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As suggested in Talk:AIDS_denialism#.22draft_of_what_you.27d_like_this_section_to_look_like.22

Points of contention

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Koch's postulates

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According to denialists, HIV has failed to satisfy the Koch's postulates postulates. Peter Duesberg, among others, have claimed that Koch's first postulate is not adequately fulfilled because there are individual cases of AIDS in which HIV cannot be isolated.[1] The Perth Group, led by Eleni Papadopulos-Eleopulos, has stated that scientists have failed to satisfy the second postulate; they claim that a precondition of isolation is purification of the virus and that current isolates of HIV are not "pure".[citation needed]

Scientific research concludes that HIV does fulfill Koch's postulates completely.[2] In cases such as those cited by Duesberg, where HIV cannot be isolated, PCR shows that the virus is present.[3] In any case, Koch's postulates have never been universally applicable. Even in Koch's time, it was recognized that some infectious agents were clearly responsible for disease in spite of the fact that they did not fulfill all of the postulates;[4][5] Koch himself disregarded three postulates for cholera and typhoid fever.[4] Currently, a number of infectious agents are accepted as the cause of disease despite not fulfilling all of Koch's postulates.[6]

Pattern of spread

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Denialists note that in North America and Western Europe, AIDS is non-randomly distributed, affecting certain groups of people more than others, and moreover it is fragmented into distinct sub-epidemics with different distributions of AIDS-defining diseases.[7] According to dissidents, 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.[8]

The consensus view is that regional variability in the pattern and spread of HIV/AIDS results from differences in the time of introduction of the virus, the social fabric of a given community, its culture, its sexual networks, the mobility of its people and the reaction of the government in mounting an AIDS control program.[9] Regional variation in infection rates and infected populations is not unique to HIV/AIDS; for example, the epidemiology of hepatitis B is very different in the U.S. as compared to Asia.[10][11] Transmission via bodily fluids has been well-demonstrated and is typical of an infectious disease: HIV behaves exactly like many other viruses in terms of its transmission through blood, sexual fluids,[12][13][14][15] and breast milk,[16] suggesting that HIV does in fact spread like an infectious disease.[17][18][19][20]

HIV harm questioned

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In addition to the claims regarding the variations in AIDS definition between North America, Western Europe, and Africa, another fact cited as supporting the hypothesis that HIV is harmless is that a small number of HIV-positive people remain relatively healthy 15 or 20 years after testing positive for HIV.[21] Conversely, some HIV-seronegative people develop what would have been considered AIDS-defining diseases had they tested positive [22].

According to the mainstream perspective, the long period of HIV infection preceding AIDS manifestations is to be expected; HIV can take years to cause the immunosuppression necessary to permit opportunistic disease to occur. Extensive studies conducted before treatment was available found the mean duration between HIV infection and the development of AIDS to be eight to ten years.[23] By this measurement, Hepatitis C would also be a "harmless" virus, as its latent stage may run longer than 20 years.[24] There are many other well-known infectious diseases that develop slowly with a long latency period between infection and disease, such as Creutzfeldt-Jakob Disease, syphilis, and leprosy; AIDS is hardly unique in this respect.

AIDS definition

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Of substantial concern to AIDS denialists is the use of HIV antibody or viral testing as part of the definition of AIDS.[25] Some of the approximately 30 AIDS-defining diseases, including Kaposi's Sarcoma (KS) and Pneumocystis jiroveci pneumonia (PCP, formerly Pneumocystis carinii), are considered diagnostic of AIDS only when serologic evidence of HIV is present. In the absence of such evidence, these diseases are thought to be related to other immune problems, and are not diagnostic of AIDS.[25] In other words, according to denialists, the definition of AIDS is an example of circular logic: because a diagnosis of AIDS requires the presence of HIV antibodies, there can be no AIDS without HIV.[26]

Two major systems of AIDS diagnosis used today are the World Health Organization system, for use in resource-limited settings (see WHO Disease Staging System for HIV Infection and Disease),[27] and the CDC system used in the USA (see CDC Classification System for HIV Infection).[28] European countries and Canada use a variation of the CDC definition that excludes CD4 counts[citation needed]. Supporters of these definitions point out that AIDS-defining diseases such as KS and PCP (and also very low CD4 counts) are exceedingly rare in people who are HIV-negative, and that it is standard practice in medicine to include a microbial test in disease diagnosis.[29][30][31][32]

HIV test accuracy

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See also: HIV test

Denialists claim that the process of testing individuals for the presence of HIV is flawed. They assert there is a high probability of encountering a false positive, which would falsely identify someone as HIV-positive due to cross-reactivity [33]

A detailed criticism of the Western blot test and the "gold standard" of HIV isolation was published by Eleni Papadopulos-Eleopulos et al. in Bio/technology in 1993: Is a Western Blot Proof of HIV Infection? Their arguments rest on non-specificity of antibodies and lack of standardisation and reproducibility of HIV tests. In their conclusion, the authors state, "It is axiomatic that the use of antibody tests must be verified against a gold standard. The presently available data fail to provide such a gold standard for the HIV antibody tests. The inescapable conclusion from the above discussion is that the use of HIV antibody tests as predictive, diagnostic and epidemiological tools for HIV infection needs to be carefully reappraised."

In response, virologists contend that the accuracy of serologic testing has been verified by isolation and culture of HIV and by detection of HIV RNA by PCR, which are widely accepted "gold standards" in microbiology.[34][35] The consensus view of the scientific community is that current methods of HIV antibody testing are remarkably accurate. The false-positive rate among the American public ranges from 0.0006 to 0.0007 percent.[35][36] The false-negative rate for HIV antibody testing ranges from 0.001% to 0.3%, depending on the risk factors of the tested population.[37][38][39]

Critics assert that many AIDS denialists' claims of inaccuracy result from an incorrect or outdated understanding of how HIV antibody testing is performed and interpreted.[40][41] In the USA, the standard HIV diagnostic procedure combines two methods of detecting HIV antibodies: ELISA and Western blot.[42]

AIDS treatment toxicity

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Denialists claim the antiretroviral treatments prescribed to AIDS patients often cause the very symptoms they are supposed to delay.[43] To support this claim, they cite two studies from the late 1980s whose authors said they found it difficult to distinguish adverse events possibly associated with administration of Retrovir (AZT) from underlying signs of HIV disease or intercurrent illnesses.[44]

Mainstream scientists and doctors argue that dissidents are ignoring or unjustifiably dismissing abundant evidence demonstrating the effectiveness of modern antiretroviral medication. Harmful side effects do occur, and in some cases these can be severe or even deadly. However, multiple studies — conducted in Africa as well as Western countries — have found that, overall, anti-retroviral drug treatment is associated with a greatly decreased incidence of opportunistic infections and increased survival among HIV-positive people.[45][46][47][48]

References

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  1. ^ Duesberg PH (1989). "Human immunodeficiency virus and acquired immunodeficiency syndrome: correlation but not causation". Proc. Natl. Acad. Sci. U.S.A. 86 (3): 755–64. PMID 2644642. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. ^ NIAID Fact Sheet: The Evidence that HIV Causes AIDS. Accessed via National Institutes of Health website on 24 Oct 2006.
  3. ^ O'Brien SJ, Goedert JJ. (2002). "HIV causes AIDS: Koch's postulates fulfilled". Curr Opin Immunol. 8: 613–618. PMID 8902385.
  4. ^ a b Koch R. (1896) J. Hyg. Inf. 14, 319-333
  5. ^ Koch R. (1884) Mitt Kaiser Gesundh 2, 1-88
  6. ^ Jacomo V, Kelly P, Raoult D (2002). "Natural history of Bartonella infections (an exception to Koch's postulate)". Clin Diagn Lab Immunol. 9 (1): 8–18. PMID 11777823.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ The Chemical Bases of the Various AIDS Epidemics: Recreational Drugs, Anti-viral Chemotherapy and Malnutrition
  8. ^ Joint United Nations Programme on HIV/AIDS Global Report 2005 estimates and data
  9. ^ Quinn T (1996). "Global burden of the HIV pandemic". Lancet. 348 (9020): 99–106. PMID 8676726.
  10. ^ Maynard J. "Hepatitis B: global importance and need for control". Vaccine. 8 Suppl: S18-20, discussion S21-3. PMID 2139281.
  11. ^ Alter M, Hadler S, Margolis H, Alexander W, Hu P, Judson F, Mares A, Miller J, Moyer L (1990). "The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies". JAMA. 263 (9): 1218–22. PMID 2304237.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Vogt M, Witt D, Craven D, Byington R, Crawford D, Hutchinson M, Schooley R, Hirsch M (1987). "Isolation patterns of the human immunodeficiency virus from cervical secretions during the menstrual cycle of women at risk for the acquired immunodeficiency syndrome". Ann Intern Med. 106 (3): 380–2. PMID 3643769.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ Zagury D, Bernard J, Leibowitch J, Safai B, Groopman J, Feldman M, Sarngadharan M, Gallo R (1984). "HTLV-III in cells cultured from semen of two patients with AIDS". Science. 226 (4673): 449–51. PMID 6208607.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Zagury D, Fouchard M, Cheynier R, Bernard J, Cattan A, Salahuddin S, Sarin P (1985). "Evidence for HTLV-III in T-cells from semen of AIDS patients: expression in primary cell culture, long-term mitogen-stimulated cell cultures, and cocultures with a permissive T-cell line". Cancer Res. 45 (9 Suppl): 4595s–4597s. PMID 2410109.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Wofsy C, Cohen J, Hauer L, Padian N, Michaelis B, Evans L, Levy J (1986). "Isolation of AIDS-associated retrovirus from genital secretions of women with antibodies to the virus". Lancet. 1 (8480): 527–9. PMID 2869262.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ Centers For Disease Control Fact Sheet: Transmission of HIV.
  17. ^ Auerbach D, Darrow W, Jaffe H, Curran J (1984). "Cluster of cases of the acquired immune deficiency syndrome. Patients linked by sexual contact". Am J Med. 76 (3): 487–92. PMID 6608269.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ Gazzard B, Shanson D, Farthing C, Lawrence A, Tedder R, Cheingsong-Popov R, Dalgleish A, Weiss R (1984). "Clinical findings and serological evidence of HTLV-III infection in homosexual contacts of patients with AIDS and persistent generalised lymphadenopathy in London". Lancet. 2 (8401): 480–3. PMID 6147547.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ^ Francis D, Curran J, Essex M (1983). "Epidemic acquired immune deficiency syndrome: epidemiologic evidence for a transmissible agent". J Natl Cancer Inst. 71 (1): 1–4. PMID 6575197.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ Jaffe H, Bregman D, Selik R (1983). "Acquired immune deficiency syndrome in the United States: the first 1,000 cases". J Infect Dis. 148 (2): 339–45. PMID 6604115.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ^ AIDS: Scientific or Viral Catastrophe? by Neville Hodgkinson, 2003, accessed 11 October 2006.
  22. ^ HIV-negative "AIDS" in Kentucky: a case of idiopathic CD4+ lymphopenia and cryptococcal meningitis.
  23. ^ Rutherford G, Lifson A, Hessol N, Darrow W, O'Malley P, Buchbinder S, Barnhart J, Bodecker T, Cannon L, Doll L (1990). "Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study". BMJ. 301 (6762): 1183–8. PMID 2261554.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ^ NIH Consensus Statement on Hepatitis C, accessed 31 August 2006.
  25. ^ a b Website of Roberto A. Giraldo HIV tests cannot diagnose HIV infection, Gallo et al. 2006
  26. ^ Therefore, the perfect correlation is not a natural coincidence but a perfect artifact of the definition of AIDS by its hypothetical cause, HIV. It is one of the purest examples of circular logic.
  27. ^ WHO (1990). "Interim proposal for a WHO Staging System for HIV infection and Disease" (PDF). Wkly Epidemiol Rec. 65 (29): 221–224. PMID 11809639.
  28. ^ 1993 CDC: Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults
  29. ^ Martin J, Ganem D, Osmond D, Page-Shafer K, Macrae D, Kedes D (1998). "Sexual transmission and the natural history of human herpesvirus 8 infection". N Engl J Med. 338 (14): 948–54. PMID 9521982.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ^ Rezza G, Andreoni M, Dorrucci M, Pezzotti P, Monini P, Zerboni R, Salassa B, Colangeli V, Sarmati L, Nicastri E, Barbanera M, Pristerà R, Aiuti F, Ortona L, Ensoli B (1999). "Human herpesvirus 8 seropositivity and risk of Kaposi's sarcoma and other acquired immunodeficiency syndrome-related diseases". J Natl Cancer Inst. 91 (17): 1468–74. PMID 10469747.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. ^ Sitas F, Carrara H, Beral V, Newton R, Reeves G, Bull D, Jentsch U, Pacella-Norman R, Bourboulia D, Whitby D, Boshoff C, Weiss R (1999). "Antibodies against human herpesvirus 8 in black South African patients with cancer". N Engl J Med. 340 (24): 1863–71. PMID 10369849.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  32. ^ Kovacs J, Gill V, Meshnick S, Masur H (2001). "New insights into transmission, diagnosis, and drug treatment of Pneumocystis carinii pneumonia". JAMA. 286 (19): 2450–60. PMID 11712941.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ^ The presence of positive HIV serology in Africans represents no more than cross-reactivity caused by an abundance of antibodies induced by the numerous infectious and parasitic diseases which are endemic in Africa
  34. ^ Busch M, Eble B, Khayam-Bashi H, Heilbron D, Murphy E, Kwok S, Sninsky J, Perkins H, Vyas G (1991). "Evaluation of screened blood donations for human immunodeficiency virus type 1 infection by culture and DNA amplification of pooled cells". N Engl J Med. 325 (1): 1–5. PMID 2046708.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  35. ^ a b MacDonald K, Jackson J, Bowman R, Polesky H, Rhame F, Balfour H, Osterholm M (1989). "Performance characteristics of serologic tests for human immunodeficiency virus type 1 (HIV-1) antibody among Minnesota blood donors. Public health and clinical implications". Ann Intern Med. 110 (8): 617–21. PMID 2648922.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  36. ^ Burke D, Brundage J, Redfield R, Damato J, Schable C, Putman P, Visintine R, Kim H (1988). "Measurement of the false positive rate in a screening program for human immunodeficiency virus infections". N Engl J Med. 319 (15): 961–4. PMID 3419477.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  37. ^ Farzadegan H, Vlahov D, Solomon L, Muñoz A, Astemborski J, Taylor E, Burnley A, Nelson K (1993). "Detection of human immunodeficiency virus type 1 infection by polymerase chain reaction in a cohort of seronegative intravenous drug users". J Infect Dis. 168 (2): 327–31. PMID 8335969.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ Busch M, Eble B, Khayam-Bashi H, Heilbron D, Murphy E, Kwok S, Sninsky J, Perkins H, Vyas G (1991). "Evaluation of screened blood donations for human immunodeficiency virus type 1 infection by culture and DNA amplification of pooled cells". N Engl J Med. 325 (1): 1–5. PMID 2046708.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  39. ^ Van de Perre P, Simonon A, Msellati P, Hitimana D, Vaira D, Bazubagira A, Van Goethem C, Stevens A, Karita E, Sondag-Thull D (1991). "Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda". N Engl J Med. 325 (9): 593–8. PMID 1812850.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  40. ^ HIV Science and Responsible Journalism
  41. ^ How Immunoassays Work: The Curious Case of AIDS Denialist Roberto Giraldo and his Ignorance of the Basics
  42. ^ Gürtler L (1996). "Difficulties and strategies of HIV diagnosis". Lancet. 348 (9021): 176–9. PMID 8684160.
  43. ^ Articles on AZT hosted by Peter Duesberg
  44. ^ Virusmyth.net: HIV & AIDS - AZT, Zidovudine, Retrovir - Product Information
  45. ^ Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy
  46. ^ Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature
  47. ^ Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d'Arminio Monforte A, Knysz B, Dietrich M, Phillips A, Lundgren J (2003). "Decline in the AIDS and death rates in the EuroSIDA study: an observational study". Lancet. 362 (9377): 22–9. PMID 12853195.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  48. ^ Sterne J, Hernán M, Ledergerber B, Tilling K, Weber R, Sendi P, Rickenbach M, Robins J, Egger M. "Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study". Lancet. 366 (9483): 378–84. PMID 16054937.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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