The Tainted Ignorance of HIV/AIDS Denialism

Related: The Breathtaking Inanity of Henry Bauer’s HIV/AIDS Denialist Balderdash.

Despite being a emeritus professor in chemistry and science studies and a well-known critic of the pseudohistorical nonsense of Immanuel Velikovsky, Henry Bauer is a leading HIV/AIDS denialist and a passionate believer in the existence of the Loch Ness Monster. His falsehoods about HIV/AIDS have been debunked many times before on this website and they seem to get more absurd as time goes by. He shows no signs of slowing down and continues to spew pseudoscientific claims about HIV/AIDS on his blog. Although, he calls himself a “skeptic”, he is a typical anti-science denialist who uses all of the common tricks.

Earlier in 2013, Bauer wrote a post on his denialist blog called Immaculate infection by HIV where he attempts to point to a dozen or so alleged facts that he thinks are fundamentally unexplainable from the perspective of modern medicine. He even goes so far as to claim that mainstream science should be tempted to consider the virus “supernatural” because of the alleged properties that Bauer puts forward. In reality, his post is filled with misguided half-truths and outright falsehoods. He complains that no vaccine or chemical microbicide is available, yet fails to understand the unique difficulties with HIV vaccine development and the trade-off related to chemical microbicide usage. He claims that HIV is difficult to transmit and thinks this is incompatible with the size of the HIV/AIDS pandemic, despite the fact that these rates are just averages that tell you nothing about the spread. He rejects the fact that HIV can be spread via contaminated needles, stating point-blank that needles do not have sex with each other. He calls HIV a “politically incorrect” virus, despite the fact that we know that differences in incidence are primarily due to a complex interaction of well-known epidemiological, social and economic factors. Bauer fails to understand many basic medical facts, including TB as an opportunistic infection for individuals with HIV/AIDS, that HIV leads to immune suppression which allows opportunistic infections to take root, that there are entire databases with HIV sequences, the consilience of multiple, independent lines of evidence and so on.

Causes of HIV genetic diversity

Bauer finds it extraordinary that HIV can mutate into many different strains and combinations. However, some of the important reasons behind this are known: it has a fast replication cycle, high mutation rate and the enzyme reverse transcriptase promotes recombination. These factors grow even more potent if a cell is infected by more than one virus particle.

Vaccine development is difficult because of well-known reasons

In a similar fashion, Bauer finds it weird that there are no effective vaccines against HIV yet. However, this is not weird when you take into account the vast scientific knowledge about HIV and the interaction between HIV and the human immune system. Due to factors promoting genetic diversity, it is difficult to find any conserved epitope and HIV can evade the immune system by several ways including antigenic escape, hiding inside cells, the killing of CD4+ T cells (a central player in the human immune system) and interference with antigen presentation (NIAD, 2008; Johnston and Fauci, 2008).

As scientists learned more about HIV from the 1980s and onward, they have realized that HIV vaccine development poses unique challenges that makes it very difficult. But they are working on it. Taking these practical difficulties and twisting them to a tool against mainstream medicine is highly problematic. Similar issues with vaccine development occurs with e. g. malaria, but I highly doubt that Bauer would attempt to use this fact to argue against the existence of the malaria parasite.

Bauer also brings up chemical microbicides claiming that no such product can inactivate HIV. This is technically speaking wrong. Industrial-strength bleach would probably due the trick. However, this would also compromise the health of the individual, so it is of course not used. One fundamental trade-off with chemical microbicides against HIV that Bauer seems oblivious of is the following: it has to be strong enough to inactivate HIV, but not so strong that it irritates the mucosal barriers of the individual who uses it. If that happens, it can lead to inflammation and compromised barrier function, facilitating HIV infection.

Difficulty of transmission

Bauer tries to make a big deal out of the fact that the average probability of transmission per exposure event appears low at first sight. However, most people experience more than one exposure event and this figure is the average probability and it tells us nothing about the spread. There are going to be a subset of cases were the transmission probability per exposure event is considerably higher. The classic example is a pre-existing infection with e. g. HSV-2. Thus, there is no contradiction between an apparently low average probability of transmission and the scale of the global HIV/AIDS pandemic.

HIV spreads via similar mechanisms across the globe

The major risk groups for HIV infection includes children born to HIV+ mothers, individuals who use injectable drugs, men who have sex with men, individuals who have unprotected casual sex, sex workers and the marital partner of those individuals. The precise proportion of different mechanisms vary between continents for a number of factors, such as greater access to technology that prevent mother-to-child transmission in Europe and the U. S. compared with Africa.

HIV can spread when drug users share contaminated needles

Bauer seems puzzled by the fact that a substantial portion of HIV infections occur by sharing infected needles because “needles have no intercourse with one another”. Yes, believe it or not, he actually makes this argument for real. In reality, an individual with HIV who uses a needle for drug injection can spread HIV to the person sharing the needle with him or her. The first person sticks the needle into his or her body and blood containing HIV comes into contact with the needle. Then, another drug user uses the same needle to inject drugs, potentially becoming HIV infected. It is unclear how this could be confusing to Bauer. Presumably, motivated reasoning can make people believer very weird things. He clarifies in the comment section that he does not understand how the needles came to be infected in the first place, but as we have seen, it is the result of getting inserted into an individual with HIV.

Exclusive breastfeeding

Breastfeeding can spread HIV from mother to child. However, if the mother is on antiretroviral medication, this risk is minimized. The downside with not breastfeeding is that the child does not receive maternal antibodies through the milk. If a child is given e. g. solid foods at a very young age, this risks compromising the mucus membrane lining of the gastrointestinal tract (UNICEF, 2012). If such a child is also given breastfeeding, this increases the risk of transmitted HIV. This explains why HIV can spread from mother to child via the breast milk, but rarely occurs in the child is exclusively breastfed.

Higher incidence of HIV among African-Americans due to factors unrelated to ethnic group status

African-Americans have a higher incidence of HIV than European-Americans primarily because of four factors (CDC, 2013). First, the background prevalence of HIV is higher among African-Americans and African-Americans tend to have sex with other African-Americans. This means that a given African-American has a higher risk of becoming infected by HIV just by the fact that the prevalence is higher. Second, the prevalence of other sexually transmitted infections (STIs) are higher among African-Americans and some of these STIs are themselves risk factors for HIV infections (e.g. HSV-2 cause genital sores which facilitates HIV transmission). Third, stigma surrounding HIV and being gay is likely to make African-American individuals less likely to seek out medical services for prevention, testing and treatment (people who are unaware of their HIV infection are more likely to spread it than those that know that they are HIV infected). Thus, there may be a crucial difference in available information on HIV prevention. Fourth, many socio-economic factors can contribute to higher incidence of HIV, including less access to health care, higher rates of incarnation, legal system discriminations and poverty.

Bauer claims that HIV is a “politically incorrect” virus because the incidence among African-Americans is higher than among European-Americans. He attempts to use this fact to prop up his belief that the mainstream HIV/AIDS science is “inescapably racist”. In reality, the incidence discrepancy is due to a complex interaction of well-known epidemiological, social and economic factors unrelated to “race”. Here is how one critic describe the approach taken by Bauer (Snout, 2010):

What is arguably “racist”, then, is to deliberately ignore or deny the excessive mortality and suffering of African-Americans due to HIV/AIDS, and furthermore to seek for ignorant ideological reasons to undermine competent efforts to address the causes of the problem (such as efforts to reduce the rates of undiagnosed HIV). It might not be deliberate “racism” on Henry Bauer’s part, but it sure is dumb.

‘Noticed first’ does not imply ‘appeared first’

The first known case of HIV infection occurred in Africa in the late 1950s. But researchers in the U. S. and Europe first noticed HIV when it started killing gay men in California and New York in the early 1980s. After that, light was shone on the true extent of the HIV/AIDS pandemic in Africa.

Bauer attempts to distort this by claiming that HIV first “caused disease” in the U. S. and later re-invaded Africa to cause disease among “the blackest region of the South”. In reality, HIV “caused disease” and killed people in Africa too before it was discovered in the United States. Bauer is confusing the time-point at which an event occur with the time-point at which people in the U. S. become aware of the event. These are two separate things. The reason why HIV/AIDS hit “the blackest region of the South” (by which Bauer presumably means sub-Saharan Africa) worse than the Northern parts of Africa is because of more high-risk cultural behavioral patterns in the South and stronger religious-based social control in the North. There is nothing mysterious here.

Tuberculosis is an opportunistic infection

The reason that many individuals with tuberculosis also have HIV is because HIV, by virtue of suppression the immune system, is a risk factor for tuberculosis infection. Here is how Kalichman (2009) explains it:

TB is an opportunistic infection, becoming active n people with immune suppression. It stands to reason that TB patients have a high prevalence of HIV infection. The HIV-TB co-epidemics are well established.

HIV mortality is not independent of age

Bauer makes the peculiar claim that HIV mortality rate is independent of age, unlike other viral infections. However, this turns out to be untrue. Between 2003 and 2007, the mortality rate differed substantially in relation to age. For individuals 65 or older, 63% of the individuals survived at least 36 months, whereas the corresponding figure for people between 30 and 34 was 95% (CDC, 2011). To be sure, older individuals may be diagnosed later to a certain extend, but the difference in survival is so large that even taking this into account would probably still show a marked difference.

HIV –> immune suppression –> opportunistic infections

HIV leads to immune suppression by reducing the number of CD4+ T cells by various mechanisms. This, in turn, leads to immune suppression as CD4+ T cells are an important cog in the human immune system. This leaves the body vulnerable to a long list of opportunistic infections.

Bauer tries to make a big deal of the fact that more and more opportunistic infections have been added to the clinical diagnosis criteria of AIDS. He thinks this means that HIV has “learned” to cause more and more disease over time, apparently completely oblivious to the fact that it is not HIV directly that cause these diseases, but the immune suppression caused by HIV allow these opportunistic infections to flourish. As scientific progress has been made, researchers have found more opportunistic infections associated with HIV/AIDS. It is not that the HIV virus has “learned” anything. Rather, it is the knowledge of scientists and medical researchers that have increased with regards to the identity of opportunistic infections that individuals with HIV/AIDS are susceptible to.

Bonus round 1: The 18-month-old child in India was probably infected via blood transfusion

Bauer links to a story about an 18-month-old child in India who tested positive for HIV despite the fact that her parents both tested negative. He also claims that the baby was not “exposed to any of the other known routes of HIV transmission”. As it turns out, this is false. The baby was given blood transfusions after an infection with pneumonia turned critical. Although the donor allegedly tested negative, superintendent MohanRao of Government General Hospital found that medical records had been tampered with and Indian health authorities think that the private hospital fudged the records to avoid blame. Doctors now state that “it is clear now that the child has been infected through blood transfusion” (Times of India, 2013a).

It is also important to remember that India has less stringent safety controls over blood transfusions than the U. S. or countries in Europe (Times of India, 2007; Times of India, 2013b), so blood transfusion as the infection route is an explanation that is plausible with respect to the background information and fits all the available evidence.

Bonus round 2: HIV has been isolated, sequenced and imaged

HIV can be isolated form every infected individual (NIAID, 2010). It has been visualized using high-tech methods such as scanning electron microscopes and three-dimensional cryo-electron microscopy (HIV Sequence Database, 2010; Public Health Image Library, 2005; Carlson et al, 2010, de Marco et al, 2010, Zhao et al, 2013; Earl et al, 2013).. There are even several entire databases dedicated to HIV sequences (Kuiken et al., 2003). The two biggest databases are the HIV Sequence Database in Los Alamos stores all published HIV sequences and provides annotation information and bioinformatics tools for sequence analysis and HIV RT/Protease Sequence Database at Stanford specifically gathers sequences related to HIV drug resistance (Kuiken, Korber and Shafer, 2003). Despite this enormous scientific progress, Bauer continues to parrot the HIV/AIDS denialist myth that HIV “has never been isolated” in absence of “contaminating cellular proteins”. He clearly misunderstands the basic biology of viruses, as viruses hijack the cellular replication and translation systems to produce more copies of itself. These alleged “contaminating cellular proteins” are viral proteins created by the host cell under the control of the virus.

Bonus round 3: Gold standard and testing algorithm

An HIV diagnosis is never done based on the result of a single ELISA antibody test. Instead, a testing algorithm is deployed whereby several tests are made. These can include a confirmatory Western Blot and a RT-PCR test. Bauer claims that no test can diagnose an HIV infection because there is no gold standard. He clearly misunderstands the testing algorithm used, as a single test is not the entire basis for an HIV diagnosis. Furthermore, a PCR test can be considered an acceptable gold standard, especially if used in conjunction with other tests. Finally, even if there was no gold standard to compare tests against, this would not necessarily be a major problem. There is no gold standard for radiometric dating of very ancient material. The gold standard emerges from the independent convergence of evidence were the different methods reach the same result within the margin of error. Such a consilience is far more impressive than the result of any single method. Thus, a positive ELISA test together with a confirmatory Western Blot provides strong evidence of being infected with HIV.

Conclusion

Bauer is apparently under the impression that his concerns are unexplainable for modern mainstream science and medicine. He could not be more wrong. HIV occurs in many different strains because of e. g. fast replication cycle and a high mutation rate. Vaccine development is difficult because of the way HIV interacts with the immune system. Although the average rate of transmission might appear low, it says nothing about the spread. There are many factors that increase the risk of HIV transmission. HIV can be spread by contaminated needles and giving young babies solid food can compromise the protective mucosal lining in the gut. The higher incidence of HIV among African-Americans is not related to ethnic group status or harmful stereotypes. HIV mortality is not independent of age and HIV suppress the immune system and allows many different opportunistic infections from taking root. The 18-month-old child in India was probably infected via blood transfusion and the private hospital tries to cover it up. HIV has been isolated, sequenced and imaged over and over again and the convergence of independent lines of evidence shows that HIV testing is highly accurate.

References

Carlson, Lars-Anders, de Marco, Alex, Oberwinkler, Heike, Habermann, Anja, Briggs, John A. G., Kräusslich, Hans-Georg, & Grünewald, Kay. (2010). Cryo Electron Tomography of Native HIV-1 Budding Sites. PLoS Pathog, 6(11), e1001173.

CDC. (2011). HIV Surveillance Report 2011. Accessed: 2013-10-05.

CDC. (2013). CDC Fact Sheet: HIV and AIDS among African Americans. Accessed: 2013-10-05.

de Marco, Alex, Müller, Barbara, Glass, Bärbel, Riches, James D., Kräusslich, Hans-Georg, & Briggs, John A. G. (2010). Structural Analysis of HIV-1 Maturation Using Cryo-Electron Tomography. PLoS Pathog, 6(11), e1001215. doi: 10.1371/journal.ppat.1001215

Earl, Lesley A., Lifson, Jeffrey D., & Subramaniam, Sriram. (2013). Catching HIV ‘in the act’ with 3D electron microscopy. Trends in Microbiology, 21(8), 397-404.

Johnston, Margaret I., & Fauci, Anthony S. (2008). An HIV Vaccine — Challenges and Prospects. New England Journal of Medicine, 359(9), 888-890.

Kalichman, S. (2009). Denying AIDS: Conspiracy Theories, Pseudoscience and Human Tragedy. New York: Copernicus Books.

Kuiken C, Korber B, Shafer R. W. (2003). HIV sequence databases. AIDS Rev. 5(1):52-61.

NIAID. (2008). Challenges in Designing HIV Vaccines. Accessed: 2013-10-05.

NIAID. (2010). The Evidence that HIV Causes AIDS. National Institutes of Allergy and Infectious Diseases. Accessed: 2013-08-03.

Public Health Image Library. (2005). Scanning electron micrograph of HIV-1 virions budding from a cultured lymphocyte. Accessed: 2013-08-03.

Snout. (2010). Henry Bauer, HIV/AIDS and race . Reckless Endangerment. Accessed: 2013-10-05.

The Times of India. (2007). Unsafe blood transfusions rampant. Accessed: 2013-10-05.

The Times of India. (2013a). HIV-positive baby’s parents pass paternity test, probe given to APSACS. Accessed: 2013-10-05.

The Times of India. (2013b). Wrong blood transfusion govt’s mistake: Tarun Gogoi. Accessed: 2013-10-05.

UNICEF. (2012). HIV and Infant Feeding. Accessed: 2013-10-05.

Zhao, Gongpu, Perilla, Juan R., Yufenyuy, Ernest L., Meng, Xin, Chen, Bo, Ning, Jiying, . . . Zhang, Peijun. (2013). Mature HIV-1 capsid structure by cryo-electron microscopy and all-atom molecular dynamics. Nature, 497(7451), 643-646.