Duesberg hypothesis

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The Duesberg hypothesis is the claim that chemicals from recreational and pharmaceutical drug use, and not HIV (human immunodeficiency virus), is the primary cause of AIDS. In this approach, AIDS is taken to be a name for a group of unrelated diseases caused by abuse of recreational drugs such as heroin and cocaine, malnutrition, and/or DNA chain terminator drugs such as AZT that are frequently prescribed to fight HIV infection, whereas HIV is seen as an opportunistic passenger virus, thereby bringing into question the issue of whether HIV infection ever actually occurs.

Contents 1 Proponents of the Duesberg hypothesis 1.1 Duesberg hypothesis claims immune collapse caused by legal and illegal drug use 1.2 Duesberg claims current AIDS definitions skew data 1.3 Duesberg claims AIDS in Africa is unrelated to AIDS anywhere else 1.4 Duesberg notes that HIV-positive people don't immediately develop AIDS 1.5 The dissenter's offer to infect himself 1.6 Duesberg claims that retroviruses like HIV must be harmless to survive 2 Common views of Duesberg and his opponents 3 Opponents of the Duesberg hypothesis 3.1 Opponents claim immune collapse caused by HIV's effects, not drugs 3.2 Opponents claim current AIDS definitions supported by best science 3.3 Opponents claim AIDS in Africa is also caused by HIV 3.4 Opponents claim that nearly all HIV-positive people will develop AIDS 4 Quotations 5 References 6 External links

Proponents of the Duesberg hypothesis

The most prominent defenders of this theory are molecular cell biologist Peter Duesberg, biochemist David Rasnick and journalist Celia Farber.

Duesberg hypothesis claims immune collapse caused by legal and illegal drug use

Duesberg believes that there is a statistical correlation between decreases in recreational drug use and decreases in AIDS cases. He points to a rapid increase of AIDS cases in the 1980s that correspond to an epidemic of recreational drug use in the United States and Europe. However, it must be remembered that HIV and AIDS were only discovered in the early to mid-eighties, so it is no surprise that the number of AIDS cases rose exponentially. Although the 1960s are notorious for drugs, drug usage (e.g. of Heroin, Cocaine, Amphetamines, Poppers) has very much increased since then (with a temporary decline in the 1990s) and is still much higher than in the 1960s. Duesberg supposes that a major component of the present day 'drug craze' that wasn't present in the 60's is the use of 'poppers' aka amyl nitrite and butyl nitrite, inhaled by mostly gay men to enhance their sexual experiences. Both chemicals are highly cytotoxic and easily overused. The now more regular occurrence of the once rare Pneumocystis carinii pneumonia (PCP) and Kaposi's sarcoma are theorized to occur in patients that regularly use such inhalants. However, no evidence has been proposed for this theory.

Moreover, Duesberg asserts that treating AIDS with high doses of drugs such as the antiviral AZT, which became widely available about ten years after the beginning of the AIDS epidemic, has proven to be more fatal than the recreational use of drugs such as heroin and cocaine. This assertion finds some support in the early Physician's Desk Reference listings for AZT (listed as Retrovir), where the drug's manufacturer warns that the drug's side effects are "indistinguishable" from the symptoms of AIDS. AZT also induces miscarriages, generates birth defects, and causes cancer in children born to AZT-treated mothers. Because of concerns with AZT's side effects, many AIDS patients are now treated with a cocktail of protease inhibitor and reverse transcriptase inhibitor drugs. However, any given drug cocktail may fail to work in any specific case, and in 1997, 53% of San Francisco's gay men had a strain of HIV that was resistant to one or more of the 20 approved anti-HIV drugs, with the result that AZT is still used in some cases.

Duesberg explains the prevalence of AIDS among male homosexuals in Western countries such as the United States by pointing to the prevalence of recreational drug use among male homosexuals in such countries. As reported in medical literature, male homosexuals in such countries use a great deal of sexual stimulants, including "poppers" (nitrate inhalants), amphetamines, ethyl chloride, Cocaine, and Heroin. Many of these drugs are known to inhibit the functioning of the body's immune system, at least briefly. At the time of Duesberg's book, no one had done long term studies on the effects of the chemicals on the immune system.

Benzene derivatives in most sexual lubricants and already lubricated condoms are also suspected to cause intoxications, because they are absorbed well into the body if placed into the intestines. Benzene intoxication shows some of the symptoms, e.g. immune suppression, cancer and inverted CD4/CD8 ratio, observed in AIDS patients as well. The fact that a large number of heterosexual couples also used sexual lubricants and lubricated condoms with benzene derivatives without causing a corresponding AIDS epidemic within this community during the 1980s is not addressed by Duesberg.

Duesberg claims current AIDS definitions skew data

Although the first definitions of AIDS mentioned no cause, proponents of HIV as a cause of AIDS no longer define AIDS independently of the hypothesized cause. Duesberg also points to the fact that a significant number of AIDS victims have died without proof of HIV infection. These people aren't always classified as having AIDS, because there is no proof that they had HIV, yet they're otherwise like AIDS patients. Since AIDS is now defined as X diseases plus HIV, victims with X diseases and no HIV don't count as AIDS patients.

With such logic, claims Duesberg, it is impossible by definition to offer evidence that AIDS doesn't require HIV--even though public health officials compiled exactly that data in the early years of the AIDS epidemic, before HIV tests were available anywhere in the world.

Duesberg claims AIDS in Africa is unrelated to AIDS anywhere else

Reported AIDS cases in Africa and other parts of the developing world, where only limited attempts are made to test for HIV infection, include people who do not belong to Duesberg's preferred risk groups of drug addicts and male homosexuals, and it would be difficult to separate the collected data to exclude non-drug users and non-gays. In fact, Duesberg writes on his website that "There are no risk groups in Africa, like drug addicts and homosexuals."

According to Duesberg, the majority of African AIDS cases may be explained away as malnutrition, parasitic infection, and poor sanitation, even though African AIDS cases have increased in the last two decades as HIV's prevalence has increased and as malnutrition and poor sanitation have declined in Africa.

The diseases AIDS victims catch differ radically between African and Western populations. Of course, there are many differences between what diseases these victims are exposed to and thus have the opportunity to catch. The AIDS-associated disease Kaposi's sarcoma, which requires uncontrolled infection with the sexually transmitted HHV-8 (since renamed KSHV for Kaposi's Sarcoma Herpes Virus), occurs in sexually promiscuous gay males but rarely in any AIDS patients of any sexual orientation who do not have a history of sexual promiscuity. Outside of sexually promiscuous HIV+ patients, Kaposi's sarcoma occurs in very few people who do not have a specific genetic mutation, HLA-DR, which affects immune system function.

Duesberg notes that HIV-positive people don't immediately develop AIDS

There are many people who have HIV and have not yet developed AIDS and don't use the chemicals Duesberg hypothesizes cause AIDS. Mainstream scientists expect that nearly all of these people will develop AIDS within ten to fifteen years after infection, but in the meantime, they are relatively healthy. According to the Duesberg hypothesis, these people will remain as healthy as anyone else.

The dissenter's offer to infect himself

Duesberg's most radical challenge to the HIV-AIDS hypothesis is his offer to infect himself with HIV. However, he claims that it is not permissible for him to do so without the approval of the U.S. National Institutes of Health and the university that employs him.

Duesberg claims that retroviruses like HIV must be harmless to survive

Peter Duesberg argues that retroviruses like HIV must be harmless to survive, because after reverse transcription of their RNA to DNA, they depend on cell division to replicate. They cannot replicate in neurons, for example, because these cells do not divide (after the age of one year). The normal mode of proliferation of retroviruses is from mother to child, thus implying the survival of the infected mother and the child for decades. Humans carry more than 300 different harmless retroviruses in their DNA, all of whose genomes are very similar to the HIV genome.

Due to the dependence of retroviruses on cell division, researchers in the 1970s suspected that they might be a cause of cancer. It was one of the major achievements of Peter Duesberg's career in the 1980s to show this not to be the case.

Common views of Duesberg and his opponents

Nitrite inhalants ("Poppers") are dangerous drugs -- independently of the HIV-AIDS discussion. Nitrites cause methemoglobinemia and have been observed to be mutagenic, carcinogenic and immunosuppressive in animals and humans. They have an effect on both the humoral and cellular immunity. HIV research found that they stimulate viral replication and secretion of viral proteins involved in Kaposi's sarcoma growth.

Thus, both sides agree that nitrite inhalants (and other drugs) at least accelerate the development of Kaposi's sarcoma and other AIDS-defining diseases, i.e. that Nitrites are a cofactor -- but they don't agree on nitrites or other drugs being the main cause of AIDS or Kaposi's sarcoma.

Opponents of the Duesberg hypothesis

The current consensus in the scientific community is that the Duesberg hypothesis has been refuted by the huge mass of available evidence, showing that Koch's postulates have been fulfilled by HIV, that virus numbers in the blood correlate with disease progression and that a plausible mechanism for HIV's action has been proposed.

In the 9 December, 1994 issue of Science (Vol. 266, No. 5191), Duesberg's methods and claims were evaluated and found that:

• it is abundantly evident that HIV causes disease and death in hemophiliacs (Cohen, 1994a)
• HIV fulfills Koch's postulates (Cohen, 1994b)
• the AIDS epidemic in Thailand cited by Duesberg as confirming his theories in fact is evidence tending to confirm the role of HIV in AIDS. (Cohen, 1994c)
• AZT and illicit drug use, contrary to Duesberg's claims, do not cause an immune deficiency to or similar to that seen in AIDS (Cohen, 1994d)

Opponents claim immune collapse caused by HIV's effects, not drugs

Indeed, the vast majority of people with AIDS never received antiretroviral drugs, including those in developed countries prior to the licensure of AZT in 1987, and people in developing countries today where very few individuals have access to these medications (UNAIDS, 2003).

As with medications for any serious diseases, antiretroviral drugs can have toxic side effects. However, there is no evidence that antiretroviral drugs cause the severe immunosuppression that typifies AIDS, and abundant evidence that antiretroviral therapy, when used according to established guidelines, can improve the length and quality of life of HIV-infected individuals.

In the mid-1980s, clinical trials enrolling patients with AIDS found that AZT given as single-drug therapy conferred a modest (and short-lived) survival advantage compared to 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 never indicated 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 effectively counters the argument that AZT causes AIDS (NIAID, 1995).

Subsequent clinical trials found that patients receiving two-drug combinations had up to 50 percent increases in time to progression to AIDS and in survival when compared to people receiving single-drug therapy. In more recent years, three-drug combination therapies have produced another 50 percent to 80 percent improvements in progression to AIDS and in survival when compared to two-drug regimens in clinical trials (HHS, 2005). Use of potent anti-HIV combination therapies has contributed to dramatic reductions in the incidence of AIDS and AIDS-related deaths in populations where these drugs are widely available, an effect which clearly would not be seen if antiretroviral drugs caused AIDS (Palella et al., 1998; Mocroft et al., 1998; Mocroft et al., 2000; Vittinghoff et al., 1999; Detels et al., 1998; de Martino et al., 2000; Hogg et al., 1999; Schwarcz et al., 2000; Kaplan et al., 2000, McNaghten et al., 1999).

Opponents claim current AIDS definitions supported by best science

Early definitions of AIDS did not include any reference to the cause. The changes were made as the weight of evidence accumulated and consensus was developed.

For this aspect of the debate, a particularly relevant feature of AIDS is the relentless decline of immune system function. Without anti-HIV drug therapy, the collapse of the immune system is essentially unstoppable, although it may proceed in an uneven fashion. By contrast, a person who receives chemotherapy for cancer can expect to have severely depressed immune system function for a time after treatment ends, and then to recover to normal or near-normal stages. Assuming no further need for chemotherapy, this person may expect essentially normal immune function for the rest of his or her life.

AIDS patients, however, do not recover significantly from downturns in immune function; in the absence of HIV suppression, their immune system eventually collapses. The natural course of AIDS is the long-term and essentially irreversible loss of immune system function. Other than HIV infection, which Duesberg proponents reject, there are very few known causes of chronic immune system failure, notably most forms of leukemia and a few rare genetic disorders, and these cases are both uncommon and not in the Duesberg hypothesis' risk groups of intravenous drug users and male homosexuals.

Although proponents of the Duesberg hypothesis assert the existence of HIV-negative people with long-term immune system failure (other than due to known causes, like leukemia), they have yet to publish case studies on any such individuals or to work with any medical centers to have other known causes excluded. Instead, they merely state that they believe such people to exist, because it is the logical outcome of their ideas, without producing a single case to support the assertion.

Importantly, there is nothing about the datasets that forces researchers to pay attention to the HIV status of a participant; in fact, studies show intriguing differences in AIDS behaviors based on factors other than HIV infection. For example, hemophiliacs who acquired HIV through contaminated blood products were less likely to develop certain opportunistic infections (and more likely to die of liver failure) than people who acquired HIV through sexual contact. Duesberg, however, rejects both the existing data and the challenge to present proof himself. (Edit: According to Out of Control, Celia Farber's March 2006 article in Harper's, all 25 of Duesberg's research proposals since 1991 have been rejected by the NIH. It is hardly fair to say that Duesberg "rejects ... the challenge to present proof" in light of this knowledge.)

Opponents claim AIDS in Africa is also caused by HIV

The Duesberg proponents say that AIDS in Africa is the result of poor sanitation and malnutrition, not HIV. Opponents note the following facts:

• AIDS in Africa has increased during the last two decades, and so has the prevalence of HIV.
• Sanitation and nutrition, on the other hand, have noticeably improved since the 1980s, when the Ethiopian famine was prominent in the news.
• AIDS in Africa largely kills sexually active working-age adults.
• The groups that have HIV are the ones dying from AIDS. For example, in areas where surveys show 50% of people with HIV are women, that area will show that 50% of people dying from AIDS are women. In areas where 20% of HIV+ people use recreational drugs, then 20% of the people dying from AIDS use recreational drugs.

If the Duesberg hypothesis is right, one wonders why AIDS kills so many otherwise healthy adults in Africa at the same time that health has improved among the children and the elderly, who are normally the most vulnerable to poor sanitation and malnutrition, and least vulnerable to sexually transmitted diseases.

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

Duesberg claims as support for his idea that many drug-free HIV+ people have not yet developed AIDS; other scientists note that many other drug-free HIV+ people have developed AIDS, and that if they wait long enough, it is very likely that nearly all of the HIV+ people will develop AIDS. Mainstream scientists also note that drug-using HIV-negative people do not seem to suffer from immune system collapse.

Quotations

Warren Winkelstein Jr., a Berkeley AIDS researcher, characterized Duesberg's continued publicizing of his theory as "irresponsible, with terribly serious consequences".

Helene Gayle, who was associate director of the Centers for Disease Control and Prevention (CDC) office in Washington, D.C., characterized Duesberg's message as "very damaging" to AIDS prevention projects.

Martin Delaney, of Project Inform, has been an active opponent of Duesberg's "continuing public campaign" "to convince the public, people at risk of HIV infection, and people already infected that they are in no danger from this virus, that AIDS is solely a behavioral disease, and that current treatments for the disease and recreational drug abuse are in fact the cause of the disease."

Science's special news report, which followed a 3-month investigation, found that "Mainstream AIDS researchers argue that Duesberg's arguments are constructed by selective reading of the scientific literature, dismissing evidence that contradicts his theses, requiring impossibly definitive proof, and dismissing outright studies marked by inconsequential weaknesses."

"(Duesberg )...has built a case on what to some looks like possible misinterpretation, misuse of statistics, and highly selective cherry-picking of the data while contrary evidence is ignored." Martin Delaney (Science, p. 314, Vol. 267, No. 5196, Jan. 20, 1995).

References

• Cohen J. (1994) The Duesberg phenomenon. Science 266, 1642-1644 PMID 7992043

• Cohen J. (1994a) Duesberg and critics agree: Hemophilia is the best test. Science 266, 1645-1646 PMID 7992044

• Cohen J. (1994b) Fulfilling Koch's postulates. Science 266, 1647 PMID 7992045

• Cohen J. (1994c) The epidemic in Thailand. Science 266, 1647 PMID 7992046

• Cohen J. (1994d) Could drugs, rather than a virus be the cause of AIDS? Science 266, 1648-1649 PMID 7992047

• de Martino M, Tovo PA, Balducci M, Galli L, Gabiano C, Rezza G, Pezzotti P. (2000) Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National AIDS Registry. JAMA 284, 190-197 PMID 10889592

• Detels R, Munoz A, McFarlane G, Kingsley LA, Margolick JB, Giorgi J, Schrager LK, Phair JP. (1998) Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA 280, 1497-1503 PMID 9809730

• Hogg RS, Yip B, Kully C, Craib KJ, O'Shaughnessy MV, Schechter MT, Montaner JS. (1999) Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ 160, 659-665 PMID 10102000

• Kaplan JE, Hanson D, Dworkin MS, Frederick T, Bertolli J, Lindegren ML, Holmberg S, Jones JL. (2000) Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis. Suppl 1, S5-14 PMID 10770911

• McNaghten AD, Hanson DL, Jones JL, Dworkin MS, Ward JW. (1999) Effects of antiretroviral therapy and opportunistic illness primary chemoprophylaxis on survival after AIDS diagnosis. Adult/Adolescent Spectrum of Disease Group. AIDS 13, 1687-1695 PMID 10509570

• Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, d'Arminio Monforte A, Yust I, Bruun JN, Phillips AN, Lundgren JD. (1998) Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet 352, 1725-1730 PMID 9848347

• Mocroft A, Katlama C, Johnson AM, Pradier C, Antunes F, Mulcahy F, Chiesi A, Phillips AN, Kirk O, Lundgren JD. (2000) AIDS across Europe, 1994-98: the EuroSIDA study. Lancet 356, 291-296 PMID 11071184

• Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N. Engl. J. Med. 338, 853-860 PMID 9516219

• Schwarcz SK, Hsu LC, Vittinghoff E, Katz MH. (2000) Impact of protease inhibitors and other antiretroviral treatments on acquired immunodeficiency syndrome survival in San Francisco, California, 1987-1996. Am J Epidem 152, 178-185 PMID 10909955

• Vittinghoff E, Scheer S, O'Malley P, Colfax G, Holmberg SD, Buchbinder SP. (1999) Combination antiretroviral therapy and recent declines in AIDS incidence and mortality. J. Infect. Dis. 179, 717-720 PMID 9952385

External links

• The Evidence That HIV Causes AIDS NIH fact sheet February 2003
• How HIV Causes AIDS NIH fact sheet November 2004
• 1994 Interview with Kary Mullis about HIV and AIDS
• Peter Duesberg on AIDS
• Virusmyth, questioning the existence of HIV
• AIDS ACQUIRED BY DRUG CONSUMPTION AND OTHER NONCONTAGIOUS RISK FACTORS -PETER H. DUESBERG

pt:hipótese de Duesberg