Dear Dr. Culshaw: What is HIV Disease?
Posted originally on BarnesWorld
“Read your article, 'Why I Quit HIV.' AIDS is simply advanced or end stage HIV disease. Period. Nothing more, and nothing less. Its artifical [sic], and only a classification. It really doesn't seem that you understand that distinction.”
If there were ever a term that made even less sense than the ephemeral AIDS, it would have
to be HIV disease. To the best of my knowledge, this term was coined partly to be able to apply to anyone who happened to test positive for HIV antibodies but didn’t necessarily have an AIDS-defining disease or an abnormally low CD4 count, and partly to cement the connection between HIV and any disease.
But HIV alone causes no disease – even by official orthodox definition, unless we have taken to including an inverted CD4/CD8 ratio in the “disease” classification, rather than what it is – a laboratory anomaly that may indicate or foreshadow disease. And when one looks a little bit closer, not only does HIV disease begin to seem just as vacuous as it really is, but the idea of AIDS as a properly defined syndrome also begins to fall apart.
The acronym AIDS was introduced to replace the previously used pejorative term GRID (Gay-Related Immune Deficiency). Regardless, AIDS remains to this day a government-defined syndrome with, simultaneously, no specific clinical symptoms of its own yet a myriad of indirect illnesses and symptoms supposedly “caused” by the immune suppression—really quite a clever idea, since essentially everything is a symptom.
To really understand the paradoxical nature of AIDS and “HIV disease”, it is germane to consider the very reason that the distinction of a clinical syndrome exists in the first place. To define a clinical syndrome is useful when initially attempting to better understand what might be the causative agent of said syndrome. (It is important to bear in mind, too, that most syndromes actually consist of a collection of interconnected symptoms rather than of disparate diseases.)
Plainly speaking, one designates a syndrome before one has any knowledge of the precise molecular mechanism of pathogenesis underlying the set of symptoms. Defining the clinical syndrome enables public health authorities and physicians to narrow the scope of their investigation to factors common to all those people in the epidemiological cohort among which the syndrome is manifest. A clinical syndrome is useful when it illuminates a causative agent of a disease, and this identification ideally has the effect of narrowing the scope of the clinical syndrome. That is, as we know more about what causes the syndrome, the number of symptoms under the syndrome umbrella should become smaller as we identify and throw out those that clearly do not fit the pattern.
AIDS is peculiar historically in that the definition of the syndrome actually became more expansive after the alleged causative agent was identified. This is contrary to all logic and counter to the reasoning that underlies the existence and usefulness of the clinical syndrome designation in the first place. Moreover, these expansions make it very difficult to properly analyze epidemiological data. As the definition expanded and as it became more and more clear that HIV did not do at all what it was purported to do—that is, kill CD4+ T-cells by any detectable method—researchers began to invent more and more convoluted explanations for why their theory was correct. The logical, scientific thing to have done would have been to notice that their original disease designation did not accurately identify the causative agent or agents and, rather than changing the syndrome, reconsider the supposed causative agent(s) and try to find one that explained the observations better. As we know, this has not happened.
Even a diagnosis of HIV-positive accompanied by no clinical symptoms at all can result in an individual’s inclusion under the umbrella of AIDS, which flies in the face of the very reason for the designation of a syndrome as a set of clinical symptoms. In another major lapse of logic, the classification of HIV-free AIDS, “Idiopathic CD4+ Lymphocytopenia” or ICL for short, was introduced in 1993 to actually exclude from the AIDS designation people who were free of any trace of HIV but still had symptoms that would ordinarily result in their being classified as having the syndrome AIDS.
So what, then, is “HIV disease”? It is a vacuous classification, because it does not mean any sort of disease or even a set of symptoms necessarily. As far as I can tell, “HIV disease” means “testing positive on an HIV test”, perhaps accompanied by any type of lowered immunity – as though anyone in the general population does not suffer from lowered immunity from time to time. As far as I can tell, the entire reason for the term “HIV disease” is just in case anyone dares to think for a moment that HIV really has little to do with disease at all. Once again, no hope is allowed.
So it would appear that “AIDS” and “HIV disease” are not, in fact, the same thing, as my concerned e-mailer pointed out, unless of course one takes them both to signify “meaning nothing and everything at once”.
Rebecca V. Culshaw worked on mathematical models of HIV infection for almost ten years. She received her Ph.D. in mathematics (with a specialization in mathematical biology) from Dalhousie University in Canada in 2002 and is currently an assistant professor of mathematics at the University of Texas at Tyler. She is a celebrated internet author as a result of her writings on Lew Rockwell, and "Science Sold Out: Does HIV Really Cause AIDS?", a book based on those essays is due this December. [The miniature at the top left is Hypatia of Alexandria (370-415), famous as the first woman known to have made a substantial contribution to the development of mathematics.]
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"Dear Dr. Culshaw,
"Dear Dr. Culshaw,
"You talk a lot about how the HIV tests are not very accurate. It's my understanding that they are actually very accurate and I'm afraid you're misleading people into not being tested when they should be."
Yet another peculiar feature of the HIV/AIDS gospel is how much of what we hear, and even much of what doctors and researchers believe to be true, is so far removed from what is documented in the scientific literature that when one learns what really is in the literature, the immediate reaction is disbelief.
I doubt that very many ordinary citizens - or god forbid, medical practitioners - are aware that in HIV antibody test kits are warning sentences saying things like: "EIA [Elisa] testing cannot be used to diagnose AIDS." I doubt that many people who submit to this testing have any knowledge that their very future, their ability to obtain insurance, to bear children naturally, to travel, or to live without fear, are hanging on the results of a test that has not even been approved to diagnose HIV infection without being "confirmed" by numerous similar tests, all of which work in the same way, and all of which contain similar warnings.
But I doubt even more that the majority of medical practitioners are aware of the subtle but significant shift in the language used in HIV test kits since the beginning of the AIDS era. For example, from 1984 until the very recent past, test kit inserts contained the unambiguous statement "AIDS is caused by HIV". In 2002, the OraSure toned down that statement to say: "AIDS, AIDS-related complex and pre-AIDS are thought to be caused by HIV."
But just this year, in a remarkable - and potentially significant - shift in thinking, the trend seems to be toward making an even less committal statement. For example, Abbott Diagnostic's ELISA test insert contains the following sentence: "Epidemiologic data suggest that the Acquired Immune Deficiency Syndrome (AIDS) is caused by at least two types of human immunodeficiency viruses, collectively known as HIV."
Vironostika appears to be even less willing to support a true causal role, as their 2006 test kit insert says: "Published data indicate a strong correlation between the acquired immune deficiency syndrome (AIDS) and a retrovirus referred to as Human Immunodeficiency Virus (HIV)."
What this is telling us is that twenty-two years later, we've still got nothing. As the recent Rodriguez et. al. paper indicates, virus levels (as dubiously measured by viral load tests) have almost zero influence on CD4+ cell decline, and these are the cells that have so long been believed to be dying at HIV's behest. As Zvi Grossman stated in a recent paper, "The pathogenic and physiologic processes leading to AIDS remain a conundrum." In other words, we still have no clue what HIV actually does. Where are the T-cells going? No one knows. What is viral load, anyway? No one knows.
After twenty-two years, we're back to correlation - back to epidemiology. Yet we're still stuck in the same pattern of promoting these tests that may measure something - but no one really understands what it is. Worse yet, we're using the results of these tests to literally ruin people's lives. Something is very, very wrong.
Perhaps the most disturbing trend of late is the "strong recommendation" that all pregnant women be tested for HIV. And if she doesn't get tested for HIV during her pregnancy we'll strongly recommend that she be tested while she is in labor. Am I the only person disturbed by this? To terrorize and intimidate women when they are at their most vulnerable - while they are pregnant and while they are giving birth - is a sign of a society that is suffering a worse sickness than the one that so terrorizes it.
At its worst, this type of medical terrorism results in situations such as the tragic case of Joyce Ann Hafford (as chronicled to such devastating effect by Celia Farber in her recent article in Harper's magazine), who died as a result of nevirapine toxicity. The fact that Hafford may well have been falsely positive only makes the loss all the more gruesome. And we cannot forget the fact that we have no idea what will happen in the long term to children who receive these drugs in utero. We
have no idea, just as we have no idea whether they would even get sick if they did not receive the drugs.
When all is said and done, the only support we have for any role HIV may play in AIDS is an epidemiological correlation. Worse, it is a correlation between manifestations of a particular clinical syndrome and the results of an antibody test that has never been standardized, never been verified against true viral isolation, and which is not even approved for diagnosis of HIV infection. For this test we have put all manner of discriminatory laws on the books, but we don't
even know what the tests mean. And if we don't know what they mean, any correlational data that might be obtained from them must be looked on with caution, if not thrown out entirely. When all is stripped away, as we slowly begin to understand just how uncertain the foundations of the entire HIV/AIDS industry are, all we are left with is nothing.