Do you mean what I think you mean when you use the word “AIDS” by Anita Allan

Do you mean what I think you mean when you use the word “AIDS”?

From correspondence personal and available on the Internet, it is obvious that the Great AIDS Debate has become bogged down due to a lack of common understanding of the two words “AIDS” and “HIV”. Everyone uses the words but there is no agreement on their meaning. I hope I do not have to point out that this is a serious defect in a dialogue.

The fact is the question: what is AIDS, depends on what continent you are on, which country of that continent you live in, and even the year of diagnosis because over the years different definitions of AIDS have evolved.

In effect the HIV-causes-AIDS theory is rendered completely contradictory by AIDS definitions. By this I mean that if for arguments sake one accepts that HIV causes AIDS then it should not be possible to diagnose AIDS any other way except by somehow showing HIV infection. In practice, though, AIDS can be diagnosed in the absence of immune deficiency and even after negative results on blood tests.

To date there have been five definitions of AIDS – but none of them explain AIDS as a definable disease.

The CDC’s first definition of AIDS (1) stated:

“The CDC defines a case of AIDS as a disease, at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease. Such diseases include KS [Kaposi’s sarcoma], PCP [Pneumocystis carinii pneumonia], and serious OOI [other opportunistic infections].

“These infections include pneumonia, meningitis, or encephalitis due to one or more of the following: aspergillosis, candidiasis, cryptococcosis, cytomegalovirus, norcardiosis, strongyloidosis, toxoplasmosis, zygomycosis, or atypical mycobacteriosis (species other than tuberculosis or lepra); esophagitis due to candidiasis, cytomegalovirus, or herpes simplex virus; progressive multifocal leukoencephalopathy, chronic enterocolitis (more than 4 weeks) due to cryptosporidiosis; or unusually extensive mucocutaneous herpes simplex of more than 5 weeks duration.

“Diagnoses are considered to fit the case definition only if based on sufficiently reliable methods (generally histology or culture). However, this case definition may not include the full spectrum of AIDS manifestations, which may range from absence of symptoms (despite laboratory evidence of immune deficiency) to non-specific symptoms (e.g fever, weight loss, generalized, persistent lymphadenopathy) to specific diseases that are insufficiently predictive of cellular immunodeficiency to be included in incidence monitoring (e.g., tuberculosis, oral candidiasis, herpes zoster) to malignant neoplasms that cause, as well as result from, immunodeficiency”.

From this definition it’s quite clear that in 1982 the CDC was not sure what AIDS was, other than it appeared to be due to immune deficiency from unknown cause manifesting in any of 14 different diseases. So, a diagnosis of AIDS – the effect – did not need an identified cause!

In 1984 the CDC revised the definition extending AIDS defining diseases to include non-Hodgkin’s lymphoma and lymphoma of the brain. Then the announced “discovery” of HIV as the cause of AIDS during 1984 led to another revision in June 1985. Seven more diseases were added bringing the total of manifesting diseases to 21, and in the process groups previously specifically excluded from an AIDS diagnosis fell under the AIDS umbrella.

This happened because finding a viral cause for immune deficiency had the unfortunate effect of voiding the conditional clause of the 1982 definition. It stated that a diagnosis for AIDS could be made only in people with an “opportunistic disease” if there was no known cause for diminished resistance to that disease. At that stage it was well known that certain groups of people were prone to infections of all kinds. This included patients undergoing cancer chemotherapies; transplant patients; those being treated with high doses of corticosteroids to control inflammatory and autoimmune diseases; people born with defective immune systems; and men over the age of 60 who developed Kaposi’s sarcoma, since they were at risk for this cancer. Once HIV was recognised as the cause of AIDS, people in all these categories previously specifically excluded, could be diagnosed AIDS.

Another bizarre paradox of the 1985 definition was that some (not all) opportunistic diseases previously diagnostic for AIDS were now diagnostic only if HIV were present. In other words, a patient who tested negative on an HIV antibody screening assay with, for example, disseminated TB did not have AIDS, but the identical TB in a patient who tested positive on an HIV antibody screening assay was AIDS.

Meanwhile, in Africa, where diagnostic tools were not always available a CLINICAL definition of AIDS was agreed at the WHO workshop in Bangui, Central African Republic, October 22-24 1985.(2) According to this definition, no HIV test was necessary and HIV infection was inferred. According to the Banqui Definition AIDS was diagnosed as follows:

1. ADULTS: In the absence of known causes of immunosuppression AIDS may be diagnosed by a consideration of:

• MAJOR SIGNS, that is weight loss >10% of body weight; chronic diarrhoea >1 month; prolonged fever >1 month (intermittent or constant).

• MINOR SIGNS: persistent cough for >1 month; generalised pruritic dermatitis; recurrent herpes zoster, oro-pharyngeal candidiasis; chronic progressive and disseminated herpes simplex infection; generalised lymphadenopathy.

• In addition, the presence of generalized Kaposi’s sarcoma or cryptococcal meningitis suffice by themselves for the diagnosis of AIDS.

• 2. CHILDREN: In infants and children, AIDS may be diagnosed if the subject presents at least two of the following minor signs in the absence of known causes of immuno-suppression.

• MAJOR SIGNS: weight loss or abnormally slow growth; chronic diarrhoea > 1 month; prolonged fever > 1 month.

• MINOR SIGNS: generalised lymphadenopathy; oro-pharyngeal candidiasis; repeated common infections (otitis, pharyngitis etc).

Drs Joseph McCormick and Susan Fisher-Hoch from the CDC, who attended the Bangui WHO workshop, explained the rationale behind the definition as follows:

“We still had an urgent need to begin to estimate the size of the AIDS problem in Africa…But we had a peculiar problem with AIDS. Few AIDS cases in Africa receive any medical care at all. No diagnostic tests, suited to widespread use, yet existed…In the absence of any of these markers [e.g., diagnostic T4/T8 white cell tests], we needed a clinical case definition…a set of guidelines a clinician could follow in order to decide whether a certain person had AIDS or not. [If we] could get everyone at the WHO meeting in Bangui to agree on a single, simple definition of what an AIDS case was in Africa, then, imperfect as the definition might be, we could actually start to count the cases, and we would all be counting roughly the same thing.

“The definition was reached by consensus, based mostly on the delegates’ experience in treating AIDS patients. It has proven a useful tool in determining the extent of the AIDS epidemic in Africa, especially in areas where no testing is available. Its major components were prolonged fevers (for a month or more), weight loss of 10 percent or greater, and prolonged diarrhoea…”(31

This clinical definition means that in Africa a person can be diagnosed as HIV infected without any tests. On the other hand, a positive reaction on a single Elisa which is the most common test used in South Africa, more often than not also leads to a diagnosis of HIV infection even when the person has no symptoms whatsoever.

To make matters even more confusing, in 1987 the CDC redefined AIDS (4). According to this set of revisions, the list of opportunistic infections grew to 24, again enlarging the pool of potential AIDS patients. Even more alarming was that 12 opportunistic diseases, including Pneumocystis carinii pneumonia, Kaposi’s sarcoma, disseminated cytomegalovirus infection, and esophageal candidiasis, were diagnostic for AIDS regardless of whether there was any evidence of HIV infection!

The redefinition allowed AIDS to be diagnosed as follows, I quote:

1. If no laboratory evidence of HIV – If there is no other cause of immunodeficiency (listed in 1A below) and an indicator disease from 1B definitively diagnosed, then AIDS.

2. If laboratory evidence of HIV – If an indicator disease from 1B or 2A is definitively diagnosed or a disease from 2B is presumptively diagnosed, then AIDS.

3. If laboratory evidence of HIV is negative – If there is no other cause of immunodeficiency from 1A and Pneumocystis carinii is definitively diagnosed then AIDS; and/or if there is no other cause of immunodeficiency from 1A and CD4<400 and an indicator disease from 1B is definitively diagnosed, then AIDS.

1A. Causes of immunodeficiency that disqualify diseases as indicators of AIDS in the absence of laboratory evidence for HIV infection

• high-dose or long-term systematic corticosteroid therapy or other immunosuppressive/cytotoxic therapy <3 months before the onset of the indicator disease.

• any of the following diseases diagnosed <3 months after diagnosis of the indicator disease: Hodgkin’s disease, non-Hodgkin’s lymphoma (other than primary brain lymphoma), lymphocytic leukemia, multiple myeloma, any other cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphadenopathy.

• a genetic (congenital) immunodeficiency syndrome or an acquired immunodeficiency syndrome atypical of HIV infection, such as one involving hypogammaglobulinemia

1B. Indicator diseases diagnosed definitively

• candidiasis of the esophagus, trachea, bronchi, or lungs

• cryptococcosis, extrapulmonary

• cryptosporidosis with diarrhea persisting >1 month

• cytomegalovirus disease of an organ other than liver, spleen, or lymph nodes in a patient >1 month of age

• herpes simplex virus infection causing a mucocutaneous ulcer that persists longer than 1 month; or bronchitis, pneumonitis, or esophagitis for any duration affecting a patient >1 month of age

• Kaposi’s sarcoma affecting a patient < 60 years of age

• lymphoma of the brain (primary) affecting a patient < 60 years of age

• lymphoid interstitial pneumonia and/or pulmonary lymphoid hyperplasia (LIP/PLH complex) affecting a child <13 years of age

• Mycobacterium avium complex or M. kansasii disease, disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph nodes)

• Pneumocystis carinii pneumonia

• progressive multifocal leukoencephalopathy

• toxoplasmosis of the brain affecting a patient >1 month of age

2A. Indicator diseases diagnosed definitively

• bacterial infections, multiple or recurrent (any combination of at least two within a 2-year period), of the following types affecting a child <13 years of age: septicemia, pneumonia, meningitis, bone or joint infection, or abscess of an internal organ or body cavity (excluding otitis media or superficial skin or mucosal abscesses), caused by Haemophilus, Streptococcus (including pneumococcus), or other pyogenic bacteria

• coccidioidomycosis, disseminated (at a site other than or in addition to lungs or cervical or hilar lymph nodes)

• HIV encephalopathy (also called “HIV dementia”, “AIDS dementia,” or “subacute encephalitis due to HIV”)

• histoplasmosis, disseminated (at a site other than or in addition to lungs or cervical or hilar lymph nodes)

• isosporiasis with diarrhea persisting >1 month

• Kaposi’s sarcoma at any age

• lymphoma of the brain (primary) at any age

• other non-Hodgkin’s lymphoma of B-cell or unknown immunologic phenotype and the following histologic types:

• small noncleaved lymphoma (either Burkitt or non-Burkitt type)

• immunoblastic sarcoma (equivalent to any of the following, although not necessarily all in combination: immunoblastic lymphoma, large-cell lymphoma, diffuse histiocytic lymphoma, diffuse undifferentiated lymphoma, or high-grade lymphoma)

• any mycobacterial disease caused by mycobacteria other than M. tuberculosis, disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph nodes)

• disease caused by M. tuberculosis, extrapulmonary (involving at least one site outside the lungs, regardless of whether there is concurrent pulmonary involvement)

• Salmonella (nontyphoid) septicemia, recurrent

• HIV wasting syndrome (emaciation, “slim disease”)

2B. Indicator diseases diagnosed presumptively

• candidiasis of the esophagus

• cytomegalovirus retinitis with loss of vision

• Kaposi’s sarcoma

• lymphoid interstitial pneumonia and/or pulmonary lymphoid hyperplasia (LIP/PLH complex) affecting a child <13 years of age

• mycobacterial disease (acid-fast bacilli with species not identified by culture), disseminated (involving at least one site other than or in addition to lungs, skin, or cervical or hilar lymph nodes)

• Pneumocystis carinii pneumonia

• toxoplasmosis of the brain affecting a patient >1 month of age

End quote.

The 1987 CDC re-definition explicitly stated that “regardless of the presence of other causes of immunodeficiency, in the presence of laboratory evidence for HIV, any disease listed indicates a diagnosis of AIDS.”

In other words, according to official guidelines AIDS could be diagnosed among people who were born with congenital immune deficiencies; who had demonstrable, pre-existing, or coexisting causes of immune suppression due to chemotherapy, radiation treatment, or corticosteroid use; and among transplant patients who were on regimens of immunosuppressive drugs for life.

In case the absurdity of this isn’t immediately evident let me summarise the situation. At this stage people with diseases identical in all respects to those used to define AIDS, were not AIDS patients if they tested HIV antibody negative. However, some people were AIDS patients if they went down with opportunistic infections even if they tested HIV antibody negative. In addition, in patients who tested HIV antibody positive almost any disease was diagnostic for AIDS even if there were fundamental causes for their immune suppression.

Even the 1987 definition was not the end of the story, because in 1993 the CDC expanded the definition.(5): “this expansion includes all HIV-infected adults and adolescents who have less than 200 CD4+ T-lymphocytes/microlitre or a CD4+ T-lymphocyte percent of total lymphocytes less than 14, or who have been diagnosed with pulmonary tuberculosis, invasive cervical cancer, or recurrent pneumonia”.

In other words, the new definition was based mainly on results of laboratory tests – positive test for HIV-antibodies and low enough T4-cell count. This meant that contrary to earlier definitions of AIDS, the official position was now that opportunistic infections were not necessary to diagnose AIDS.

Truly the Mother of All Diseases – MAD.

The implication of all of this is that in Africa the syndrome (the “s”) encompasses at least 30 diseases, none of them new. There is no common denominator among these diseases; some of them have nothing to do with immune deficiency, such as dementia – the brain being independent of the immune system. Even the big killer malaria falls into the AIDS definition. All these diseases encompassing the big killers raging across the continent are reduced to so-called “opportunistic infections” caused by a single agent, HIV. A person presenting with any of these diseases in Africa could be diagnosed as having AIDS – and by implication HIV – on symptoms without blood tests. So TB which is endemic in Africa killing something like 800,000 people a year, is a major AIDS-defining disease. TB sufferers in Africa run the real risk of simply being told they have HIV for which there is no cure – and then being sent home to die without getting even the drugs for TB!

Knowing this, many choose the option of simply not reporting in ill at such clinics and hospitals that exist. Under such circumstances it is not really surprising to hear that higher mortalities per year were being recorded as the so-called HIV/AIDS epidemic rages on in Africa. Also – malnutrition has the exact symptoms of AIDS: fever, weight loss, diarrhoea. Instead of getting food to these people it is proposed to send antiretrovirals because even malnutrition is HIV/AIDS.

The schizophrenic definition of AIDS is definitely not scientific. But what the definitional expansions do indicate is how easy it is to double or treble the number of AIDS cases. Seen in this context, the huge numbers of AIDS cases in Africa need not be occurring because greater numbers of people are infected with some putative virus, but rather by definition – and one in which no one can get sick with any disease or die of anything except HIV/AIDS – nor can they be cured because once diagnosed HIV “infected” everything that happens to you from then on to death has but one cause – HIV.

References:

1. CDC Morbidity and Mortality Weekly Report 31 1982 (37): 507-508.

2. World Health Organisation Epidemiological Record No 10 March 7, 1986, page 71.

3. Joseph B. McCormick and Susan Fisher-Hoch, Level 4: Virus Hunters of the CDC (Atlanta: Turner Publishing, 1996), pp. 188-90.

4. CDC Morbidity and Mortality Weekly Report 36 Supplement 1S (1987)

5. CDC Morbidity and Mortality Report 41RR-17