people with AIDS, a range of antibody, antigen, RNA tests and cell culture techniques provide indirect evidence of HIV activity. These tests, when performed on healthy people, may also provide similar evidence, clouding the issue somewhat, especially as even if HIV may cause some people to develop AIDS, some people have been identified as "long-term non-progressors" and never develop symptomology consistent with a diagnosis of AIDS. Indirect evidence aside, HIV has never been isolated directly.

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Accurate? If so, it should be merged. If not, it should be corrected in the AIDS reappraisal article. Whig 05:31, 12 Jun 2005 (UTC)

The AIDS article cannot contain all accurate statements about AIDS. "If accurate, include it" is an inappropriate heuristic. The question to be asked is "would incorporation of this material improve the article". If so, it should be incorporated, if not, not. Reasons an accurate statement might not improve an article is that it is trivial, or it adds very little additional information, is repetitive, or is not terribly pertinent. - Nunh-huh 06:36, 12 Jun 2005 (UTC)

An excellent point, but if this statement is true, and is relevant to the claim that AIDS=HIV (which the article presently states) then it is properly included. If HIV is not found in the blood of people with AIDS, then it tends to discount the claim. Perhaps prior HIV infection triggers an immune response which, perhaps like multiple sclerosis, results in an abnormal immune system thereafter. In this case, we could say that HIV triggers AIDS in vulnerable people (excluding non-progressors), but we could not fairly say that AIDS is simply HIV infection. If this makes the article a bit more complex than otherwise, that may seem unfortunate, but our desire should be accuracy rather than simplicity. Whig 03:30, 13 Jun 2005 (UTC)

WHen denialists say "HIV is not found in the blood of people with AIDS", they mean that the whole, intact, virus can not be isolated. The virus, however, is present in people with AIDS; its presense can be assessed by checking for viral RNA and proteins, so the "alternative" theory that you've conjured up is unnecessary. Such speculations certainly have no place in the AIDS article. - Nunh-huh 05:04, 13 Jun 2005 (UTC)

Can we please abstain from calling people who pose questions "denialists"? It is ad hominem and does not advance the discussion at all. As I understand the matter, and please correct me if my understanding is incorrect, "checking for viral RNA and proteins" are based on use of the polymerase chain reaction, which Kary Mullis, the inventor of PCR, disputes as being proof of an exogenous virus. Other interpretations seem to exist, and I am unaware of studies that support or refute them, such as that the PCR results may indicate part of the germ line. In any case, I don't think (but stand to be corrected) viral load tests are commonly used to diagnose AIDS, nor whether studies have been done to find whether they may exist in people who test negative for HIV antibodies. To a lay person like myself, it is hard to know that one interpretation is correct and another wrong merely based upon the number of people on either side of the dispute. This is, in any case, a real factual dispute, is it not? If not, then what agenda do you suppose prominent scientists like Mullis have for disagreeing with the mainstream?

You can certainly call the denialists anything you choose. It's not an ad hominem term. PCR is used in some tests of viral RNA, but in no tests of proteins. Viral load tests are used routinely in the management of AIDS. I can't guess why Mullis chooses to disagree with everyone else, or fails to recognize years of clinical experience. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

I just watched a show on Discovery earlier today about T.rex and a recent dispute over whether it was a carnivore or a carrion eater. The carnivore position has been held as mainstream for many decades, yet the measurement of the forelimbs led one iconoclastic scientist to question that consensus, and based on the information presented and the opinions of many other researchers, apparently the carrion eater hypothesis now has at least a certain amount of legitimate support. If the "whole, intact, virus can not be isolated" according to your own statement above, and if it is undisputed, then it is a fact that ought to be included with appropriately cited interpretations. Whig 03:57, 14 Jun 2005 (UTC)

Can you isolate a "whole, intact, virus" from the bloodstream of a person with a rhinovirus-caused headcold? No. Nonetheless, rhinoviruses do cause headcolds. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

"A virus isolated from the nasal secretions of a calf with acute respiratory disease was found to possess the general properties of rhinoviruses. Serologically it was related to the M-17 strain, a type 1 bovine rhinovirus, but distinct from the EC11 strain representing type 2. Seroconversion in neutralising antibody to the isolate was demonstrated in paired serum samples derived from the calf. This is the first report of bovine rhinovirus isolation in the Sudan and Africa. Whether bovine rhinoviruses play any significant role in bovine respiratory disease in the Sudan is not known and has yet to be determined." [1] That was a result from a quick Google search for rhinovirus isolation, and while it didn't involve isolation from the bloodstream of "a person with a rhinovirus-caused headcold" it does seem likely that some such rhinoviruses have been isolated from similar nasal secretions. Has this truly never been done? In any case, as I understand it, the problem with rhinoviruses in general is that there are so many and they mutate so quickly, plus the health impact is generally so minor as to not be worth trying to create vaccines. Influenza, however, has clearly been isolated and immunizations are commonly given to vulnerable people. Whig 05:24, 14 Jun 2005 (UTC)

Infection pattern

In North America and Western Europe, AIDS affects specific groups of people, and is fragmented into distinct sub-epidemics with different AIDS-defining diseases. According to the definition from WHO and the US health authority CDC, AIDS in Africa looks completely different from the corresponding syndrome in North America and Western Europe; one example that has been cited is that in Africa AIDS affects roughly equal numbers of men and women, while in North America and Western Europe it affects more men than women. Another statistic that is sometimes cited is that AIDS is highly correlated with drug use in Western countries, while it is associated with malnutrition and poor living conditions in Africa.

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Accurate? If so, it should be merged. If not, it should be corrected in the AIDS reappraisal article. Whig 05:35, 12 Jun 2005 (UTC)

This passage is used in the revisionist article in order to use the (outdated) WHO definition to cast doubt upon causation, when in fact the inadequacy of the old definition is that as an operational definition it fails to discriminate who is HIV positive and who is not. I don't believe there's any important facts in this passage that haven't appeared in the AIDS article, though of course I can't tell if they are in the current revision, as it's being continually tinkered with. - Nunh-huh 06:36, 12 Jun 2005 (UTC)

If this definition is outdated and no longer accurate, can you provide the more up-to-date and accurate definition? Is there now a universal definition which applies in the US, Canada, Europe and Africa? Why does AIDS remain a predominantly male disease in North America and Europe if it is claimed to affect relatively equal numbers of men and women in Africa? Is this a definitional problem, is this due to different vectors of infection (unsanitary needles in Africa, for instance), or is there some other reason for this disparity? Whig 03:30, 13 Jun 2005 (UTC)

Diseases are not defined, they are described. Operational definitions must be used before an etiology is known: in AIDS, the etiology is now known and operational definitions are useful only where testing for the virus is impractical or economically infeasible, and for prognostic indications. Please read the references I've left you on my talk page. This is not a definitional problem: different socioeconomic and sexual sociologic factors account for differences in diseasse distribution in various nations and continents. - Nunh-huh 05:04, 13 Jun 2005 (UTC)

Is the etiology of AIDS in North America and Europe known to be the same as the etiology of AIDS in Africa? The references you left me on your talk page don't answer this question.

The link to the website I left there does. The link alone won't do much: you'll have to read it. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

Quoting:

• HAART has had a significant impact on survival 10 years after HIV infection in all age groups: "Survival after introduction of HAART in people with known duration of HIV-1 infection. The CASCADE Collaboration. Concerted Action on Serconversion to AIDS and Death in Europe." Lancet. 2000;355:1158-1159.
• HAART has dramatically increased the time from HIV infection to AIDS: Tassie JM, Grabar S, Lancar R, et al. "Time to AIDS from 1992 to 1999 in HIV-1-infected subjects with known data of infection." J Acquir Immune Defic Syndr. 2002;30:81-87.
• HAART has increased the chance of surviving for 2 years after AIDS onset: Fordyce EJ, Singh TP, Nash D, et al. "Survival rates in NYC in the era of combination ART." J Acquir Immune Defic Syndr. 2002;30:111-118
• Reduction of maternal-child transmission risk: Connor EM, Sperling RS, Gelber R, et al. "Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment." N Engl J Med. 1994;331:1173-1180.

None of these seem from their titles to be about etiology at all, much less a comparison of North American, European and African AIDS. Whig 03:57, 14 Jun 2005 (UTC)

Yes, the link you didn't list deals with the strawman of expecting identical disease patterns in disparate cultures.. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

Is AIDS inconsistently defined?

Some of the approximately 30 AIDS-defining diseases, including Kaposi's Sarcoma and Pneumocystis carinii pneumonia (PCP), are considered diagnostic of AIDS only when HIV antibodies are present. In the absence of such evidence, these diseases are thought to be related to other immune problems, and are not diagnosed as AIDS. The definition of AIDS is an example of circular logic: because diagnosis with AIDS requires the presence of HIV antibodies, there can be no AIDS without HIV, by definition. Moreover, many of the AIDS-defining diseases, such as cervical cancer, have nothing to do with immune deficiency, and should not be considered part of the definition of AIDS.

AIDS was originally defined without reference to HIV—by necessity, since AIDS was defined as a syndrome before HIV was discovered. The first definition of AIDS by the CDC in September 1982 listed 13 diseases, "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." Supporters of the HIV theory claim that it is not uncommon in medical science for a disease to first be described in terms of its physical manifestations, and to later have its definition altered as its causes become more evident.

HIV was discovered in 1984, and a year later, after discussion with epidemiologists, the CDC changed its operational definition of AIDS to add a small additional number of conditions which would be considered AIDS-defining if (and only if) they occurred in conjunction with a positive HIV test. The original list of conditions continued to trigger an AIDS diagnosis with or without a positive HIV test. Once the idea that HIV causes AIDS had become widely accepted, it was added to the definition of the syndrome.

As experience with the disease continued, it became clear that it was associated with a broader array of illnesses than those initially identified. In 1987 the CDC added some of these to the case definition, including encephalopathy and wasting syndrome. These had not been in the initial definition because they are not conditions that are recorded during epidemiological surveillance.

It became apparent, however, that the operational case definition did not adequately reflect clinical experience. There were patients who were HIV infected but who did not have AIDS-defining illnesses who were doing poorly, and others who had AIDS-defining illnesses (such as one Kaposi's sarcoma lesion) yet were doing well. In January, 1993, the definition was again changed, to trigger an AIDS diagnosis on the basis of a CD4 cell count below 200 or a CD4 percentage below 14, and adding additional indicator diseases based on epidemiological observation: invasive cervical cancer, pulmonary tuberculosis and recurrent pneumonia. The core list of diseases identified in the original definition of the disease in 1982 continue to be AIDS-defining, even if an HIV test is not performed.

It is for these reasons that the changing AIDS definition is merely a reflection of a broadened understanding of the disease, rather than a "circular" definition requiring a specific etiology. There is a strong correlation between HIV and AIDS, and thus it is perfectly natural for the presence of HIV antibodies to be a defining characteristic of AIDS.

There is no consistent definition of AIDS across political or international boundaries. In Africa, a laboratory test is not required for a diagnosis of AIDS—this is because impoverished nations consider the test too expensive for routine use. This leaves global AIDS epidemiology without clear standards or norms.

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Accurate? If so, it should be merged. If not, it should be corrected in the AIDS reappraisal article. Whig 05:36, 12 Jun 2005 (UTC)

Actually I personally find this section to be internally inconsistent and needs serious copyediting anyhow. Whig 05:47, 12 Jun 2005 (UTC)

Actually, it's intentionally misleading, as it suggests that AIDS is a disease that is "defined" rather than described. Why are you suggesting a section you find internally inconsistent as beneficial? - Nunh-huh 06:36, 12 Jun 2005 (UTC)

I don't think we need to assume that inconsistencies are intentional deception, rather there have been multiple editors who have made statements that contradict other statements made by other editors. I'm certainly not in favor of adding this section without substantial cleanup. The internal inconsistency that I see here is that one statement claims that the description employs circular logic (if AIDS is described by a set of conditions "in the presence of HIV antibodies" where the exact same set of conditions "in the absence of HIV antibodies" would not be considered AIDS, then it seems circular to me), whereas another statement claims that the description is not circular but just a "broadened understanding" (this seems like a non sequitur to me). Perhaps what is needed is a more clarified description/definition (which, see the section above this where I've asked what the up-to-date and accurate definition is). Whig 03:30, 13 Jun 2005 (UTC)

Please see the link I left you on my talk page. It will explain why the charge of circular logic is invalid.- Nunh-huh 05:04, 13 Jun 2005 (UTC)

For those joining us, I believe Nunh-huh refers to this link: [2] — it's interesting reading, though it begins with a strawman analogy to cigarette smoking and lung cancer, and I haven't yet had time to review it fully. Does this article fairly and accurately reflect your personal position, Nunh-huh? Whig 03:57, 14 Jun 2005 (UTC)

I don't prescribe to dogmas, but don't recall anything significant there that's wrong. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

In regards to the "AIDS defining illness" Kaposi's sarcoma I found the following link that may be interesting: [3] — the contention seems to be that KS correlates with amyl nitrite use, though this may be only a co-factor. Could anyone with some medical background comment? Whig 05:58, 12 Jun 2005 (UTC)

Yes, KS correllates with amyl nitrates correlates with being a gay male. Which is of no particular importance, because KS is caused by a human herpes virus. - Nunh-huh 06:36, 12 Jun 2005 (UTC)

Which goes back to my question above, if AIDS correlates in North America and Europe with gay males, but does not correlate with homosexuality in Africa, we have an issue that should be resolved in the article. Whig 03:30, 13 Jun 2005 (UTC)

It's an "issue" to be dealt with in the denialist article, as it relates only to their (strawman) expectation that diseases should occur in the same socioeconomic groups on different continents. - Nunh-huh

I don't see the strawman here, if we have one etiology (HIV) and one disease (AIDS), there may be different vectors (anal sex vs. unsanitary needle sharing or untreated venereal diseases) causing different communities to be affected in North America and Europe vs. Africa.

The strawman is the idea that patterns should be the same. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

However, if we do not see proportionately much heterosexual HIV/AIDS in North America, and we do in Africa, the reason for this difference should be identified as well as possible. Whig 03:57, 14 Jun 2005 (UTC)

In the meantime, I'm going to spend some time reading the link you sent, and hopefully it will shed some light and perhaps persuade me that the mainstream view is correct. Even if so, I think that means we should incorporate what evidence exists to support the mainstream view where it has been questioned. If there is no ambiguity, then the article should make this clear with proper references and citations. Whig 03:57, 14 Jun 2005 (UTC)

In the past, such "support" has been deited out of the denialist article. I'm sure you'll work hard to incorporate the references you've been given in the appropriate articles, once you've read them. - Nunh-huh 04:20, 14 Jun 2005 (UTC)

I've read the Steven B. Harris article you provided, and he makes some persuasive points. I'd like to see critical responses, however, as the article itself said, "Skeptic usually features several voices on one subject, but because of the length we decided to allow the AIDS skeptics to respond in the next issue" — no link for which is apparent. In regard to the journal citations above, I'm not really qualified to evaluate them, and I don't have ready access to said journals, so I wouldn't really know how properly to incorporate them, but you should certainly take use these resources to provide attributed statements and responses in the respective articles. I think even Harris makes some points which are actually critical of the current AIDS article however. At the very least, it would be nice to paraphase (can we quote as fair use?) the paragraph where he points out:

There is nothing in the HIV/AIDS theory which demands that any particular transmission mechanism be the chief cause of the spread of HIV infection in any given place, or which demands that the HIV virus be as infectious in one locality as another. For example, it now seems likely from many studies that sexual transmission of HIV often requires mucosal tissue trauma, which is much more likely with anal intercourse, and/or a concomitant inflammation or ulcer from a second sexually transmitted disease. Because transmission may be inefficient even so, promiscuity also greatly enhances the chance of HIV spread. These requirement(s) for efficient HIV sexual transfer easily explain the difference between spread of HIV in tropical Africa vs. the developed countries. They also adequately explain why a disease which spreads well sexually only in populations with an extreme level of both promiscuity and rectal mucosal trauma (i.e., one sub-segment of American homosexual men) has not yet become a generally spreading sexually-transmitted disease epidemic in the U.S. [4]

Whig 04:56, 14 Jun 2005 (UTC)

Whig, please keep this giant quote out of the article. If you insist on creating a section about the fringe belief that AIDS is not caused by HIV when it occurs in Africa, please keep it in the AIDS reappraisal article. I don't think this article should waste time responding to these claims. Rhobite 06:49, Jun 14, 2005 (UTC)

Rhobite, if you read my comments above, you should know that I disagree strongly with the idea that we ought to constrain such discussion to a separate ghetto. The sheer fact of the non-heterosexual spread (or should that be heterosexual non-spread) of AIDS in North America and Europe is enough to cause many people to question the medical establishment, which for years did predict a general epidemic outside of the original risk groups. At the same time, it is cited that this general epidemic currently does exist in Africa and the developing world. If we fail to address this disparity, without even providing possible reasons for it, our readers will reasonably infer that the AIDS reappraisers are addressing genuine issues that the main article does not. At the same time, I can see a reasonable desire to keep the main article to a manageable size, and therefore we might address things in a relatively summary form here and link to other articles for more detail. Whig 17:43, 14 Jun 2005 (UTC)