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The Scientific Challenge of Hepatitis C - Jon Cohen
Science 1999 285: 26-30. (in News Focus)
“A virus that infects some 170 million people worldwide is causing rising rates of liver disease; like HIV, it is a wily foe for researchers developing drugs and vaccines. HIV may hold some lessons”
Nobody would have mistaken the international conference on hepatitis C, held last month at the National Institutes of Health (NIH), for an international conference on AIDS. For the past decade, international AIDS meetings have attracted roughly 10,000 researchers; only 775 scientists attended the 4-day hepatitis C meeting.* While drug companies working on anti-HIV drugs jam the exhibit halls at AIDS gatherings, not a single company set up a stand at the hepatitis C meeting. If activists infected with hepatitis C virus, or HCV, attended the gathering, none made their presence felt. Not a single press conference was held, reflecting the low media turnout (one). Yet HCV has infected an estimated 170 million people worldwide--more than four times as many as HIV--and, during the next few years, the number of annual U.S. deaths from HCV-caused liver damage and cancer may overtake deaths caused by AIDS. source...
Hepatitis C "Lookback" Effort Misguided, Critics Charge
As many as 250,000 Americans who received blood transfusions as long ago as 1987 will be notified that they may have been infected with hepatitis C (HCV).
Under the "targeted HCV lookback" program approved by Secretary of Health and Human Services Donna Shalala, individuals who received blood that subsequently tested positive for hepatitis C, using an effective test that was developed in 1992, will be contacted and urged to get tested for the virus. source...
Endogenous Viruses and Chronic Disease
Viruses resident in the human genome may have evolved from jumping genes that increasingly appears to be necessary for the survival of the organism. Some virologists think that we may be creating a range of debilitating chronic diseases by failing to take them seriously into account. Dr. Mae-Wan Ho and Prof. Malcolm Hooper report.
“A second example is the intensive effort directed to creating a vaccine for the hepatitis C virus. Unfortunately, there is no hard evidence in the scientific literature that hepatitis C virus exists. Urnovitz continued, "As a scientist I am compelled to ask, how can we vaccinate people against a disease-causing agent that has not been fully characterised?" source...
Latent Viruses and Mutated Oncogenes: No Evidence for Pathogenicity
PETER H. DUESBERG AND JODY R. SCHWARTZ
Progress in Nucleic Acid Research and Molecular Biology 43:135-204, 1992
Department of Molecular and Cell Biology / University of California at Berkeley / California 94720
II. Inactive Viruses and Diseases Resulting from the Loss of Cells
A. Human Immunodeficiency Virus (HIV) and AIDS
AIDS is a new syndrome of 25 previously known diseases (49-52). In America, 61% are microbial diseases such as pneumonia, candidiasis, tuberculosis, cytomegalovirus, and herpes virus disease (50, 52) that result from immunodeficiency due to a severe depletion of T-cells (49, 51). The remaining 39% of AIDS diseases are dementia, wasting disease, Kaposi sarcoma, and lymphoma, which are not consistently associated with immunodeficiency and microbes (52-54). In the U.S., 32% of AIDS patients are intravenous drug users (52, 55), about 60% are male homosexuals (52) who frequently used drugs as aphrodisiacs (54, 56-64, 103), and most of the remainder have severe clinical or congenital deficiencies, including hemophilia (52, 54, 61). Over 80% of the American AIDS patients are 20- to 44-year olds, of which about 90% are males (52). Different AIDS-risk groups have different AIDS diseases. For example, homosexuals have 20 times more Kaposi sarcoma than other AIDS patients (65), intravenous drug users have a proclivity for tuberculosis (66, 67), "crack" (cocaine) smokers for pneumonia (68), and users of the cytotoxic DNA-chain-terminator AZT, prescribed to inhibit HIV, for anemia, nausea, and lymphoma (69-71).
About 50% of all American AIDS patients are currently confirmed to have antibodies to a retrovirus, termed human immunodefieieney virus (HIV) (51, 54, 72). However, all AIDS diseases occur in all risk groups in the absence of HIV (see Section II,A,3) (54). In the U.S., HIV is fixed to an extremely constant reservoir of about 1 million carriers, ever since 1985, when it became possible to detect antibody against HIV (the "AIDS test") (54, 73). HIV is naturally transmitted from mother to child, like other retroviruses, at an efficiency of about 50% (54). This efficiency might be higher than serological tests indicate, because some proviruses of other perinatally transmitted human retroviruses only become immunogenic with advanced age (54) (see Section III). Sex is another natural mode of transmission. However, it is highly inefficient, depending on an average of about 1000 sexual contacts (54, 74), because there is no HIV provirus detectable, even with the polymerase chain reaction (PCR), in semen in 24 out of 25 HIVpositive men (75). Since 1987, when AIDS was given its current definition (50), about 30,000, or 3% of the 1 million Americans infected by HIV (53, 54, 73), develop AIDS annually (52).
1. The Virus-AIDS Hypothesis
Currently, most medical scientists believe that AIDS is caused by HIV (51). The hypothesis assumes: (i) that AIDS is new because HIV is thought to be new in all countries with AIDS (14, 51); (ii) that AIDS is acquired by sexual and parenteral transmission of HIV; (iii) that HIV causes immunodeficiency by killing infected T-cells; (iv) that 50-100% of HIV infections lead to fatal AIDS diseases; (v) that AIDS occurs on average only 10 years after antibodies to HIV appear (a positive "AIDS test"), to reconcile the low (3%) morbidity with the large number of asymptomatic HIV carriers; (vi) that antibodies to HIV do not neutralize the virus (53, 76, 77), to reconcile AIDS with antibodies to HIV; and (vii) that all unrelated AIDS diseases are caused by the same HIV (49, 51, 54, 78).
In view of this hypothesis, AIDS has been defined exclusively by the association of the 25 indicator diseases with antibody to HIV (50, 51, 54). Further, "safe sex" (49, 51) and "clean injection equipment" for recreational drugs (55) are recommended as AIDS prophylaxis for uninfected persons, and the cytotoxic DNA-chain-terminator, 3'azidothymidine (AZT) is prescribed to infected healthy, as well as sick, persons to inhibit HIV (51, 71, 80a, 79, 80). The presence of antibody to HIV in a healthy person is interpreted as a prognosis for AIDS. Testing and counseling are provided routinely to applicants of the U.S. Job Corps (81). Several countries, including the U.S. and China, bar entry to HIV-positive persons. And a negative "AIDS test" for antibodies to HIV has become mandatory in the U.S. since 1985 for the approximately 12 million blood donations that are collected annually (82) by the American blood banks and the Red Cross (Irwin Memorial Blood Bank, San Francisco, personal communication, 1990) and for admission to the U.S. Army (73, 83).
Each of the seven assumptions of the virus-AIDS hypothesis can be challenged on epidemiological and virological grounds:
1. Since all new microbes spread exponentially in a population (11), the complete failure of HIV to spread from its 1985 level, when it became first detectable, indicates that the American "HIV epidemic" is old. This is particularly compelling if one considers that there is no antiviral vaccine and no antiviral drug. Thus, HIV is not new in the U.S.
2. Given that procreative sex is about 10% efficient (3 days per month) and sexual transmission of HIV only 0.1%, it follows that HIV depends on perinatal transmission for its survival (54). If HIV survives naturally via perinatal transmission, it cannot be pathogenic by itself, just like all other perinatally transmitted parasites (12)-except if one assumes latent periods that exceed the normal generation time of humans. Indeed, chimpanzees experimentally inoculated and health care workers accidentally inoculated with HIV do not develop AIDS (51, 54). Thus, sexual transmission of HIV cannot be a sufficient cause for AIDS.
3. Since no more than 1 in 500 T-cells of AIDS patients ever contains a DNA provirus of HIV and over 99% of infected T-cells survive infection (84), and since about 1 in 25 T-cells is regenerated during the 2 days it takes a retrovirus to infect a cell, HIV infection cannot be responsible for the loss of T-cells in AIDS (53). Thus, HIV, like all other retroviruses, does not kill cells (53, 85, 86). Indeed, HIV is propagated commercially for the "AIDS test" in cultured lines of the same human T-cells that it is said to kill in vivo (87).
4. The assumption that HIV is 50-100% fatal within 10 years cannot be correct, because about 1 million Americans carry HIV since 1985 but only about 30,000 develop AIDS annually since 1987, when AIDS received its current definition (50). Instead, it would take 33 years for all U.S. HIV carriers to develop AIDS diseases based on the current data (3% per year). An average latent period of 10 years would predict that 100,000 Americans would develop AIDS in 1 year.
5. Since viruses, as self-replicating toxins, are all fast immunogens and thus potentially fast pathogens, but AIDS diseases are estimated to occur on average only 10 years after HIV is neutralized by antiviral antibodies, the assumption that HIV needs 10 years to cause AIDS is arbitrary. The long intervals between infection and AIDS probably indicate that HIV is not even necessary for AIDS, because there is no "late" HIV activity, and because antibodies continue to neutralize the virus during AIDS (53, 54).
6. The complete absence of free HIV in nearly all AIDS patients (53, 54, 88)-the reason that the isolation of HIV had escalated into an international scandal (89, 90)-invalidates the assumption that antibodies to HIV do not neutralize HIV. Indeed, antiviral immunity effectively restricts HIV in AIDS patients (91, 92) to 1 provirus in about 500 T-cells, and viral activity to less than 1 in 10,000 T-cells (53, 54, 84).
7. Since all AIDS diseases occur in the absence of HIV in intravenous drug users, homosexuals, and hemophiliacs, HIV is not even necessary for AIDS diseases-except for their classification as AIDS (53, 54).
Because of the many virological and epidemiological inconsistencies of the virus-AIDS hypothesis, some, notably Montagnier (93) and recently Maddox (94-96), have proposed that HIV is not sufficient for AIDS. Accordingly, a number of "cofactors" such as mycoplasmas (85, 93) and other viruses (15, 76) have been postulated as helping HIV to cause AIDS. However, there is no consensus at this time about a specific cofactor that would be sufficient to cause AIDS in combination with HIV (76, 93). Moreover, there is not even one plausible hypothesis as to how a latent retrovirus such as HIV, which is present in no more than 1 in 500 T-cells, could possibly help another microbe to cause AIDS that, by itself, is not able to do so.
Indeed, there are at least six inconsistencies between AIDS and infectious disease:
1. Paradoxically, there is not even one case reported in the scientific literature of a health care worker who contracted AIDS from a patient, although there were over 200,000 AIDS patients in the U.S. in the last 10 years (52). Likewise, not even one scientist contracted AIDS from the "AIDS virus" or from other microbes from AIDS patients, which are propagated in hundreds of research laboratories and companies (53, 54, 87).
2. All new infectious diseases spread exponentially in susceptible populations (11). However, despite widespread alarm, AIDS claims since 1987 only about 30,000 or 0.03% per year from a reservoir of over 100 million susceptible, sexually active Americans. This is particularly paradoxical for a presumably infectious syndrome, because conventional venereal diseases are increasing in the U.S. (97) and because there is no anti-HIV vaccine and no anti-HIV drug.
3. The distribution of all infectious venereal diseases is almost even between the sexes (98). By contrast, 90% of American AIDS is restricted to males since 1981 (52). This is incompatible with infectious venereal disease.
4. Almost all (94%) of the Americans who develop AIDS have been subject to abnormal health risks (52). These risks include either long-term consumption of recreational, psychoactive, and aphrodisiac drugs and anti-HIV drugs such as the cytocidal DNA chain-terminator AZT (see below) or congenital or acquired deficiencies such as hemophilia (52, 54). This indicates that specific health risks are necessary for AIDS.
5. The observations that distinct AIDS-risk groups have distinct AIDS diseases-e.g., homosexuals having 20 times more Kaposi sarcoma than HIV carriers from other risk groups (65), intravenous drug users having a proclivity for tuberculosis (66, 67), "crack" (cocaine) smokers for pneumonia (68), and AZT users for anemia, nausea, and lymphoma (69-71)-are also difficult to reconcile with a single infectious cause.
6. All AIDS diseases occur in all AIDS-risk groups in the absence of HIV (54).
In view of these inconsistencies between AIDS and infectious disease and the total lack of a common active microbe in AIDS, several investigators, including us, have concluded that AIDS may not be infectious (54, 56-62, 99-102).
2. The Drug-AIDS Hypothesis
An alternative hypothesis proposes that American AIDS diseases, above their normal background, are the result of the long-term consumption of (a) intravenous and (b) oral recreational drugs, and (c) anti-HIV drugs (54, 60, 103). The following epidemiological and drug-toxicity data support this hypothesis.
a. Intravenous Recreational Drugs. Currently, 32% of the American AIDS patients come from groups that use intravenous drugs such as heroin, cocaine, and others (52, 55). This group includes about 75% of the heterosexual AIDS cases, 71% of the females with AIDS, and over 10% of the male homosexuals and hemophiliacs with AIDS (52, 55). In addition, about 50% of American children with AIDS were born to mothers who are confirmed intravenous drug users and another 20% to mothers who had "sex with intravenous drug users" and are thus likely users themselves (52, 55). Likewise, 33% of European AIDS patients are intravenous drug users (104).
b. Oral Recreational Drugs. Approximately 60% of the American AIDS patients are 20- to 44-year-old male homosexuals (52). The following evidence indicates that they come from groups who use oral psychoactive and aphrodisiac drugs. A survey of 3916 self-identified American homosexual men, the largest of its kind, reported in 1990 that 83% had used one, and about 60% two or more, drugs with sex during the previous 6 months (105). These drugs include nitrite and ethylchloride inhalants, cocaine, amphetamines, methaqualone, lysergic acid, phenylcyclidine, and more (59, 61-63, 101,105-112). A study of 359 homosexual men from San Francisco reported in 1987 that 84% had used cocaine, 82% alkylnitrites, 64% amphetamines, 51% quaaludes, 41% barbiturates, and 20% injected drugs, and 13% shared needles (107). This group had been randomly selected from a list of homosexuals who had volunteered to be investigated for hepatitis B virus infection and to donate antisera to hepatitis B virus between 1978 and 1980.
Nitrite inhalants and possibly other drugs are preferred by male homosexuals as aphrodisiacs because they facilitate anal intercourse (105, 111, 113, 114). For example, an early CDC study that included 420 homosexual men found nitrite use far more frequent among homosexuals than among heterosexuals and correlating directly with the number of different homosexual partners (57). Surveys studying the use of nitrite inhalants in San Francisco found that among homosexual men 58% were users in 1984 and 27% in 1991 compared to less than 1% among heterosexuals and lesbians of the same age group (115).
The nitrites are directly toxic as oxidants of biological molecules such as hemoglobin, and are effective mutagens (101, 103). The National Institute on Drug Abuse reports correlations from 69% (116) to virtually 100% (101, 113) between nitrite inhalants and Kaposi sarcoma and pneumonia, which are diagnosed as AIDS in the presence of antibody to HIV (50, 51, 54). In view of this, a causal link between nitrite inhalants and Kaposi sarcoma and pneumocystis pneumonia in homosexuals was first suggested in 1982 by the CDC (57) and other investigators (56, 58). As a consequence, the sale of nitrite inhalants was banned by the U.S. Congress in 1988 (Public Law 100-690) (117, 118). The direct and indirect toxicity associated with the long-term use of other recreational drugs has been described elsewhere (103).
c. Anti-HIV Drugs. About 80,000 Americans and 120,000 persons worldwide with and without AIDS currently take the cytocidal DNA chain-terminator AZT (54) and an unknown number take other DNA chain-terminators such as ddI and ddC (71). AZT has been prescribed since 1987 to symptomatic (51, 70, 79, 119), and since 1990 to asymptomatic, carriers of HIV, including babies and hemophiliacs (80, 120), in an effort to inhibit HIV DNA synthesis (121). Thus, an unknown, but possibly high, percentage of the 30,000 Americans that currently develop AIDS per year (52) have used AZT prior to or after the onset of AIDS. For instance, 249 out of 462 HIV-positive, AIDS-free homosexual men from Los Angeles, included in the above survey (105), are on AZT or ddI (122).
Although AZT is an inhibitor of HIV DNA synthesis, it is not a rational medication for persons with antibodies to HIV for the following reasons: (i) There is no proof that HIV causes AIDS. (ii) Since no detectable RNA-dependent viral-DNA synthesis occurs, and since the number of infected cells remains stable once the virus is neutralized by antibodies (53, 54) only cell DNA with and without proviruses of HIV is terminated by AZT treatment. Further, since AZT cannot distinguish infected from uninfected cells, and only 1 in 500 T-cells is infected in AIDS patients and asymptomatic carriers (54, 84), it kills 500 uninfected cells for every infected cell. Thus, AZT is inevitably toxic, killing 500 times more uninfected than infected cells. (iii) In view of the hypothesis that HIV causes AIDS by killing T-cells (49, 51), it is irrational to overkill infected cells with AZT.
As expected from an inhibitor of DNA synthesis, many studies report AZT-mediated toxicity. Anemia, neutropenia, and leukopenia occur in 20-50%, with about 30-50% requiring transfusions within several weeks (70, 71, 123-125). Severe nausea from intestinal intoxication is observed in up to 45% (70, 71, 80) and severe muscle atrophy in 6-8% (70, 126-128). Acute hepatitis, insomnia, headaches, dementia, seizures, and vomiting are also reported effects of AZT (71). Lymphomas appear in about 9% within 1 year on AZT (69). AZT is also mutagenic and carcinogenic in mice (129, 130) and transforms cells in vitro as effectively as methylcholanthrene (131). AZT toxicity varies a great deal with the patient treated, due to differences in kinases involved in its uptake and in AZT metabolism (71, 121, 131, 132). All of these results explain Temin's profound observation that "... the drug generally becomes less effective after six months to a year...." (134).
Nevertheless, AZT is thought to have serendipitous therapeutic benefits based on the only placebo-controlled study of its effects on AIDS patients (70, 119). The study was sponsored by Burroughs Wellcome, the manufacturer of AZT (70, 119). In this study, T-cell counts were observed to increase from 4 to 8 weeks and then to decline to pretreatment levels. Above all, AZT was claimed to "decrease mortality" because only 1 out of 143 in the AZT-treated group died compared to 19 out of 135 in the placebo group.
However, 30 out of the 143 in the AZT group depended on multiple transfusions for survival from anemia, compared to only 5 out of the 135 in the placebo group. Since the number of subjects in the AZT group who would have died from anemia if untreated (30) was larger than the AIDS deaths and anemias of the control group combined (19 + 5), the claim of decreased mortality is not realistic (70, 119). Moreover, 66 in the AZT group suffered from severe nausea and 11 from muscle atrophy, compared to only 25 and 3 in the control group. The lymphocyte count decreased over 50% in 34% of the AZT group and in only 6% of the control. The study is further compromised by "concomitant medication" (70), the failure to consider the effects of recreational drug use and of patient-initiated randomizations of blinded AZT and placebo controls (135). The brief AZT-induced gain of T-cells may reflect compensatory hemopoiesis and random killing of pathogenic parasites (132) and the influence of concomitant medication (70).
In view of the inevitable toxicity of AZT, its popularity as an anti-HIV drug can only be explained by the widespread acceptance of the virus-AIDS hypothesis and the failure to consider the enormous difference between the viral and cellular DNA targets. This may also be the reason that long-term studies of AZT in animals compatible with human applications have not been published (71).
3. The Drug- Versus the Virus-AIDS Hypothesis
To distinguish between HIV and drugs as causes of AIDS, it is necessary to determine whether HIV carriers develop AIDS only when they use drugs, and whether HIV-free drug users develop AIDS indicator diseases.
A. Drug Use Necessary for AIDS in Presumed or Confirmed Carriers of HIV. (i) Epidemiological correlations suggest that nitrites are necessary for Kaposi sarcoma. (a) A 27- to 58-fold higher consumption of nitrites (111, 115) correlates with a 20-fold higher incidence of Kaposi sarcoma in male homosexuals compared to all other AIDS patients of the same age group (65). (b) Among male homosexuals, those with Kaposi sarcoma have used nitrite inhalants twice as often as those with other AIDS diseases (101). (c) During the last 6-8 years, the use of nitrite inhalants among male homosexuals decreased (e.g., from 58% in 1984 to 27% in 1991 in San Francisco) (115). In parallel, the incidence of Kaposi sarcoma among American AIDS patients decreased from a high of 37% in 1983 (136) to a low of 10% in 1990 (52). In fact, nitrites may be sufficient causes for these diseases, because there is no evidence that HIV was even present in any of these studies.
(ii) Specific correlations indicate that nitrites are necessary for AIDS. The first five cases diagnosed as AIDS in 1981, before HIV was known, were male homosexuals who had all consumed nitrite inhalants and presented with pneumocystis pneumonia and cytomegalovirus infection (137). Early CDC data indicate that, in 1981 and 1982, 86% of male homosexuals with AIDS had used oral drugs at least once a week and 97% occasionally (57, 138), and that every one of 20 Kaposi sarcoma patients had used nitrites (56). The National Institute on Drug Abuse reports correlations from 69% (116) to virtually 100% (101,113) between nitrite inhalants and Kaposi sarcoma and pneumonia. Again, drugs may have sufficed to cause these diseases, because HIV was not diagnosed (50, 51, 54).
(iii) The incidence of AIDS diseases among 297 HIV-positive, asymptomatic intravenous drug users over 16 months was three times higher in those who persisted than in those who stopped injecting drugs (139).
(iv) The T-cell count of 65 HIV-infected drug users from New York dropped over 9 months in proportion with drug injection-on average, 35%-compared to controls who had stopped (140).
(v) A placebo-controlled study, investigating AZT as AIDS prophylaxis in HIV-positive, AIDS-free 25- to 45-year-old male homosexuals and intravenous drug users, indicates that AZT induces diseases from within and without the AIDS definition (80). During 1 year of taking 500 mg of AZT per day, a group of 453 developed 11 AIDS cases, and a group of 457, taking 1500 mg of AZT per day, developed 14 cases. The placebo group of 428 developed 33 AIDS cases.
However, the price for the presumed savings of 22 and 19 AIDS cases with AZT was high, because 19 more cases of anemia, neutropenia, and severe nausea appeared in the 500-mg AZT group, and 72 more such cases appeared in the 1500-mg AZT group, than in the placebo group. This indicates cytocidal effects of AZT on hemopoiesis and on the intestines. Although these AZT-specific diseases were not diagnosed as AIDS, neutropenia generates immunodeficiency. Surprisingly, in view of its toxicity on leukocytes and red cells, a consistent loss of T-cells was not observed in this study. A recent study investigating AZT as AIDS prophylaxis observed leukopenia, e.g., T-cell depletion, in 82% within 1 to 1.5 years of AZT treatment (140a). The study is further compromised by the failure to report and to consider the recreational drug-use histories and the many AZT-treatment adjustments of the subjects analyzed.
(vi) Within 48 weeks on AZT, 172 (56%) out of 308 AIDS patients developed additional AIDS diseases, including pneumonia and candidiasis (125). This indicates that AZT induces AIDS diseases within less than 1 year, and thus much faster than the 10 years HIV is said to need to cause AIDS (54). Likewise, no therapeutic benefits were observed for 365 French (123) and 4 Norwegian AIDS (133) patients after 6 months on AZT.
(vii) The annual lymphoma incidence of AZT-treated AIDS patients was reported to be 9% by the National Cancer Institute and was calculated to be 50% over 3 years (69). The lymphoma incidence of untreated HIV-positive AIDS-risk groups is 0.3% per year and 0.9% per 3 years, derived from the putative average progression rate of 10 years from HIV to AIDS (54, 141,142) and the 3% incidence of lymphoma in AIDS patients (52). Thus, the lymphoma incidence is 30-50 times higher in AZT-treated than in untreated HIV-positive counterparts. In addition, "during the past three years [of AZT therapy] a progressive increase in the number of [AIDS] patients dying from lymphoma, ..." to a current level of 16%, was noted in 1991 in a group of 346 AIDS patients in London, most of whom were on AZT (143).
It is likely that the chronic levels of the mutagenic AZT, at 10-30 µM (500-1500 mg/person/day), were responsible for the lymphomas. The alternative proposal that HIV-induced immunodeficiency was responsible for the lymphomas (69) is unlikely, since cancers do not reflect a defective immune system (53, 144).
(viii) Ten out of 11 HIV-positive, AZT-treated AIDS patients recovered cellular immunity after discontinuing AZT in favor of an experimental HIV vaccine (145), indicating that AZT sufficed for immunodeficiency.
(ix) Four out of five AZT-treated patients recovered from myopathy 2 weeks after discontinuing AZT; two redeveloped myopathy on renewed AZT treatment (126).
(x) Four patients with pneumonia developed severe pancytopenia and bone marrow aplasia 12 weeks after the initiation of AZT therapy. Three out of four recovered within 4-5 weeks after AZT was discontinued (124), indicating that AZT was sufficient for pancytopenia.
b. Drug Use Sufficient for AIDS Indicator Diseases in the Absence of HIV. (i) Among intravenous drug users in New York, representing a "spectrum of HIV-related diseases," HIV was observed in only 22 out of 50 pneumonia deaths, 7 out of 22 endocarditis deaths, and 11 out of 16 tuberculosis deaths (66).
(ii) Pneumonia was diagnosed in 6 out of 289 HIV-free and 14 out of 144 HIV-positive intravenous drug users from New York (146).
(iii) Among 54 prisoners with tuberculosis in New York State, 47 were street-drug users, but only 24 were infected with HIV (67).
(iv) In a group of 21 heroin addicts, the ratio of helper to suppressor T-cells declined within 13 years from a normal of 2 to less than 1, which is typical of AIDS (50, 51), but only 2 were infected by HIV (147).
(v) Thrombocytopenia and immunodeficiency were diagnosed in 15 intravenous drug users on average 10 years after they became addicted, but 2 were not infected with HIV (148).
(vi) Lymphocyte reactivity and abundance was depressed by long-term injection of drugs not only in 111 HIV-positive but also in 210 HIV-free intravenous drug users from Holland (149).
(vii) The same lymphadenopathy, weight loss, fever, night sweats, diarrhea, and mouth infections were observed in 49 out of 82 HIV-free and 89 out of 136 HIV-positive, long-term intravenous drug users from New York (150), and in about 40% of 113 intravenous drug users from France, of which 69 were HIV-positive and 44 were negative (151). The French group had used drugs for an average of 5 years.
(viii) Among six HIV-free male homosexuals with Kaposi sarcoma, five reported the use of nitrite inhalants (152).
(ix) Similar neurological deficiencies were observed among 12 HIV-infected and 16 uninfected infants from drug-addicted mothers (153).
Thus, the long-term use of recreational and anti-HIV drugs appears necessary in HIV-positives and sufficient in HIV-negatives to induce AIDS indicator and other diseases.
It follows that the drug-AIDS hypothesis is epidemiologically and pathologically better grounded than the virus-AIDS hypothesis. About 32% of American AIDS patients are confirmed intravenous drug users, probably 60% use aphrodisiac drugs orally, and an unknown but large percentage of both behavioral and clinical AIDS-risk groups use AZT. Moreover, the consumption of recreational drugs by AIDS patients is probably underreported, because the drugs are illicit, and because medical scientists and support for research are currently heavily biased in favor of viral AIDS (68, 154, 155). The pathogenicity of these drugs is empirically known for all, and mechanistically for some, drugs, notably for AZT and nitrites (103).
Nonetheless, evidence for the role of drugs in AIDS is rejected by proponents of the virus-AIDS hypothesis (15, 77, 105). This is certainly one reason why despite the current drug-use epidemic, there are no studies that investigate the long-term effects of psychoactive drugs and AZT in animals, compatible with the time periods and dosages used by AIDS patients (155).
By contrast to the near complete correlation between drugs and AIDS, antibodies to HIV are confirmed in only about 50% of AIDS patients (51, 72), and it is a complete mystery how HIV acts as a pathogen, despite enormous research efforts (14, 15, 54, 156).
The drug-AIDS hypothesis resolves all scientific paradoxes posed by the prevailing virus-AIDS hypothesis:
1. In America, HIV is a long-established, endemic virus, but AIDS is new-because the drug epidemic is new.
2. AIDS is restricted for over 10 years to 10,000 (52) or 0.01% of the over 100 million sexually active heterosexual Americans per year, and to 20,000 (52) or 0.25% of the 8 million homosexuals, estimated at 10% of the adult male population (109, 111). But conventional venereal diseases are on the rise in the U.S. (97), and there is no vaccine or drug against HIV. This is because AIDS is due to drug consumption rather than sexual activity.
3. Over 72% of American AIDS cases are 20- to 44-year-old males (52)-although no AIDS disease is male-specific (50, 51)-because males of this age group consume over 80% of all "hard" psychoactive and aphrodisiac drugs (101, 103, 111, 115, 157, 158).
4. Distinct AIDS diseases occur in distinct risk group-because they use distinct drugs (e.g., users of nitrites get Kaposi sarcoma, users of intravenous drugs get tuberculosis, and users of AZT get leukopenia and anemia).
5. Viral AIDS occurs, on average, 10 years after HIV infection (51, 53, 54), although infectious agents, being self-replicating toxins, typically strike within weeks or months after infection (11, 12). Indeed, HIV is immunogenic, and may be mildly pathogenic in humans within weeks after infection and is then "effectively and rapidly limited" by antiviral immunity (91, 92). This is because HIV infection and AIDS are unrelated events. The duration and toxicity of drug consumption and individual thresholds for disease determine when AIDS occurs, irrespective of when and whether HIV infects.
6. HIV, as well as many other parenterally and venereally transmitted microbes and viruses, are mere markers for AIDS and AIDS risks (54, 107, 159)-because the higher the consumption of unsterile, injected drugs (140, 151) and sexual contacts mediated by aphrodisiac drugs, the more microbes are accumulated.
7. Some old diseases of hemophiliacs, other recipients of transfusions, and the general American population are called AIDS-if they coincide with perinatal or parenteral HIV infection (54).
8. Old African diseases such as slim disease, fever, diarrhea, and tuberculosis are called AIDS now, although they are clinically and epidemiologically very different from American AIDS. They occur in adolescents and adults of both sexes that are subject to protein malnutrition, parasitic infections, and poor sanitary conditions (53). Only because HIV is endemic in over 10% of Central Africans are over 10% of old African diseases now called AIDS (51, 53, 54).
The drug-AIDS hypothesis predicts that the AIDS diseases of the behavioral AIDS-risk groups in the U.S. and Europe can be prevented by controlling the consumption of recreational and anti-HIV drugs, but not by "safe sex" (51) and "clean injection equipment" (55) for unsterile (!) street drugs. According to the drug-AIDS hypothesis, AZT is AIDS by prescription. Screening of blood for antibodies to HIV is superfluous, if not harmful, in view of the anxiety that a positive test generates among the many believers in the virus-AIDS hypothesis and the toxic AZT prophylaxis, prescribed to many who test "positive." Eliminating the test would also reduce the cost of the approximately 12 million annual blood donations in the U.S. (82) by $11 each (Irwin Memorial Blood Bank, personal communication, 1990) and would lift travel restrictions for antibody-positives to many countries, including the U.S. and China. The drug-AIDS hypothesis is testable epidemiologically and experimentally by studying AIDS drugs in animals.
B. Hepatitis C Virus and Non-A Non-B Hepatitis
Non-A non-B hepatitis is observed primarily in recipients of transfusions and in intravenous drug users (3, 12, 160). It has been postulated to be a viral disease because inoculation of plasma or serum (3-75 ml) from hepatitis patients into chimpanzees induced some biochemical markers of hepatitis, such as alanine aminotransferase, in half of the animals (160). However, none of the animals developed hepatitis (161, 162). Trace amounts of presumably viral RNA have recently been detected in the liver of hepatitis patients. In addition, "nonneutralizing" antibodies to "nonstructural epitopes," from an apparently latent RNA virus, have been identified mostly in asymptomatic carriers (160). Cloning and sequencing indicated that the RNA is directly coding and measures about 10 kb. Therefore, the suspected virus has been tentatively classified as a togavirus (160). Viral RNA was only detectable after amplification with the PCR in 9 out of 15 non-A non-B hepatitis patients, and non-neutralizing antibodies were found in only 7 of the 9 RNA-positive and in 3 of the 6 RNA-negative patients (163). Likewise, liver tissues from chimpanzees inoculated with sera from hepatitis patients contain only one viral RNA molecule per ten cells (160).
In view of this evidence, the putative virus has been termed hepatitis C virus (HCV) to indicate that it is the cause of the hepatitis. Subsequently, the Food and Drug Administration has recommended, and the American Association of Blood Banks has mandated, as of 1990, the testing of the approximately 12 million annual blood donations in the U.S. (82) for antibodies to HCV at an approximate cost of $5 per test. The test was developed by Chiron Co., Emeryville, California (Irwin Memorial Blood Bank, personal communication, August 15, 1991).
However, several arguments cast doubt on the hypothesis that HCV causes hepatitis:
1. Virus-containing sera or plasma from hepatitis patients does not cause hepatitis if inoculated into chimpanzees, indicating that HCV is not sufficient to cause the disease. Moreover, since the virus has not been propagated in culture and isolated in a pure form, the possibility exists that the biochemical markers of hepatitis that are observed in chimpanzees inoculated with plasma were induced by another agent. Thus, HCV is not likely to be a sufficient cause of hepatitis in humans.
2. The presence of HCV in asymptomatic subjects at the same concentration and activity as in hepatitis patients also indicates that the virus is not sufficient to cause hepatitis.
3. The absence of viral RNA in 6 out of 15 hepatitis C patients indicates that the virus is not necessary for the disease.
It appears that HCV either causes disease by unprecedented mechanisms with as little as one RNA molecule per 10 liver cells in some and even less in other carriers, or that the virus is not the cause of non-A non-B hepatitis. By contrast, the concentration of viral RNAs made by conventional pathogenic viruses, including togaviruses, ranges from 103 to over 104 per cell (10). Therefore, it seems plausible that a latent passenger virus was identified that survives by establishing chronic asymptomatic infections at very low, nonpathogenic titers (164).
C. Measles Virus, HIV, and Subacute Scleroting Panencephalitis
In 1967, a cytocidal measles virus was proposed to be the cause of a very rare, subacute scleroting panencephalitis of children (165), based on correlations with antibodies to the virus or trace amounts of virus (3, 10, 12). The encephalitis is observed only 1-10 years after an acute primary infection, in the face of antiviral immunity, and in only about 1 out of 1 million children infected by the virus (3, 10, 12). The virus can only be isolated from the brains of 2 out of 8 encephalitis patients after cocultivation of brain cells with susceptible human cells (166). Thus, only a few intact virus particles are present in the brains of some, but apparently not in all, children with encephalitis. Viral gene expression in brain autopsies is 10- to 200-fold lower than in virus-replicating control cells, amounting to as few as 10 mRNAs per cell (167). Moreover, mutations and deletions were observed in these viral RNAs compared to wild-type measles virus (168). Accordingly, some viral RNAs are not even translated (3). By contrast, the wild-type virus causes measles within weeks after infection, at very high virus titers, and prior to antiviral immunity (10, 12).
The measles virus-encephalitis hypothesis has a number of epidemiological and virological shortcomings:
1. Since the disease does not occur concurrently with, or instead of, the conventional measles disease during a primary infection, and since antiviral immunity does not protect against the disease, measles virus cannot be sufficient to cause the subacute panencephalitis.
2. The virus cannot be a sufficient cause of the disease because only 1 in 106 infected persons develops panencephalitis, compared to one in a few if not all who develop measles disease before antiviral immunity (3, 10, 12).
3. Since viruses are self-replicating toxins, all are potentially "fast" pathogens, but encephalitis is observed only 1-10 years after infection, measles virus cannot be sufficient for panencephalitis.
4. The absence of infectious virus in some panencephalitis cases, and the very low concentration of viral RNA in all cases, suggest that measles virus is either not causative, or is causative by a mechanism that is totally different from that causing measles disease. During conventional measles disease, the virus is abundant, making over 1000 RNA molecules per cell in large numbers of cells (3, 10, 12, 167, 168).
In view of these paradoxes, it was suggested that selection of viral mutants would account for the encephalitis-pathogenicity of the virus (3, 167, 168). However, this seems unlikely, because the virus does not replicate sufficiently in encephalitis patients to generate new pathogenic variants, and because natural variants with a neurotropic specificity would then be expected.
About 15 years after the measles virus-encephalitis hypothesis was advanced, others proposed that the encephalitis was caused by a latent retrovirus closely related to HIV (169). This hypothesis also suffers from the problem that the presumed viral pathogen is latent (169). In addition, an encephalopathy is hard to reconcile with the fact that retroviruses depend on mitosis for infection (170) and the fact that neurons stop dividing soon after birth (1).
D. Phantom Viruses and Neurological Disease
The strong belief in viruses as causes of diseases has in some instances even exceeded their very definition. For example, the Nobel Prize in 1976 was given for hypothetical, slow, and unconventional viruses that would cause neurological diseases such as kuru, Creutzfeld-Jacob's, and Alzheimer's diseases, after long latent periods of up to 30 years (171). Kuru is a now-extinct neurological disease of a small tribe of 35,000 in New Guinea that reportedly was transmitted by ritual cannibalism (3, 12, 171). "Slow and unconventional" viruses have been postulated because 4 out of 7 chimpanzees had developed neurological diseases about 1-2 years after they had been inoculated intracerebrally with brain suspensions from kuru patients (172). The presumed Creutzfeld-Jacob virus failed to induce neurological disease if presumably infected materials were inoculated into the brains of chimpanzees (3). A slow, unconventional virus has also been claimed as the cause of scrapie, a neurological disease of sheep (3, 12).
Since the incubation periods from inoculation of brain suspensions from kuru patients to neurological disease in the animals (1-2 years) and from presumed infection of humans to kuru (up to 30 years) differ significantly, it is not clear whether the diseases were caused by the same agent. Considering the claim that the viruses are naturally transmitted by cannibalism, it seems inappropriate that the traumatic intracerebral inoculation was chosen to test the oral transmission hypothesis. Nevertheless, Gajdusek et al. pointed out, "To anyone who had the opportunity of observing the unique syndrome of kuru ... the similarity of its clinical picture and course to the experimentally induced syndrome ... is dramatically evident" (172).
The slow virus-neurological disease hypothesis suffers from several shortcomings:
1. None of these hypothetical viruses has ever been isolated and chemically analyzed. Their presumed properties all far exceed the known ranges of conventional viruses and even of known proteins and nucleic acids. For example, the kuru and Creutzfeld-Jacob viruses are said to resist boiling water, ionizing gamma radiation, ultraviolet radiation, and inactivation with formaldehyde (3, 171 ). Moreover, the viruses are not antigenic, and not visible under the electron microscope, although available preparations are reported to have titers of 107 lethal doses per milliliter (3). Paradoxically, the slow, unconventional viruses have since evolved into an infectious protein, termed prion, "derived from a normal cellular protein ... through an unknown posttranslational process" (173).
2. The virus-kuru hypothesis fails to account for the long latent periods between presumed infection and disease and for the restriction of the disease to a very specific risk group.
3. A recent analysis of the original data on kuru transmission casts doubt on the virus-kuru hypothesis, because the evidence for cannibalism was fabricated (174).
In view of this, we agree with a review by Gibbs, a collaborator of Gajdusek, that "many paradoxes [were] thrust on us by the discovery of these unconventional viruses as the etiological agents of chronic, progressive, degenerative diseases of the central nervous system . . . " and that "toxic or genetic determinants and even trauma lead to the same pathogenesis ..." (3). Indeed, it seems plausible that the toxicity and trauma of intracerebral inoculations of human brain suspensions from kuru patients could cause neurological diseases without phantom viruses said to be the etiological agents. The restriction of the slow neurological diseases to specific ethnic groups or to sporadic cases could reflect genetic and acquired deficiencies rather than selective and slow viruses. source...
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