AIDS: non-infectious deficiencies acquired by drug consumption and other risk factors

The Biology and Evolution of HIV

▪ Abstract  This review examines the current state of knowledge about HIV/AIDS in terms of its origins, pathogenesis, genetic variation, and evolutionary biology. The HIV virus damages the host's immune system, resulting in AIDS, which is characterized by immunodeficiency, opportunistic infections, neoplasms, and neurological problems. HIV is a complex retrovirus with a high mutation rate. This mutation rate allows the virus to evade host immune responses, and evidence indicates that selection favors more virulent strains with rapid replication. While a number of controversial theories attempt to explain the origin of HIV/AIDS, phylogenetic evidence suggests a zoonotic transmission of HIV to humans and implicates the chimpanzee (Pan troglodytes troglodytes) as the source of HIV-1 infection and the sooty mangabey as the source of HIV-2 infection in human populations. New therapies provide hope for increased longevity among people living with AIDS, but the biology of HIV presents significant obstacles to finding a cure and/or vaccine. HIV continues to be a threat to the global population because of its fast mutation rate, recombinogenic effect, and its use of human defenses to replicate itself.

Conjuring medical science: the 1986 referendum on AIDS/HIV policy in California

Medical science occupies a peculiar status in American life. On the one hand, people often view medical science as a privileged and authoritative body of knowledge that transcends other kinds of knowledge. On the other hand, medical-scientific authority can be easily conjured from the popular symbols of science, e.g., credentials, technical terms, and white lab coats. This problem can be converted into an anthropological question of meanings and symbols, based on Geertz's interpretive anthropology and Baudrillard's sociology of hyperreality. This article uses these frameworks to explore the cultural construction of medical-scientific authority in the case of a 1986 referendum on AIDS/HIV policy in California. The interpretation of that construction raises some difficult problems concerning anthropology's treatment of medical science.

Semen alloantigens and lymphocytotoxic antibodies in AIDS and ICL

More than 90% of people with AIDS develop circulating immune complexes (CICs) and lymphocytotoxic antibodies (LCTAs). Animals infected with HIV, however, never display CICs or LCTAs, and remain healthy. Similarly, HIV-infected people who do not develop CICs or LCTAs also do not progress to AIDS. The appearance of CICs and LCTAs is, however, highly prognostic for AIDS and death. Since HIV infection does not, per se, lead to the development of CICs and LCTAs, other causes are likely. One such cause, for which both epidemiologic and experimental evidence exists, is semen. Semen components include sperm, seminal fluid, lymphocytes, and sometimes infectious agents, including HIV, mycoplasmas, and herpes and hepatitis viruses, all of which independently cause immune suppression. Extensive evidence demonstrates sperm (and various viruses) contains many proteins mimicking the CD4 protein of T-helper cells, while HIV, mycoplasmas, and seminal fluid mimic class II MHC proteins of other lymphocytes. We identify a large number of protein sequences that display such mimicry using computer homology searching, and demonstrate experimentally that sperm antibodies specifically precipitate antibodies against class II MHC mimics such as mycoplasmas, which in turn precipitate antibodies to lymphocyte antigens. These data prove that immunologic exposure to sperm and lymphocytes (as may occur in receptive anal intercourse, needle sharing, or blood transfusions) is theoretically capable of initiating lymphocytotoxic autoimmunity. Such autoimmunity may play a significant role in the pathogenesis of AIDS, and will need to be addressed clinically in high risk individuals regardless of HIV status and regardless of the success of anti-HIV prophylaxis and treatment.

Five myths about AIDS that have misdirected research and treatment

A number of widely repeated and factually incorrect myths have pervaded the AIDS research literature, misdirecting research and treatment. Five of the most outstanding are: 1) that all risk groups develop AIDS at the same rate following HIV infection; 2) that there are no true seroreversions following HIV infection; 3) that antibody is protective against HIV infection; 4) that the only way to treat AIDS effectively is through retroviral therapies; and 5) that since HIV is so highly correlated with AIDS incidence, it must be the sole necessary and sufficient cause of AIDS. A huge body of research, reviewed in this paper, demonstrates the falsity of these myths. 1) The average number of years between HIV infection and AIDS is greater than 20 years for mild hemophiliacs, 14 years for young severe hemophiliacs, 10 years for old severe hemophiliacs, 10 years for homosexual men, 6 years for transfusion patients of all ages, 2 years for transplant patients, and 6 months for perinatally infected infants. These differences can only be explained in terms of risk-group associated cofactors. 2) Seroreversions are common. Between 10 and 20 percent of HIV-seronegative people in high risk groups have T-cell immunity to HIV, and may have had one or more verified positive HIV antibody tests in the past. 3) Antibody, far from being protective against HIV, appears to be highly diagnostic of loss of immune regulation of HIV, and some evidence of antibody-enhancement of infection exists. 4) Non-retroviral treatments of HIV infection, including safer sex practices, elimination of drug use, high nutrient diets, and limited reexposure to HIV and its cofactors have proven to be effective means of preventing or delaying onset of AIDS. 5) Many immunosuppressive factors, including drug use, multiple concurrent infections, and exposure to alloantigens, are as highly correlated with AIDS risk groups as HIV. These data are more consistent with AIDS being a multifactorial or synergistic disease than a monofactorial one.

Dissent in science: styles of scientific practice and the controversy over the cause of AIDS

In this paper, we use a scientific controversy, and the efforts to legitimize and undermine a theory, to examine the co-production of facts and the rules for verifying facts over time. We discuss these processes in terms of what we call 'styles of scientific practice.' In contrast to the focus of idealist philosophers on theory production and validation as forms of logic or ways of thinking, our styles of practice also include the activities of hands and eyes and the discourses between multiple actors in diverse situations. We discuss aspects of the different styles of practice deployed by opponents in a current controversy surrounding the etiology of AIDS to understand how the same data are interpreted in different ways to support diametrically opposed views. Our study describes and examines rules of confirmation used by supporters of the theory that HIV causes AIDS. For example, we introduce an 'epidemiological' style of practice used by AIDS researchers to synthesize information to understand this disease. Styles of practice stress the historically located collective efforts of scientists, technicians, administrators, institutions, and various 'publics' as they build and sustain ways of knowing. Yet, we also show that the 'history' is also a contested construction, not a given in dusty archives. We describe the different versions of history constructed by various participants in the debate to validate their current constructions and definitions of the disease AIDS. Finally, we discuss the politics behind disease definitions and the consequences of different definitions.

HIV-1 and the aetiology of AIDS

The belief that HIV-1 infection causes AIDs has been questioned, and the suggestion made that to know the correct cause of AIDS the incidence of disease in patients with and without risk behaviours and with and without antibody to HIV-1 must be known. We describe findings in such a cohort. In 715 homosexual men followed for a median of 8.6 years, all 136 AIDS cases occurred in the 365 individuals with pre-existing HIV-1 antibody. Most men negative for HIV-1 antibody reported risk behaviours but none developed any AIDS illnesses. CD4 counts fell in anti-HIV-1-positive men but remained stable in antibody-negative men, whether or not risk behaviours were present. The hypothesis that AIDS in homosexual men is caused not by HIV-1 infection but by drugs and sexual activity is rejected by these data. HIV-1 has an integral role in the pathogenesis of AIDS.

Possible supplemental mechanisms in the pathogenesis of AIDS

Multiple and diverse mechanisms have been proposed as supplements to the HIV-1 virus in the destruction of CD4+ cells and the pathogenesis of AIDS. But it is now realized that 100 times more CD4+ cells are infected with HIV-1 than was originally thought to be the case, and many antigen-presenting cells are infected as well. In addition to the direct cytopathic effect of the virus, one or a few supplemental mechanisms may well suffice to explain the progressive loss of CD4+ cells, e.g., the considerable variation in the virus and/or the destruction of uninfected CD4+ cells by one immunological mechanism or another. However, it is not yet possible to state confidently which additional mechanism(s) is important. Identification of the nature of this supplemental process has become essential for successful, nonharmful intervention.

The role of drugs in the origin of AIDS

It is proposed that the new American and European AIDS epidemics are caused by recreational and anti-HIV drugs rather than by human immunodeficiency virus (HIV). Chronologically, the AIDS epidemic in the 1980s followed a massive escalation in the consumption of recreational drugs that started in the 1960s and 70s. Epidemiologically, both epidemics derive about 80% of their victims from the same groups of 20-44 year-olds, of which 90% are males. In America 32% of these are intravenous drug users and their children, about 60% are male homosexuals who are long-term users of oral aphrodisiac drugs and an unknown percentage are prescribed the cytotoxic DNA chain terminator AZT, as inhibitor of HIV. Direct evidence indicates that these drugs are necessary for HIV-positives and sufficient for HIV-negatives to develop AIDS diseases. The drug-AIDS hypothesis predicts correctly that: (i) AIDS is new in the US, because the drug epidemic is new, while the HIV epidemic is old--fixed at a constant 1 million Americans since 1985; (ii) despite an increase in venereal diseases, AIDS remains restricted to long-term drug users and small groups with clinical deficiencies; (iii) over 72% of AIDS occurs in 20-44 year-old males, because they make up over 80% of hard psychoactive drug use; (iv) distinct AIDS diseases correlate with the use of distinct drugs, eg Kaposi's sarcoma with nitrite inhalants, tuberculosis with intravenous drugs, and leukopenia, anemia, and nausea with AZT; (v) AIDS diseases are only acquired after long-term drug consumption, rather than after single contacts as the virus-hypothesis predicts. The drug hypothesis can be tested epidemiologically and experimentally in animals. It predicts that most AIDS can be prevented by stopping the consumption of drugs, and provides a rational basis for therapy.

AIDS acquired by drug consumption and other noncontagious risk factors

The hypothesis that human immunodeficiency virus (HIV) is a new, sexually transmitted virus that causes AIDS has been entirely unproductive in terms of public health benefits. Moreover, it fails to predict the epidemiology of AIDS, the annual AIDS risk and the very heterogeneous AIDS diseases of infected persons. The correct hypothesis must explain why: (1) AIDS includes 25 previously known diseases and two clinically and epidemiologically very different epidemics, one in America and Europe, the other in Africa; (2) almost all American (90%) and European (86%) AIDS patients are males over the age of 20, while African AIDS affects both sexes equally; (3) the annual AIDS risks of infected babies, intravenous drug users, homosexuals who use aphrodisiacs, hemophiliacs and Africans vary over 100-fold; (4) many AIDS patients have diseases that do not depend on immunodeficiency, such as Kaposi's sarcoma, lymphoma, dementia and wasting; (5) the AIDS diseases of Americans (97%) and Europeans (87%) are predetermined by prior health risks, including long-term consumption of illicit recreational drugs, the antiviral drug AZT and congenital deficiencies like hemophilia, and those of Africans are Africa-specific. Both negative and positive evidence shows that AIDS is not infectious: (1) the virus hypothesis fails all conventional criteria of causation; (2) over 100-fold different AIDS risks in different risk groups show that HIV is not sufficient for AIDS; (3) AIDS is only 'acquired,' if at all, years after HIV is neutralized by antibodies; (4) AIDS is new but HIV is a long-established, perinatally transmitted retrovirus; (5) alternative explanations disprove all assumptions and anecdotal cases cited in support of the virus hypothesis; (6) all AIDS-defining diseases occur in matched risk groups, at the same rate, in the absence of HIV; (7) there is no common, active microbe in all AIDS patients; (8) AIDS manifests in unpredictable and unrelated diseases; and (9) it does not spread randomly between the sexes in America and Europe. Based on numerous data documenting that drugs are necessary for HIV-positives and sufficient for HIV-negatives to develop AIDS diseases, it is proposed that all American/European AIDS diseases, that exceed their normal background, result from recreational and anti-HIV drugs. African AIDS is proposed to result from protein malnutrition, poor sanitation and subsequent parasitic infections. This hypothesis resolves all paradoxes of the virus-AIDS hypothesis. It is epidemiologically and experimentally testable and provides a rational basis for AIDS control.

An idiotypic network model of AIDS immunopathogenesis

Considerations from a network theory of the immune system suggest that human immunodeficiency virus and allogeneic stimuli may act synergistically to cause AIDS. The immune responses to these stimuli include two components that are directed against each other. In some AIDS risk groups other antigens that mimic major histocompatibility complex antigens may substitute for allogeneic stimuli. Implications for the prevention of AIDS are discussed.

AIDS epidemiology: inconsistencies with human immunodeficiency virus and with infectious disease

The newly defined syndrome AIDS includes 25 unrelated parasitic, neoplastic, and noninfectious indicator diseases. Based on epidemiological correlations, the syndrome is thought to be due to a new, sexually or parenterally transmitted retrovirus termed human immunodeficiency virus (HIV). The following epidemiological data conflict with this hypothesis. (i) Noncorrelations exist between HIV and AIDS; for example, the AIDS risks of infected subjects vary greater than 10-fold with their gender or country. Abnormal health risks that are never controlled as independent AIDS causes by AIDS statistics, such as drug addiction and hemophilia, correlate directly with an abnormal incidence of AIDS diseases. Above all, the AIDS diseases occur in all risk groups in the absence of HIV. (ii) American AIDS is incompatible with infectious disease, because it is almost exclusively restricted to males (91%), because if it occurs, then only on average 10 years after transfusion of HIV, because specific AIDS diseases are not transmissible among different risk groups, and because unlike a new infectious disease, AIDS has not spread exponentially since the AIDS test was established and AIDS received its current definition in 1987. (iii) Epidemiological evidence indicates that HIV is a long-established, perinatally transmitted retrovirus. HIV acts as a marker for American AIDS risks, because it is rare and not transmissible by horizontal contacts other than frequent transfusions, intravenous drugs, and repeated or promiscuous sex. It is concluded that American AIDS is not infectious, and suggested that unidentified, mostly noninfectious pathogens cause AIDS.

Multi-step pathogenesis of AIDS--role of cytomegalovirus

Human immunodeficiency virus (HIV) has been shown to be the initial aetiological agent of the acquired immune deficiency syndrome (AIDS). The recent clinical, epidemiologic, pathological, immunological and molecular data presented in this review point to a multi-step pathogenesis of AIDS involving HIV as an initial cause leading to reactivation of cytomegalovirus (CMV), human herpesvirus-6 (HH-6) and other immunosuppressive organisms. Although the onset of CMV reactivation is not precisely known, it may be related to the transition from AIDS-related complex to AIDS. The molecular interactions between CMV and HIV occur in both directions. Although transcriptional activation of HIV by CMV infection (possibly via induction of NF chi B) is better known, the enhancement of CMV replication by HIV is clinically as important. The interactions between HIV or simian immunodeficiency virus (SIV) and CMV appear to be more specific than between HIV or SIV and other herpes viruses, and are also cell-type-dependent. CMV-induced immune suppression (possibly of variable magnitude with different strains) may be an additional co-factor in AIDS. In a rhesus monkey model, the interaction of SIV with rhesus CMV appears contributory to the reproduction of the full-blown simian AIDS. Patients with AIDS and disseminated CMV infection display the maximum activation of HIV p24 antigenaemia and the greatest deficiency of CD8+ T lymphocytes. Defects in CD4+ and CD8+ T cells, including HIV- and CMV-specific cytotoxic T cells, are crucially important in the progression to terminal AIDS and are related not only to HIV but also to CMV and HH-6 infections of lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)