Why is HIV/AIDS so deadly?

FYI… This is the fifth of ten posts that have nothing to do with vaccines.

Once in a while, a new loon is pointed out to me, and I read their insanity. This is the story of such an occasion:

Why is HIV/AIDS so deadly? According to the World Health Organization, AIDS kills about 1.6 million people per year. We know what causes AIDS. We know that HIV infection can be prevented through safe sex, no sex, proper screening of the blood supply, administering drugs to HIV-positive people to lower their virus counts. We have very good screening tests to administer to people and make sure they get the care that they need. And we can explain all this to millions at a time through the use of all sorts of media.

So what gives?

The answer can be a little complicated. There are some political interests involved that misuse (or don’t use) the resources given to them to combat HIV/AIDS. There are also people in very high positions of authority who believe that the disease is a proper and just punishment for all sorts of “immoral” ways of being, e.g. homosexuality.

But there is also a group of people who believe that HIV doesn’t cause AIDS, though they should know better. One of these people is Kelly Brogan, MD. According to her website, she received her medical degree from Cornell University and two science degrees from MIT. She did her residence in psychiatry and is board certified in it. With all that education, all those hours, days, weeks, and months invested in learning how to heal people, Dr. Kelly Brogan has some interesting thoughts on HIV and AIDS.

For example, women with HIV should not take drugs to reduce the chances of passing the virus on to their babies. Why? Because:

“This was the case with a now infamous, but little-publicized perinatal trial of the drug nevirapine for the prevention of transmission of HIV from mother to baby. An NIH-funded trial staged in Uganda, HIVNET 012, was hailed as demonstrating a 50% decrease in transmission, and set the stage for world-wide drug dissemination and coercion of women like Joyce Ann Hafford, to their death.”

UPDATE (9/25/14): It looks like Dr. Kelly Brogan has taken down her article. But here is Google cache to the rescue: http://webcache.googleusercontent.com/search?q=cache:http://kellybroganmd.com/snippet/hiv-pregnancy-pharma-abusing-women/

Dr. Kelly Brogan quotes a Harper’s Magazine author who seems to claim that there was no control (or placebo) group in that study. But there was a control group…

The HIVNET 012 trial was conducted in 1998 in Thailand, with some startling results:

“In February 1998, a randomized, double-blind, placebo-controlled trial sponsored by the U.S. Centers for Disease Control and Prevention in Thailand of 393 mother/infant pairs showed that a short course of oral ZDV could reduce HIV-1 transmission by about 50% over a placebo—to an overall rate of 10%—in a non-breastfeeding population (CDC, UNAIDS, NIH, and NRS, 1998; Shaffer et al., 1999). 1 As a result, HIVNET 012 researchers formally dropped the placebo arms in a letter of amendment (known as Amendment I) to the protocol, and stopped enrollment on February 18, 1998.”

The study didn’t stop there, though:

“HIVNET 012 was redesigned and reopened on April 6, 1998—with approval of the Ugandan and U.S. institutional review boards—as a randomized, open-label, Phase IIB clinical trial.2 In this newly approved protocol, the target enrollment was 400 to 600 mother/infant pairs randomized in a 1:1 ratio. Women in the NVP arm of the trial would receive a single, oral 200-milligram dose of NVP at the onset of labor. Their infants would receive a single, oral 2-milligram-per-kilogram-of-body-weight dose of NVP suspension within 72 hours of birth. Women in the ZDV arm would receive 600 milligrams of oral ZDV at the onset of labor, followed by 300-milligram doses every 3 hours during labor. Their infants would receive oral 4-milligram-per-kilogram-of-body-weight doses of ZDV twice daily for the first 7 days of life. Boehringer Ingelheim Pharmaceuticals and GlaxoWellcome, respectively, donated the study drugs.

The HIVNET 012 protocol specified follow-up of mothers for adverse events for 6 weeks after delivery. Infants were followed for adverse events until 6 weeks of age, and for serious adverse events until 18 months of age. Researchers graded such events based on toxicity tables from the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) for neonates, children, and adults, ranging from grade 1 (mild) to grade 4 (life-threatening). The 1997 Study Specific Procedures manual included the DAIDS toxicity tables, as well as a special grading system for adverse experiences related to skin rashes and dermatitis and hemoglobin in mothers (Jackson et al., 1997). As the medications were given for a week or less, the study did not modify drug doses for toxicity.”

It wasn’t all without some issues, though, and the trial was adjusted again:

“Researchers amended the study protocol in February 2000 (Amendment II) in response to findings in other studies that some women could develop viral resistance to NVP, and that some children treated with various antiretroviral drugs in utero or perinatally could possibly experience mitochondrial toxicity. The modification entailed extending follow-up of women in the NVP arm and all children in the 18-month study to 5 years, with yearly evaluations for NVP resistance in women who had received NVP (HIVNET 012 Investigators, 2000).”

And what were the final results?

“The 1999 Lancet paper also analyzed adverse events and toxic effects based on the first 556 mother/infant pairs assigned to treatment with ZDV (279 pairs) and NVP (277 pairs). The authors reported that “the rates of maternal serious adverse events were similar in the two groups (4.4% in the ZDV group and 4.7% in the NVP group),” and that “the occurrence of clinical or laboratory abnormalities in mothers was similar in the two groups.” The authors also reported that for infants, “the rate of occurrence of serious adverse events in the two groups was similar up to the 18-month visit (19.8% in the ZDV group and 20.5% in the NVP group).” The “frequency and severity of laboratory-detected toxic effects … were similar in the two groups.”

The second Lancet paper (Jackson et al., 2003), reported that infants assigned to the NVP arm continued to have a significantly lower rate of HIV-1 infection and a significantly greater likelihood of HIV-1-free survival through 18 months of age (Table 2.2). Specifically, the efficacy of NVP compared with ZDV was 41%.”

The Institute of Medicine, and others, back the study’s findings. That Harper’s Magazine article? It was widely chided for its inaccuracies regarding the relationship between HIV and AIDS.

So why does Dr. Kelly Brogan see this study as a bad thing? And who is Joyce Ann Hafford?

Joyce Ann Hafford was a 33 year-old woman who died from liver failure from the medications she was being given as she participated in a drug research study. She was HIV-positive, and she enrolled in the research study in an attempt to keep her unborn child from being born with HIV. The whole thing was an enormous mess. Ms. Hafford started showing signs of toxicity from one of the drugs, but her healthcare providers apparently put the blame on her condition and not on the drugs. The National Institutes of Health eventually confirmed that it was most likely the drug.

These things happen. I won’t deny that medications, even the life-saving ones, all have risks. At a population level, antiretrovirals are saving lives, but everyone needs to be monitored for side-effects. At the individual level, there are those who need to be treated for side-effects. Not treating HIV will inevitably lead to AIDS in 99.999999999% of people who are infected. Treating it will cause side-effects in a very, very small percentage of people being treated. It’s about weighing the risks.

Perhaps because Dr. Kelly Brogan is not an epidemiologist and most of her training appears to be in psychiatry, Dr. Kelly Brogan seems to believe that all antiretroviral drugs are the ultimate evil, which fits well with her statements about medical science:

“This medical-scientific-industrial marriage has brought us many a meme that we hold on to societally, as truths:

That depression is a chemical imbalance

That cholesterol causes heart disease

That exposure to bugs equals deadly infection, and vaccines protection

Cancer is a genetic time bomb

That HIV causes AIDS, the equivalent of certain death”

She links her last statement, the one about HIV and AIDS, to a known AIDS denialism group. I’m not even going to touch her statements and blog posts on vaccines. (She thinks that herd immunity is fiction, apparently. Something that made my head explode.)

And there you have it. People continue to die from HIV/AIDS in part because people who should know better continue to perpetuate the idea that HIV doesn’t cause AIDS, with variations to that theory. Some say that HIV is just a “passenger virus” and that it is an incidental finding with AIDS really being caused by the drugs used to treat HIV infection. Others say that HIV is a manufactured virus, aimed at homosexuals or at Africans, but still not a full-fledged cause for AIDS. And so on and so forth.

Without telling us her complete stance on the matter, Dr. Kelly Brogan certainly can seed some doubts in those who may not be initiated. But we are initiated, aren’t we, folks?


6 thoughts on “Why is HIV/AIDS so deadly?

  1. I have psoriatic arthritis and have been taking methotrexate for 10 years. Because it has a known side effect of heptotoxicity, I have monthly blood tests to monitor my liver function. A few months ago my liver started acting up, the treatment was immediately changed and my liver function is now back to normal.

    If anyone tries to tell me I should suffer without treatment rather than monitor for known side effects I will punch them in the face.

  2. Any doctor with a web page who feels the need to put their mug shot right at the top is almost always a doctor not worth one’s time. Kelly Brogan, Bob Sears, Jay Gordon, Dr. Oz, Mayer Eisenstein, Lawrence Palevsky, etc.

  3. I’d wager that the good doctor also still practices fraudian, erm, Freudian psychology, rather than some of the new fangled methods that work.
    You know, the ones that use drugs to try to balance neurotransmitters and neuromodulators.
    Perhaps this practitioner should partake of her own field of study, as a patient.

    • The good doctor deleted her post, but I’ve updated the blog post with Google cache. Some people don’t learn. You can’t hide anything on the internet anymore.

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