"AIDS Treatment News" online * New Issue #302 (searchable/indexed)

Carlton Hogan carlton at walleye.ccbr.umn.edu
Tue Sep 22 13:22:48 EST 1998

In article <3606c736.257123235 at netnews.worldnet.att.net>,
 <johnburgin at worldnet.att.net> wrote:
>On Thu, 17 Sep 1998 15:57:23 GMT, gmc0 at ix.netcom.com (George M.
>Carter) wrote:
>>Todd Miller <todd33 at ix.netcom.com> wrote:
>>>AIDS Treatment News / Immunet wrote:
>>>> Long-term survivors have usually tried many different treatments,
>>>> and found combinations which work for them.  
>>>Does anyone know of a reference that supports this statement?
>>>Is this statement true because by definition, a "long-term
>>>survivor" is a person who HAS taken the establishment's therapy,
>>>while a "long-term non-progressor" is a person who has avoided
>>>this therapy?
>>There is evidence that people with AIDS (who have progressed whether
>>they took drugs or not) have better clinical condition and survival
>>when they take drugs in combination than those who do not use drugs
>>who have progressed to AIDS.
>There is evidence to the opposite also, that is, that those taking the
>immunosuppressive "AIDS" drugs have worse clinical conditions and
>poorer survival when they take drugs(I assume you are speaking of the
>usual poisons, AZT and PI's)in combination than those who do not use
>drugs(again I am assuming the same thing) who have progressed to AIDS.

Actually, the entire body of randomized clinical trialls (the only
methodology to reliably link causal information to specific drugs)
refutes this notion, at least for persons with more advanced disease
(there is no reliable data suggesting that antiretrovirals have 
long term morbidity/mortality benefits in asymptomatic, relatively
high T-cell populations). But there are literally dozens of randomized
trials showing clear and unambiguous survival benefits for 
antiretrovirals, particularly regimens containing protease  inhibitors.
A small listing of trials that have shown "infection or death"
benefits includes CAESAR (AZT+3tC), ACTG 320 (AZT, 3tc and indinavir)
Merck 035 (same) Agouron 509 (AZT, 3tc and nelfinavir) and Abbott 047
(AZT, 3tc ritonavir) In addition to these trials, there are literally
hundreds of industry-sponsored and academic trials confirming 
dramatic virologic benefits (HIV-RNA). All respect due to Kary 
Mullis, an acid-popping chemist with no medical or virology training,
but HIV RNA has been mutiply verified as one of the single best
predictors of morbidity and mortality. Eager amateurs like Mullis 
and the Perth group claim HIV not to exist, or to be harmless.
Nevertheless, whatever HIV RNA assays (there is substantial 
agreement betwen the three most common, QC-PCR, bDNA and NASBA)
are used, there is a predictable and consistent association 
between HIV RNA levels and risk of OI or death. Whatever it's 
measuring (and virtually all investigators, including myself believe
it to be HIV) it is tightly associated with AIDS pathology.

>Really poor sentence structure and definitely a circular argument,
>kind of HIV=AIDzey(pronounced like 'sy' in easy)
>>This is a separate question of whether there is a value in using the
>>drugs for people with HIV who are progressing at fairly slow rates
>>toward AIDS.  It is probably best to wait for some period, but not
>>until T cells drop much below 100.  Indeed, some people can be HIV+
>>for 10 years without developing AIDS--but may still be progressing in
>>terms of continually but relatievly slowly declining CD4 counts.  As
>>time passes, the risk for opportunistic infections occurring rises.

>No really, if you're going to "knock those bad boys out", why not
>start early?  For that matter, why not take a cocktail with your
>multivitamin each day, especially if you want to be "absolutely sure"
>that HIV doesn't have a chance to go, mutate, waltz, swing dance...

Specific, phenotypically confirmed genotypic evidence makes it 
quite clear that HIV escape mutants gain dominance in the presence
of antiretrovirals. This is yet another line of reasoning to
suggest that these drugs act directly against HIV. There are 
clear cut codon-substitutions that have been corellated with 
HIV escaping control of therapy. This is not conjecture.
But again, I would reiterate that there is no credible data 
suggesting a long term clinical benefit to antiretroviral therapy 
in asymptomatics. But there's tons for people with more advanced disease.
The acquisition of escape-mutant populations may be part of the reason.

>>By contrast, there is a group of about 10-12% of people with HIV who
>>are either extremely slow or non-progressors (for all intents and
>>purposes).  Their CD4 count does not diminish.  There is no rationale
>>for treating these people.

>I agree, if we could just get you to see that leaving the other 88 to
>90% alone!

Antiretrovirals save lives. That is not to say that they are innocuous 
compounds, or that everyone should be compelled to take them. But 
accurate informed consent should contain information on the substantial 
benefits of today's regimens, as well as drawbacks (i.e. toxicity,
resistance, difficult to take regimens)
>>So your question needs to be clarified.  The reality is, most infected
>>people WILL progress to AIDS.  Not treating at a certain point in the
>>progression is a fatally stupid mistake.

>What reality?  Maybe in your fairy land. 

No actually the body of peer-reviewed scientific literature,

> The reality is that you need
>a reality checkup.  Treating a person past a certain point, the moment
>whenever you make the decision to start treatment with your killer
>drugs IS a stupid mistake.  Call HEAL, quickly.  Don't listen to this
>guy, he's missing some parts from his last trip to the garage.  jb

Actually everything he said can be verified by a quick trip to the 
library or MEDLINE. It is your assertions that are based entirely 
on faith, rather than evidence.

 |                                                                        |
 |   Carlton Hogan  (carlton at gopher.ccbr.umn.edu)                         |
 |   Community Programs for Clinical Research on AIDS Statistical Center  |
 |   Coordinating Center for Biometric Research                           |
 |   Division of Biostatistics, School of Public Health                   |
 |   University of Minnesota          http://www.biostat.umn.edu/~carlton |
 |   2221 University Ave SE, Suite 200              Voice: (612) 626 8899 |
 |   Minneapolis  MN 55414                            FAX: (612) 626 8892 |
   Affilation provided for purpose of identification, not representation.

More information about the Immuno mailing list

Send comments to us at biosci-help [At] net.bio.net