I have picked apart the flawed claims made by the HIV/AIDS denialist Henry Bauer a few times before and found them wanting, basically rehashing the same old debunked canards that denialists have repeated to themselves and anyone who wants to listen for decades. However, a recent blog entry by Bauer called Evidence-based medicine: No HIV/AIDS epidemic was so full of mind-numbing falsehoods and error that I just had to write a refutation.
So once more unto the breach…
The scientific evidence supports HIV as the cause of AIDS
—> Not only does Bauer think that there is no evidence that HIV causes AIDS, he also thinks that the evidence is stacked against this model. What is more, despite the fact that HIV has been isolated and probably visualized with electron microscopy, he actively believes that HIV as a virus does not even exist.
—> Nothing can be proven with absolute mathematical certainty in science, but a strong case can be made if multiple, independent lines of evidence all converge on the same general conclusion. This is what we find for the model that HIV causes AIDS.
—> The National Institute of Allergy and Infectious Diseases lists a lot of this evidence, including established epidemiological association, isolation, transmission pathogenesis, infection by HIV as a uniquely strong predictor for development of AIDS, the vast majority of AIDS-defining illnesses occur in patients with HIV, death rates are higher among HIV+ individuals than HIV- ones, HIV can be detected in AIDS patients, correlation between high HIV virus, viral antigens and viral genetic material one the one hand and increase risk of developing AIDS, efficacy of ARVs specific for blocking HIV replication improves prognosis for HIV patients, individuals with a lower viral load as a result of medication are less likely to progress to full-blown AIDS, AIDS patients have HIV antibodies, low prevalence of HIV antibodies correlate with extreme rarity of AIDS, HIV is similar to other viruses of the same type that causes immunodeficiency in their natural hosts etc. (NIAID, 2010)
—> None of these findings mathematically prove that HIV must cause AIDS, but the combined weight of the independent evidence strongly favors it. Those that reject the scientific conclusion that HIV causes AIDS must not just rationalize away each piece of evidence, but they must find another model on which the evidence is more likely.
—> The bottom line is that the HIV causes AIDS model predicts the evidence with a much higher probability than the notion that HIV does not cause AIDS.
Drop in lifespan reveals the severe impact of the HIV/AIDS pandemic
—> Bauer repeats the old canard that HIV/AIDS is not an epidemic since the population growth in certain African countries are positive.
—> This is a flawed argument, because high birthrates compensates. The severe impact of HIV/AIDS can be seen by looking at changes in average lifespan over time. As discussed in a previous blog entry, Kalichman (2009, pp. 77-78) points out that countries in southern Africa, including South Africa, have seen a massive decrease in life expectancy over the years that correspond to the occurrence of AIDS pandemic. He writes that: “Life expectancy in many countries that were improving during the post-colonial years of the 1960s and 1907s began to erode in the 1980s and 1990s, and life expectancy in many countries is now worse than even during the 1950s, the last full decade of colonialism. The reason why some countries afflicted by AIDS sustain positive population growth is simply due to high birth rates.”
Failure to provide ARVs South Africans caused 340000 deaths
––> Researchers at Harvard School of Public Health concludes in Chigwedere et. al. (2008) that over 330000 individuals with HIV/AIDS died earlier than needed because the previous President of South Africa, Thabo Mbeki, and his government refused to let his people have access to antiretrovirals. They believed that it was just a western pharmaceutical plot to destroy the future of the country and instead, he suggested garlic and lemon as treatment (Kalichman, 2009). How can Henry Bauer claim that there is no HIV epidemic?
HIV is not a harmless passenger virus
—> Another common claim is that HIV is just a harmless passenger virus.
—> However, this is contradicted by a massive amount of scientific evidence showing that when cell cultures containing cells that express CD4+ are exposed to HIV they get infected and die off, tissues removed from patients and infected show the same pattern, and infected mice with human immune systems can be infected with HIV and this results in a strong reduction in CD4+ T cells. Not only that, the mechanisms by which the depletion of T cells occurs has been extensively mapped and analyzed (Bennett et. al, 2010).
HIV has been isolated
––> Perhaps the most peculiar and absurd claim made by Bauer is that HIV has never been isolated without cellular protein contaminants.
––> This is of course nonsense, since HIV has both been isolated and what appears to be HIV has been visualized by electron microscopy. The central flaw in Bauer’s argument is that he does not seem to appreciate the way viruses replicate. They, to use a popular term, hijack the cellular replication machinery, forcing it to make more copies of the virus using cellular resources and thereby produces viral proteins from a cellular origin. An embarrassing case of ignorance of the basic biology of viruses.
Difficulties in HIV vaccine development is due to rapid mutation rate and evolution
––> Surely, if HIV was the cause of AIDS, there would have been an effective vaccine on the market ages ago?
––> Wrong! First of all, not all vaccines are as easy to produce. HIV is not alone in this. There is no currently no effective malaria vaccine on the market. Does this mean that Malaria does not exist? That it is not caused by Plasmodium? Hardly. It just means that vaccine research can sometimes be hard.
––> Furthermore, HIV has many unique challenges associated with it. The nature of the infection involves undermining central components of adaptive immunity and it has a fairly high mutation rate. It is estimated that HIV has an very high mutation rate due to the error-prone nature of reverse transcriptase, which is an enzyme that makes DNA from RNA for host integration. It is estimated that all theoretically possible point mutations in the viral genome occurs every day. Another issue is that viral integration into the host genome and becoming transcriptionally silent means that it is more difficult for the immune system to clear it from the body of a vaccinated individual. Also, there are many different version of HIV, and it is possible to be infected by more than one strain, making vaccine development difficult (Abbas et. al. 2012 p. 467; Murphy, 2012, pp. 560-561).
Reduction in HIV incidens and AIDS death rates means that preventative measures are partially working
––> Bauer also claims that the current figures for the incidens of HIV infection and deaths due to AIDS cannot be with HIV being an infectious agent responsible for the epidemic.
––> However, this ignores the fact that preventative programs and treatment modulates the impact of the virus. If people limit their high risk sexual encounters, use protection, avoid having unprotected sex with prostitutes, avoid sharing dirty needles etc. then the spread of the infectious agent can be limited (which would show up as a decrease in incidence). Furthermore, death rates decline because of treatment with ARVs. Being treated means you live longer and living longer means reduction in death rates.
ARVs are effective and cannot be rejected with the toxin gambit
––> Bauer repeats the well-known toxin gambit (Gorski, 2008), which is a debating tactic common to many forms of medicine-related forms of pseudoscience. It basically claims that well-tested medications are “toxins”.
––> However, toxic effects are dependent on dose, so that something that is toxic in very high doses can be safe at much lower doses. This is true for almost all substances, including water. If you drink too much water, it will disturb the electrolyte balance in cells, leading to water intoxication. This can sometimes be fatal. Obviously, the dose is determined by a trade-off between efficacy and toxicity. You want the dose that provides the highest efficacy while not being as harmful.
––> There is also a lot of scientific evidence that modern ARV treatment such as HAART is effective (Murphy et. al. 2001). Not only that, their usage result in decreased mortality (Whitman et. al. 2000) and HIV+ patients who display patient non-compliance are much more likely to progress to AIDS (Bangsberg et. al. 2001). There is just so much you could point to here, that the notion that ARV treatments are ineffective is plainly absurd.
There is plenty of independently converging evidence for the position that HIV causes AIDS. A positive population growth in countries afflicted by HIV/AIDS is a result of masking by high birth rates. To see the severe effects of HIV/AIDS one needs to look at average life span, which has fallen by several decades. Failing to provide HIV+ patients in South Africa with ARVs is estimated to have caused 340000 premature deaths. HIV is not a harmless passenger virus, because it has been shown that it leads to a large drop in CD4+ T cell count in vitro, ex vitro and in vivo. The claim that HIV has never been isolated in the absence of cellular contaminants is wrong because HIV hijacks the cellular machinery for its own replication, so the nucleic acids and proteins that new virus particles consist of are produced by the cell. Difficulties in the production of HIV vaccine is not because HIV does not exist, but because HIV targets adaptive immunity, high mutation rates and rates of evolution etc. Reduction in HIV incidens and AIDS death rates means that preventative measures are partially working. Many studies of the efficacy of HAART has shown that it is effective, and this cannot be refuted by claiming that ARVs are toxic, as toxic effects are dose-dependent.
References and Further Reading
Abbas, A. K., Lichtman, A. H., & Pillai, S. (2012). Cellular and Molecular Immunology (7th ed.). Philadelphia: Elsevier Saunders.
Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. A., Roberston, M., Zolopa, A. R., & Moss, A. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15(9), 1181-1183.
Bennett et. al. (2010). Myth: HIV is a harmless passenger virus. AIDSTruth. Accessed: 2012-01-15.
Chigwedere, P., Seage, G.R., III, Gruskin, S., Lee, T.-H., and Essex, M. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. J. Acquir. Immune Defic. Syndr. 49:410–415 (2008).
Gorski, D. (2008) Toxic myths about vaccines. Science-Based Medicine. Accessed: 2012-01-15.
Kalichman, S. (2009). Denying AIDS: Conspiracy Theories, Pseudoscience and Human Tragedy. New York: Copernicus Books.
Murphy, E. L., Collier, A. C., Kalish, L. A., Assmann, S. F., Para, M. F., Flanigan, T. P., . . . Nemo, G. J. (2001). Highly Active Antiretroviral Therapy Decreases Mortality and Morbidity in Patients with Advanced HIV Disease. Annals of Internal Medicine, 135(1), 17-26.
Murphy, K. (2012). Janeway’s Immunobiology (8th ed.). New York: Garland Science.
NIAID. (2010). The Evidence That HIV Causes AIDS. Accessed: 2012-01-15.
Whitman, S., Murphy, J., Cohen, M., & Sherer, R. (2000). Marked Declines in Human Immunodeficiency Virus-Related Mortality in Chicago in Women, African Americans, Hispanics, Young Adults, and Injection Drug Users, From 1995 Through 1997. Arch Intern Med, 160(3), 365-369. doi: 10.1001/archinte.160.3.365