Mar 06 2014

Raising Shields Against HIV

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125 responses so far

125 Responses to “Raising Shields Against HIV”

  1. fergl100on 06 Mar 2014 at 8:29 am

    Yes I know full well what you mean about false hopes. I have CF and was hoping about 15 years ago that gene therapy would “cure” my lungs. It’s not happened and CF research has had lots of money in that period. AH well I’ll struggle on but it is a shame. Hope it happens soon!

  2. MikeBon 06 Mar 2014 at 9:32 am

    “Researchers … used used a zinc-finger nuclease (ZFN) to render the CCR5 gene permanently dysfunctional in the T-cells taken from the patients, and then transfused the cells (about 10 billion of them) back into the patients.”

    OMG! Doesn’t this mean the HIV patient receiving this treatment will have to be labeled a GMO???

    (Just joking … but mark my words …)

  3. evhantheinfidelon 06 Mar 2014 at 10:52 am

    Is there speculation or (even better) research as to why the zinc-finger nuclease, or even the outright mutation would work for some people and not others? I guess, is it likelier to be variations in HIV, humans, something environmental, or even something yet I haven’t guessed, if anyone has any idea at all?

  4. pmb6465on 06 Mar 2014 at 11:28 am

    The Wall Street Journal had an article about this today too….

    http://online.wsj.com/news/articles/SB10001424052702304554004579421602888753292?mod=WSJ_hpp_MIDDLENexttoWhatsNewsThird&mg=reno64-wsj

  5. Bronze Dogon 06 Mar 2014 at 1:02 pm

    OMG! Doesn’t this mean the HIV patient receiving this treatment will have to be labeled a GMO???

    I’m thinking of dialogue from X-COM: Enemy Within. You can apply “gene mods” to your soldiers that often includes giving them alien features. (In silly sci-fi fashion, of course. You want a secondary heart? Just give us three days!) At one point, Dr. Valen speaks with concern about how it will affect them once the war’s over. I’d agree long term medical issues would be a concern. On the other hand, thinking about anti-GMO rhetoric and their notions of genetic purity, I’d wonder if they’d start a campaign of discrimination against gene modded veterans. My inner comic geek wanders over to the mutant registration acts the X-Men had to deal with.

  6. pdeboeron 06 Mar 2014 at 1:21 pm

    Very cool. Maybe this will lead to a HIV shot that is very different from conventional vaccines. I hope the living without the CCR5 receptor has no ill effects though.

    Regarding the second child to be “cured”. I though HIV viral load was sometimes not detectable when undergoing antiretroviral treatment. This second child is still being treated. The first was off meds for 18 months and showed no signs of the virus? Is this a case of the media exaggerating standard affair for children born with HIV?

  7. Steven Novellaon 06 Mar 2014 at 1:57 pm

    I don’t have the details on the second case. They don’t appear to be published yet. But in the first case they used detection techniques that go beyond the standard viral load test.

    They do acknowledge that the only way to be sure is to go off of medications and follow the blood tests, but that is very risky. So it’s a catch 22.

  8. DietRichColaon 06 Mar 2014 at 4:13 pm

    Dr. Novella – Yes, you do need to balance enthusiasm with sober assessment… but on this one, it’s a real possibility you may just get to be excited and stay excited.

    My wife is a biochemist at a cancer research center, and her research largely revolves around protein engineering and gene therapy. She isn’t directly involved in the gene therapy itself — she describes her work more as developing the “toolkits” that are used to carry out the gene therapy. My knowledge of biochemistry is… lacking… but I DO recognize ZFNs because my wife talks about them all the time. The ZFNs are one type of “toolkit”.

    Apparently there are four primary platforms for gene-editing being explored for gene therapy applications. ZFNs are one (the oldest and most well-characterized), TALENs (transcription activator-like effector nucleases), homing endonucleases, and the CRISPR (clustered regularly interspaced short palindromic repeats) / Cas9 system. I included the acronym names for clarity… please don’t ask me what they actually do. There are other methods too, but she says these are the 4 big ones.

    While her lab doesn’t collaborate with the specific group you mention… this process of using these gene editing tools to modify T-cells then reintroducing the T-cells back into the body is very promising. She always comes back from conferences and meetings very excited. When I ask her to quantify for me what she really means and why she’s excited (because the real biochemistry usually goes over my head), her response is always just “one of these guys is going to do it!” (use gene therapy to cure something). And not just in the “this concept will work” but as in they are actually making it happen.

    And this method is not just limited to CCR5 and HIV. While there are groups involved with each of the different gene-editing methods working on targeting CCR5 for obvious reasons, she said this method is also viable for “arming” T-cells to combat specific cancers or other diseases too. She said if you’re interested in more on this, check out this interview with Dr. Carl June (the last author on the paper you cited):

    http://www.cancerresearch.org/our-strategy-impact/people-behind-the-progress/scientists/dr-carl-june-offers-pancreatic-cancer-patients-re

    At this point, it isn’t so much a question of IF we can do this, it’s WHO is going to do it first (which platform will work best) and get it all the way through clinical trials. It’s a very exciting time.

    Crossing my fingers that I’m not just giving everyone more false hope… but this might be one of those “5 years away” things that really truly is.

  9. hardnoseon 06 Mar 2014 at 6:58 pm

    For all we know at this time, AIDS will never be cured. I don’t see any reason to get excited about preliminary research.

    And the story of AIDS is not nearly as shining as you think. The HIV drugs are extremely toxic and cause serious side effects, especially after prolonged use.

    We really do not know how effective they are, because it is not possible to compare treated vs. untreated patients (for ethical reasons, a standard treatment can’t be withheld).

    The original AZT trials never showed any benefit after 2 years.

    We simply do not know if the benefits of ARV drugs outweigh the terrible side effects, which may include death from cancer, liver disease, heart disease, etc.

    HIV is a huge money-making industry, lots of it funded by us taxpayers.

    I am a skeptic, not an HIV denier. I really think if you want to call yourself a “skeptic,” you should reign in your ecstasy when praising the HIV industry. At least become informed about some of the dangers of the HIV drugs.

    I am not an AIDS researcher, but have followed this subject carefully for years. I believe that AIDS is a much more complicated disease than what mainstream researchers believe, and that is why it can’t be cured by anti-HIV drugs.

  10. Ekkoon 06 Mar 2014 at 7:10 pm

    @hardnose
    “I am not an AIDS researcher, but have followed this subject carefully for years. I believe that AIDS is a much more complicated disease than what mainstream researchers believe, and that is why it can’t be cured by anti-HIV drugs.”

    If you are really a skeptic, “belief” should not enter into things. How on earth can you say any of this with a straight face? What makes you think mainstream researchers are off the mark but somehow you have more insight than them?
    This isn’t a subject I know a lot about but my impression is that being HIV+ has gone from a death sentence to more like a manageable chronic disease. Where do you source these “non mainstream” opinions of yours from?

  11. grabulaon 07 Mar 2014 at 2:17 am

    @hardnose – the proof is in the pudding. We have several decades of evidence as to whether these drugs work or not. In the 80′s people were dying of AIDS. Now a days, they effectively live long and healthy lives. That doesn’t count as evidence to you? If the medication isn’t helping than what would you say is?

    Side Effects suck, but taking the medication is a choice and I’m betting the numbers indicate most people are willing to live with the side effects in order to extend their lives.

    “I am not an AIDS researcher, but have followed this subject carefully for years. I believe that AIDS is a much more complicated disease than what mainstream researchers believe, and that is why it can’t be cured by anti-HIV drugs.”

    So in one stroke you claim not to be an AIDS researcher but you know better than the AIDS researchers?

    I’m also pretty sure no one is stating HIV is being cured so much as treated currently, which is a big difference. Anything that might potentially be a cure is worth getting excited about.

  12. steve12on 07 Mar 2014 at 2:20 am

    @Hardnose

    With so many claims, links would be great

  13. Aardwarkon 07 Mar 2014 at 3:37 am

    Hardnose,

    I respect your skeptical (and non-denialist) position regarding HIV/AIDS, but have two points to make in addition to the three replies you already received (that I also perfectly agree with).

    First, you quote lack of success of treatment with AZT alone as an argument against HAART. Well, if you read carefully the available literature on antiretroviral therapy, as you say you did, then I think you must already know why AZT alone failed. The reason is that the virus quickly develops resistance to a single drug. Current treatment success only happened when three or more antiretroviral agents, with different mechanisms of action, were combined. In this way, evolution of the virus toward resistance is (in most cases) prevented, or at least significantly delayed.

    In addition (second part of the first point) it is not true that treatment effects are not verified (because you cannot have a ‘no treatment’ arm in the clinical studies). Any proposed improvement to the treatment protocol is always tested against the current protocol without this improvement. In this way, the treatment evolves in sequential steps, and that is how we got to the present protocol. It can certainly be improved, by the same strategy, in the future. And there is every possible reason to expect that it will, be our excitement great or small.

    (N.B. The treatment by genetically modified T cells, that is discussed here, is a new strategy, so it will, naturally, be tested against HAART alone – again not ‘tested against itself’ as you implied).

    The second point – profits made by drug manufacturers and earnings of medical professionals may be considered to be fair or less so (or even grossly unfair). It certainly merits serious discussion. However, this is a separate question from the one at hand – whether the treatment works. This is the very reason we advocate science-based medicine: to know what works and what does not, regardless of who is selling it and for how much.

    (And, by the way, when quoting the profits made by treating disease, one should not overlook how much of these go into research of new or improved drugs – hardly an unimportant issue.)

  14. BillyJoe7on 07 Mar 2014 at 6:12 am

    Only one stone left for me….

    HN: “For all we know at this time, AIDS will never be cured”

    We don’t know all at this time, so it’s not possible to conclude that AIDS will never be cured.

  15. SteveAon 07 Mar 2014 at 7:52 am

    This article from Sense About Science may be of interest:

    The Dallas Buyers Club and the myths of Aids activism

    http://www.senseaboutscience.org/blog.php/84/dallas-buyers-club-and-the-myths-of-aids-activism

  16. Steven Novellaon 07 Mar 2014 at 8:28 am

    Hardnose – when it is unethical to withhold standard of care you can compare treatments to each other, and you can compare to historical controls.

    In the case of HAART treatment, the historical controls are pretty dramatic – almost 100% fatal within a few years without treatment.

    On HAART patients basically have a normal life expectancy. That is a dramatic result that is undeniable. Sure, medications with fewer side effects would be nice, and we are moving in that direction. But, wow, way to focus on the negative. Have you ever spoken to anyone who is HIV positive? Do you have any idea how the average HIV positive person feels about HAART?

  17. dsdotyon 07 Mar 2014 at 8:31 am

    It’s hard to argue with your view that HIV is a scientific success story, but it does seem at odds with the traditional gay community narrative, in which homophobia and scientific infighting minimized research and funding, and hampered co-ordinated efforts amongst the people who were working on the disease. I’m curious: do you believe that narrative misunderstood what was happening in the scientific community, or that it was an accurate reflection of the early years of the epidemic, and that scientists subsequently turned the narrative around?

  18. hardnoseon 07 Mar 2014 at 9:12 am

    Steve N,

    You are confused, but most people are confused about this. The AIDS diagnosis changed since the epidemic was first noticed. Other factors have changed. It is impossible to draw conclusions about causation based on what you have said.

    Comparisons are between AZT and newer drugs — that tells us nothing about whether any of the drugs are safe or effective.

    AIDS was originally a death sentence because only very sick patients arrived at the clinics. Now all that is required is a positive HIV test and low counts of certain immune system cells. Many things besides AIDS can cause that.

    The gay lifestyle also changed since the epidemic began, and people became much more careful. AIDS might not be exactly the same disease that it once was.

    We know that HIV drugs can kill opportunistic infections (because they can kill anything), giving the illusion that they address the underlying disease. But it is very possible that killing HIV has no effect on the disease. HIV might be a causal factor (or it might not), but it does not seem to be the only cause. Even Luc Montagnier, co-discoverer of HIV, does not consider it a sufficient cause.

  19. hardnoseon 07 Mar 2014 at 9:12 am

    Also consider the long latency of HIV. Even before the new drugs, some patients lived 10 or 20 years with no symptoms. That is another confounding factor.

  20. Steven Novellaon 07 Mar 2014 at 9:43 am

    hardnose – I am sorry, but it is you who are confused.

    But let me clarify what I wrote. Once you have AIDS your life expectancy is about 3 years, after a serious infection it is about 1 year. HIV causes an acute infection followed by an average clinical latency of 10 years before progressing to AIDS.

    This is the natural history of the disease, which is well documented. It can be affected by overall health, genetics, age at onset, HIV strain, etc. but this basic natural history in untreated individuals has not significantly changed over the years.

    With HAART treatment, the clinical latency can be extended indefinitely, giving people a normal life-expectancy, and greatly reducing infectivity. Treatment with HAART extends life expectancy at any stage of the illness, but is more effective the earlier it is started and the more consistently it is used.

    HAART affects viral load, CD4 counts, and risk of opportunistic infections and other complications of HIV – such as cancer and HIV dementia.

    It is absolutely wrong to say that HAART could be entirely responsible for improved outcome without addressing the underlying illness because it treats opportunistic infections. HAART drugs are only anti-viral. Many opportunistic infections are bacterial. Some complications are directly due to HIV, or are the result of immune dysfunction but not related to infections, such as Kaposi’s sarcoma.

    HIV is the causal factor in AIDS – there is no might or might not. There may be modulating factors, but HIV causes AIDS. This is well established.

    Finally, even though we cannot randomize patients to not receive HAART, we can do observational studies comparing those who are compliant with HAART with those who are not compliant. We can also evaluate the effectiveness of HAART programs in other countries that have previously had no availability of the drugs. In every case, HAART treatment and compliance is associated with dramatically reduced mortality:
    http://cid.oxfordjournals.org/content/46/4/507.long
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933160/
    http://www.ncbi.nlm.nih.gov/pubmed/24307741

    Frankly you are spouting HIV denialist propaganda and do not have a working knowledge of the science of HIV and AIDS. This is a complex area of medicine and unless you have medical expertise, I would not presume to think you have a better understanding than the experts.

  21. Kawarthajonon 07 Mar 2014 at 10:29 am

    @Hardnose “Comparisons are between AZT and newer drugs — that tells us nothing about whether any of the drugs are safe or effective.”

    Doesn’t the fact that patients are living normal length lives a sign that these drugs are effective??? What have changes in the gay lifestyle got to do with the progression/treatment of the disease in those who have acquired the HIV virus? Nothing, I would suspect. Besides, the vast, vast majority of those infected with HIV are not gay. Furthermore, those on long-term treatment for HIV typically lead normal lives, not bed ridden and sickly.

    As for your comment on the medications being “toxins”, everything can be a toxin given the correct dosage – even pure water. Of course they cause side effects, but most drugs do. They prevent the most serious side effects of the disease, however, – horrible illnesses followed by death. I would leave it up to those who suffer from HIV infection to determine which is more important to them.

  22. steve12on 07 Mar 2014 at 11:56 am

    @Hardnose

    In general, you make a lot of claims about facts that are highly questionable and almost never provide links.

    I’m not talking about interpretations or opinions, but facts. When you do this, you gotta back it up with something. We’re not in bar – you can easily send us links backing up the factual claims you’re making and we can hash it out from there.

  23. etatroon 07 Mar 2014 at 12:20 pm

    A sliver of HIV denialism was in HN’s first comment, saying that AIDS cannot be cured by anti-HIV drugs. He’s been rhetorically making a distinction in every comment implying that HIV is not the causative agent of AIDS. As a syndrome, AIDS is essentially prevented by ant-HIV medications. Very well documented cases (one or two large studies actually) of treatment withdrawal and modification show that when therapy stops,viral loads go up and CD4 counts go down. Those are the effective markers leading to AIDS, which is diagnosed when CD4 falls below 200 cell/mL. (There are actually different stages of HIV/AIDS and the WHO classification scheme is different than the CDC scheme). Treatments can fail if the virus acquires a resistance mutation (which is more probable if patient is non compliant), switching drugs will in most cases bring VL back down and CD4 back up. This phenomenon is extremely well documented, we know which mutations confer resistance to which drugs and in the institute that I work at, it is standard practice to get the viral genotype before prescribing.
    HN notes that the “latency” period is very long for some people, but he is misapplying the word “latent,” which has a specific meaning in virology. Latency for HIV means that the viral genome is integrated into the host cells’ genome and does not replicate by producing viral proteins and assembling virions. It can reproduce though whenever the cell itself replicates & divides. The population of latently infected cells is called the viral reservoir, which is not normally measured in the clinic, but in research studies (at my institute), patients with undetectable viral load have about 0.1% latently infected cells in the blood. I am specifying the blood because latently infected cells can also be in bone marrow and in tissues. I think what he means is lag-period between infection and immune suppression, which is highly variable, yes. But the dynamics of acute infection work almost like clockwork, with about a two week lag period followed by exponential increase in VL, at this point CD4 cells die, then circulating VL starts to go down at 4 weeks and will go down to a plateau level that is variable (with therapy, will go to undetectable in most cases by 8 weeks post initiation). All of this is so well documented (just search pubmed), that it must be huge feat of cognitive dissonance & delusion to deny.

  24. Steven Novellaon 07 Mar 2014 at 12:25 pm

    To clarify further – the term “clinical latency” is often used, as I did above, to refer specifically to the period between the acute infection and first clinical signs or symptoms of AIDS.

  25. hardnoseon 07 Mar 2014 at 12:44 pm

    Steve N,

    You did not link anything showing that AIDS patients treated with HAART live normal lives. That seems very unlikely given the toxicity of the drugs.

    I would also like to complain about the label “HIV denier” being thrown around. That’s just a tactic for discrediting anyone who finds the mainstream view unconvincing.

    From the beginning, AIDS researchers were desperate for a simple explanation, and a straightforward treatment (kill the bugs, get cured).

    That is understandable but, sadly, AIDS does not seem to be a straightforward infectious disease.

    If you really think about it, how many cures has the medical industry come up with in the past 50 years?

    We have more and better antibiotics, surgical and imaging technology. But our understanding of most diseases has been stalled for a long time.

    Some of you whole claim to be skeptics are really enthusiastic supporters of whatever the mainstream consensus happens to be.

  26. Ekkoon 07 Mar 2014 at 1:58 pm

    hardnose,
    You are demonstrating many classic examples of the Dunning-Kruger effect.

    “But our understanding of most diseases has been stalled for a long time.”
    You fail to give a single example.
    If our medical understanding of diseases – their etiology, pathology, treatments, prognosis, etc. has stalled in most cases, you should be able to give several specific examples.

    My impression is more that you don’t know what you are talking about.

  27. zorrobanditoon 07 Mar 2014 at 2:11 pm

    All very interesting, hardnose (and everyone else), but I think we’ve had enough hand and arm waving. How about some links everyone can check out?

  28. hardnoseon 07 Mar 2014 at 2:19 pm

    Ekko,

    Just think of any of the most common chronic diseases. How much progress has there been in understanding and treating MS, for example? And aside from recommending lifestyle improvements, how has the understanding of heart disease and stroke improved? How about cancer? We are hardly any better off than 50 years ago.

    What about dementia? Really nothing new or better.

    Mental illness? More and fancier drugs, but they only dull symptoms. Understanding in psychiatry has barely changed in over a century.

  29. steve12on 07 Mar 2014 at 2:36 pm

    Hardnose just isn’t having it. He’s just gonna talk shit and back none of it up. Because it’s SO HARD to paste links.

    “Understanding in psychiatry has barely changed in over a century.”

    This is just ridiculous. Serious mental illness is not cured. But to say that our understanding of the genetics and neural substrate substrate underlying mental illness has not changed in the past 100 years… that is (pardon the pun) insane.

    If you wanna claim this was a bit of hyperbole, no worries. But if you’re serious, you need to demonstrate some SERIOUS knowledge floating around 100 years ago!

  30. Hosson 07 Mar 2014 at 2:55 pm

    hardnose

    Several people have been asking you for something besides your(painfully ignorant) opinion. Can you stop asserting and start providing evidence? Your word alone is not good enough…no ones is.

    Or do you have nothing besides a narrative, which you base all your claims off of, that with 10 minutes of googling is demonstrably false.

    Do you not know how to do research?

  31. Ekkoon 07 Mar 2014 at 3:08 pm

    hardnose,
    MS is not a common chronic disease for starters. Heart disease, diabetes, cancer, arthritis, these are common ones. But still, there is a massive amount of research that has been done to broaden understanding of genetic and environmental causative factors of MS as well a lot of current research into potential treatments.
    When you say about cancer that “we are hardly any better off than 50 years ago” – what do you mean? What kind of cancer? What age groups? Hardly better off in our understanding of the cause and progression? The treatments? For example, survival rates for cases of childhood cancers have vastly improved across a wide variety of types. Treatments for previously untreatable forms of childhood cancers and with less toxicity have come about thanks to research.
    http://onlinelibrary.wiley.com/doi/10.3322/caac.21219/full

    “how has the understanding of heart disease and stroke improved?”
    http://brain.ubc.ca/research/stroke/
    http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.8968559/k.DE2D/2014_Report_on_health__Creating_Survivors.htm

    Again, I don’t think you’ve ever really bothered to look into this much and are just being hardnosed about wanting to only see the negative.

  32. Solenoidon 07 Mar 2014 at 3:08 pm

    Hardnose:

    “How much progress has there been in understanding and treating MS, for example?”

    Please direct your attention to AVONEX by Biogen Idec (http://www.biogenidec.com/therapies.aspx?ID=5489) or AUBAGIO by Genzyme (http://www.genzyme.com/Company/Business-Units/Multiple%20Sclerosis.aspx), or LEMTRADA, also by Genzyme (currently fighting its way through the FDA)(http://news.genzyme.com/press-release/genzyme-receives-complete-response-letter-fda-lemtrada-alemtuzumab-application)

    “How about cancer?”

    How about GLEEVEC (www.gleevec.com/) and VELCADE (http://www.millennium.com/ourMedicines/Velcade.aspx)?

    “any of the most common chronic diseases”

    Autoimmune diseases – Infliximab, Adalimumab, and Etanercept.
    Diabetes – Lantus
    Influenza – Oseltamivir

    Need I go on?

  33. Steven Novellaon 07 Mar 2014 at 4:13 pm

    hardnose – you are making a lot of bold claims without evidence. These things may seem “obvious” to you, but that is likely just confirmation bias.

    I never said that patients with HIV live normal lives. I said they have normal life expectancy.

    Your examples of our lack of progress are based entirely on your own personal ignorance. MS, for example, was a terrible example to use. 50 years ago we knew very little about the disease. The only treatment available was steroids for acute exacerbations.

    Since then our understanding of immunology in general, and the immunology of MS, has exploded. We now have a far more detailed map of the immune system.

    We also have developed a list of specific immune modulating drugs that actually alter the course of the disease. – Avonex, Betaseron, Copaxone, Aubagio, Extavia, Gilenya, Rebif, Novantrone, Tecfidera and Tysabri. None of these drugs were available 20 years ago, let alone 50. The management of MS has been transformed in the last 50 years.

    Cancer is another terrible example (well, all your examples are terrible). 5 year survival in 1975 was 50%, now it is 68% and 81% for childhood cancers (all cases, all cancers). If you think the experience of a cancer sufferer in 1964 is similar to that of someone in 2014, then you clearly have no idea what you are talking about. Not only has survival steadily increased, but surgical procedures are much more specific and less radical, and chemotherapy (although, of course, remains highly toxic) is far less toxic than the older drugs.

    Your claims are so disconnected from reality that, again, the only reasonable conclusion is to seriously call into question your sources. It is as if you are reading anti-scientific propaganda and believing it without question – even though the internet now puts the actual facts at your finger tips. It really is quite ironic that you are trying to grab the “skeptical” high ground while spouting such propaganda.

  34. BillyJoe7on 07 Mar 2014 at 4:20 pm

    HardNose,

    Regarding denialism.

    There is the consensus view of specialists working in their area of expertise and based on all of the accumulated evidence in that area of expertise. And then there is your opinion based on your reading of non-scientists and the scientific fringe dwellers. This means, by definition, that you are an AIDS denier. Furthermore, you are in denial of your denialism. That is a pretty big hole you’ve fallen into. I wonder if you’ll ever be able to pull yourself out.

    I suggest you keep reading this blog and the science based medicine blog.
    Maybe you’ll eventually get a sense of why what you’ve been reading up till now is total rubbish.

  35. zorrobanditoon 07 Mar 2014 at 5:09 pm

    “I never said that patients with HIV live normal lives. I said they have normal life expectancy. ”

    First, do we really know this? Has it been long enough yet for these human beings, some of whom were quite young when they were infected, to live out their “normal life expectancy”? I don’t know when exactly the current drugs were developed, but it was considerably more recently than, say, 70 years ago, the “normal” life expectancy of a baby born in this country. One hopes, of course, that this statement about life expectancy is true, but I don’t see how we could know that yet.

    Second, I was hoping that hardnose would post some links at least about the side effects of the current medications, since he seems determined to take a dark view. There may not be any for all I know, but I think I remember hearing that there are some, and that some of these can be quite serious.

    This is not at all to diminish the remarkable achievements in this area which I have seen in my lifetime. I was practicing law in San Francisco in the 1980′s when an AIDS diagnosis was a death sentence (often swiftly carried out), and when very many of my clients died of the disease. There are many horrible stories from that time, as well as many stories of heroism. All the gains we have made should be viewed against that background!

  36. etatroon 07 Mar 2014 at 8:10 pm

    Sorry I missed the “clinical latency” term, for some reason, I always use “lag,” and reserve “latency” for it’s virology meaning. For those demanding links, there are dozens of life expectancy publications out there on HIV infection. One is at pubmed.gov/23221765. It is a review summarizing several cohort studies. From the paper, those published 1980-2009, without treatment life expectancy was 10 years after seroconversion, but depends on age at seroconversion. Studies from 2010-2013. Estimates range from 68-75 years assuming 30 yr at diagnosis and good adherence. Another, assumed diagnosis at age 20, diagnosed between 1996-1999 estimated 50 yr, diagnosed between 2006-2008 estimated 65.8 yr. Another one pubmed.gov/23287403.

    The side effects can be viewed by looking at the package inserts for any medication, which you should easily be able to google. Don’t turn this into a LMGTFY game. Some of the earlier gen drugs had metabolic side effects causing fat redistribution about the torso. The combination used for high dose post exposure prophylaxis caused eye-yellowing in some people. Miraviroc, a CCR5 inhibitor caused dizziness and fatigue in some people. The big concern w HAART medications is drug interactions, they cause increased half life of some medications if they share a common metabolic pathway. Which is why an infectious disease specialist who focuses on HIV should be consulted before someone on HAART starts new drugs for any reason. The Wikipedia entries on cytochrome P450 enzymes explain the mechanisms pretty well.

    Regarding the righteous indignation at being labeled an HIV denier, if you deny that HIV causes AIDS, you are by definition an HIV denier. (Not AIDS denier like you said). Aidstruth.org is a site that two Johns Hopkins profs put together on their spare time which compiles some resources on the history & effects of HIV denialism. I am a researcher on HIV associated neurocognitive disorders and HIV interactions with drugs of abuse.

  37. hardnoseon 07 Mar 2014 at 11:33 pm

    “Cancer is another terrible example (well, all your examples are terrible). 5 year survival in 1975 was 50%, now it is 68%”

    Lead-time bias and over-diagnosis can account for a lot of the supposed improvement.

  38. hardnoseon 07 Mar 2014 at 11:49 pm

    “I was hoping that hardnose would post some links at least about the side effects of the current medications, since he seems determined to take a dark view. There may not be any for all I know, but I think I remember hearing that there are some, and that some of these can be quite serious.”

    The drugs are extremely toxic, and they do not only target HIV. All cells of the body are affected. The principle is similar to chemotherapy for cancer — use toxic substances and hope they will kill the cancer cells before damaging normal cells. Except cancer drugs are taken only temporarily, while HAART must be taken for life.

    Advocates will tell you HAART is less toxic than AZT, but that is not saying much.

    The HAART side effects that HIV patients often suffer from are sometimes called “HIV related” diseases. This is to obscure the fact that they result from the treatment, not from HIV.

    In general, HAART results in premature aging and causes many of the diseases associated with advanced age.

    Of course, it is easy to blame HIV, instead of HAART, for this, if you are determined to continue selling HAART.

  39. hardnoseon 08 Mar 2014 at 12:02 am

    “Maybe you’ll eventually get a sense of why what you’ve been reading up till now is total rubbish.”

    I spent a lot of time trying to find out the truth about HIV and AIDS. I read the extremes of both sides and found that both were irrational. I do not agree with the HIV deniers.

    But I also found that the original research supporting the HIV hypothesis was very weak, and that all subsequent research rested on the original research. When I say the “HIV hypothesis” I mean the idea that AIDS is caused by a bug, the HIV, and lives are saved by zapping the bug with toxic substances. It is the infectious disease model, which has worked so well for bacterial infections.

    I think the miracles of HAART are mostly an illusion. HIV advocates always mention the early days of the AIDS epidemic when gay men were dying in droves. Then there was a dramatic change, and many patients diagnosed with AIDS were able to survive.

    Various things happened at that time, and one was the discovery of HIV and methods for treating the infection. HIV advocates always assume that the HIV treatments are what made the difference. They don’t think about all the other things that also changed, the confounding factors.

    For example, many more people were diagnosed with HIV AIDS. They did not necessarily all have the same disease that had been killing gay men.

    The story is a typical example of something extremely complicated that people desperately want to believe is simple. In addition, there are intense marketing campaigns devoted to selling HAART all over the world. Big piles of money being made from this.

    I can’t just post a couple of links to explain the massive confusion. I had to do a lot of serious searching and careful reading. Trudging through all that marketing BS was not easy. And yes, supposedly scientific studies can be marketing BS. If you don’t know that, you should not call yourself a skeptic.

  40. BillyJoe7on 08 Mar 2014 at 1:34 am

    HardNose,

    All you have done here is give your own opinion about what you may or may not have read (and understood) about HIV/AIDS/ARVs. This is less than useless to us. After all, you are not an expert on the subject and your posts inspire very little confidence that you have the ability to read the literature intelligently. Of course that is just my opinion for what it is worth.

    You say that you have read both sides, but I think that is unlikely. The more likely scenario is that you have approached the HIV/AIDS/ARVs question from the denialist perspective, read the denialist literature with confirmation bias, and read the conclusions of the experts with jaundiced eyes. Otherwise please give your reasons for believing the denialist literature and disbelieving the conclusions of the experts.

  41. BillyJoe7on 08 Mar 2014 at 1:40 am

    HardNose,

    “And yes, supposedly scientific studies can be marketing BS. If you don’t know that, you should not call yourself a skeptic”

    We do know that.
    But how disingenuous of you to imply otherwise, and to imply a lack of scepticism as a result.
    Now, perhaps you can show a similar level of scepticism regarding the denialist literature with which you are so obviously familiar.

  42. Steven Novellaon 08 Mar 2014 at 7:27 am

    Hardnose wrote: “HIV advocates always assume that the HIV treatments are what made the difference. They don’t think about all the other things that also changed, the confounding factors.”

    This is pure nonsense. I’m sorry to break this to you, but you are not smarter than the collective knowledge and experience of the scientific community. To assume that scientists who have dedicated their careers to understanding HIV and AIDS take a simplistic approach and make unwarranted assumptions that you have seen through is nothing but naivete and hubris.

    It also indicates that you have not read and understood the scientific literature.

    The job of scientists is to consider a question from all angles, to ask all the questions, and to address all assumptions.

    As has already been pointed out, there are copious studies showing that HAART reduces viral load, that this correlates with all the markers of HIV and AIDS, including CD4 counts, and that there is a close relationship between CD4 counts and susceptibility to AIDS related illness. Compliance with the drugs correlates with improved markers and improved clinical outcomes. Stopping treatment is associated with worsening. As programs are introduced into communities or countries, outcomes improve. The data is not weak – it’s overwhelming.

    Further, when I referred to HIV related diseases I was specifically referring to diseases caused by HIV directly (not side effects from the drugs or just things that happen to patients with HIV) – such as HIV dementia. Here, also, all the ducks are in a row. HIV dementia correlates with viral load, and outcomes can be improved by increasing treatment (so clearly it’s not a drug side effect).

    Regarding cancer outcomes, lead time is only partly responsible for the improved numbers. Better treatment is also demonstrably having an effect also.

    You also did not address MS. At least acknowledge that you were 100% wrong about MS.

  43. Bruceon 08 Mar 2014 at 8:05 am

    Hardnose: “HIV advocates always assume that the HIV treatments are what made the difference. They don’t think about all the other things that also changed, the confounding factors.”

    Didn’t you say in one of your first posts on this site that people in general are not living longer despite data showing otherwise? Have you changed your stance now in that modern life is not in fact as dangerous as you made out?

    If not, how do you stack up HIV treatments NOT making people live longer (despite evidence otherwise), and people in general NOT living longer (despite evidence otherwise) with the fact that there are some mysterious “cofounding factors” that make HIV patients live longer and the rest of the population not?

    I am all for people having their own opinions or misunderstandings of the data on specific issues, but your own internal logic does not stack up.

  44. Bruceon 08 Mar 2014 at 8:18 am

    Hardnose,

    I would also add that you have yet to post even one link to a study to back up your views in this thread. You keep threatening evidence but you don’t seem able to provide it. It is very easy to come on to a forum and tell people they are wrong and that you are right because you have read everything, but in order to convince people you are going to have to provide evidence in some way or another. You “it is too complicated” gambit is really just showing how little you understand of it and how easily you are swayed by bullcrap.

  45. zorrobanditoon 08 Mar 2014 at 11:12 am

    “I think the miracles of HAART are mostly an illusion. HIV advocates always mention the early days of the AIDS epidemic when gay men were dying in droves. Then there was a dramatic change, and many patients diagnosed with AIDS were able to survive.”

    Now wait a minute. I was there. When people were dying in droves, and they weren’t all gay men either. The blood tests we rely on now hadn’t been invented yet, and many people had been infected in a variety of ways, from heterosexual sex to infected blood products to needle contamination. There was even one little cluster of cases that had been spread by a barber (according to my memory). The medical people were out of ideas, and people really were dying in droves.

    I remember when so little was known about how the disease spread that I was regarded as a hero when I visited an infected client at his home to prepare a Will for him. Because so far as anyone (including me) knew, I was running a risk of infection. This was when some doctors refused to treat these people, for the same fear.

    I remember when a diagnosis of AIDS was a death sentence, and I don’t mean in the distant future either, I mean weeks or months. Now it isn’t, however inconvenient the side effects of the medications may be.

    Whatever you say you are not going to talk me into the idea that the meds have nothing to do with this, or that really nothing has changed (!!).

  46. hardnoseon 08 Mar 2014 at 12:56 pm

    zorrobandito,

    Yes, things have changed. But we don’t know which things caused the decrease in AIDS deaths.

    Originally, AIDS was diagnosed when patients had certain rare infections and cancers, resulting from a suppressed immune system.

    After HIV was discovered, the AIDS diagnosis centered on a positive HIV test, plus low counts of certain immune cells. A patient does not have to be extremely sick now to be diagnosed with AIDS.

    Therefore, many more people are diagnosed, and they are not necessarily very sick. So of course you would expect a decline in mortality.

    That is not the only confound, but it is one of the more obvious ones.

  47. Bruceon 08 Mar 2014 at 1:18 pm

    Hardnose,

    Please define the following:

    “rare infection”
    “cancers”
    “suppressed immune system”
    “HIV”
    “AIDS diagnosis”/”diagnosed with AIDS”
    “certain immune cells”

    Can you please show how your argument holds up medically, and I would very much appreciate some kind of medical validation of all those terms and statistics to back up the claims you are making.

  48. hardnoseon 08 Mar 2014 at 6:57 pm

    “you are not smarter than the collective knowledge and experience of the scientific community. To assume that scientists who have dedicated their careers to understanding HIV and AIDS take a simplistic approach and make unwarranted assumptions that you have seen through is nothing but naivete and hubris.”

    This is not a question of smartness. Like so many current medical problems, AIDS is extremely complex, and beyond anyone’s understanding. A researcher might understand something about the limited area they specialize in, but no one is capable of grasping the big picture. This is not because we aren’t smart enough — it’s because the world is just too complex.

    As a graduate student and as a researcher in my field, I saw many mistakes that seemed idiotic, made by very smart scientists. Was I smarter than they were? Of course not. But I am an extremely “hardnosed” skeptic, and I question everything. I understand that nature is overwhelmingly complex, and I also understand that people need to simplify and fool themselves into thinking they grasp much more than they actually do.

    The AIDS problem fascinated me, even though it is not my field, because the logical errors and careless thinking we so obvious and astounding. No real skeptic can resist getting immersed in this kind of thing.

    Of course I could never say anything, because I would be called an HIV denier and that is deadly for any scientist’s career. Now I am retired so I don’t care as much, but I still don’t express my opinions publically.

  49. etatroon 08 Mar 2014 at 9:42 pm

    HN – you really are the embodiment of “the band playing on,” and I never imagined that I’d encounter this level of delusion. It is something that one reads about thinking that civilization had moved past it and, well, we won’t repeat THAT mistake again. And yet — here you are. It’s kind of fascinating.

    You really haven’t said anything concrete or substantive but you’ve revealed some biases and misunderstandings that make anything you say seem un(in)credible. You haven’t said anything except that AIDS is complex. Yes, it is complex, but what in the description of HIV as the causative agent of AIDS is demonstrably wrong? It is both complex and understandable. The theoretical models of how HIV should work and it’s interactions with the immune system have all been proven to be correct. Some recent studies (aside from the therapy interruption studies I mentioned before) are here: 1) http://www.nejm.org/doi/full/10.1056/NEJMoa1110187. Showing that rate of t-cell recovery is mainly a function of time from infection to therapy initiation, and 2) http://www.ncbi.nlm.nih.gov/pubmed/24105030. Which showed that risk AIDS related death is directly related to time from infection to therapy initiation and that the early initiators had a hazard ratio of 1.01 of dying due to AIDS associated complications, essentially living a life time equivalent in length to a non-HIV infection person, matching for demographics and other indicators. I think they talked about that study on the SGU podcast when it was first published.

    I am interested in your hubris, though. What mistakes did you observe by researchers earlier in your career that contribute to this particular worldview? What are the logical errors and careless thinking? So far you’ve only used the argument from incredulity. You alluded to changes in the homosexual lifestyle, and I’d be interested in what observations you’ve made or data you’ve read about the changes in the homosexual lifestyle between the 80s and today, because I don’t accept the premise. Secondly, I’d be interested in some of the proposed mechanisms that would link this lifestyle to an acquired immunodeficiency syndrome. I can almost guarantee that I won’t accept the validity of these claims, but I am genuinely interested in knowing what they are.

    HIV denialism is a a particularly insidious form of discrimination, targeting groups from the poor, women (in Africa more so than N America), gays, and addicts. The interaction of a person’s prejudices and experiences that contribute to how a person gets there mentally is pretty fascinating. HIV denialism is also quite dangerous, as we’ve learned, from a public health perspective. That is why being an “out” HIV denier would have social and professional costs to a scientist. You have my sympathy.

  50. BillyJoe7on 09 Mar 2014 at 1:25 am

    HardNose,

    “AIDS is extremely complex, and beyond anyone’s understanding”

    This is incorrect.

    Certainly, no one person knows and understands every detail about HIV/AIDS/ARVs
    (I’ve put them all together because youve denied all three).
    But there are many academics and clinicians who understand them to a degree that they can confidentally make truthful statements about all three, and certainly sufficiently for them to be confident about who has HIV, who has AIDS, what causes it, who needs treatment and with what, and what the prognosis is for those who are treated and those who are not. You don’t need to know and understand every detail about HIV/AIDS/ARVs to know and understand this.

    Look up the Nirvana fallacy: http://en.wikipedia.org/wiki/Nirvana_fallacy

    “A researcher might understand something about the limited area they specialize in, but no one is capable of grasping the big picture”

    Well, now you’ve gone from “details” to “big picture”.
    The “big picture” is a different kettle of fish.
    Given sufficient investment of time (and reading reliable sources!), even a layman can grasp the “big picture”. Certainly clinicians specialising in the treatment of AIDS grasp the “big picture”. They have to do so to be able to to treat the condition effectively.

    “As a graduate student and as a researcher in my field, I saw many mistakes that seemed idiotic, made by very smart scientists. Was I smarter than they were? Of course not”

    Of course not. Which is probably why you tought they were making idiotic errors.
    Look up the Dunning-Kruger Effect: http://rationalwiki.org/wiki/Dunning-Kruger_effect

    “The AIDS problem fascinated me, even though it is not my field, because the logical errors and careless thinking we so obvious and astounding”

    Look up the Dunning-Kruger Effect: http://rationalwiki.org/wiki/Dunning-Kruger_effect

    “I understand that nature is overwhelmingly complex, and I also understand that people need to simplify and fool themselves into thinking they grasp much more than they actually do”

    I’m going to take that as a self-reference? (;

    “Of course I could never say anything, because I would be called an HIV denier and that is deadly for any scientist’s career”

    Which means that you never got any feedback from the experts in the field in which you were just an amateur dabbler. That is a great pity, because now no one is ever going to able to persuade you that your opinon about a field in which you have no expertise at all is incorrect. To admit error now would mean negating a large slice of your life. Your closet denialism would suggest you don’t have the courage for that.

  51. DietRichColaon 09 Mar 2014 at 3:23 am

    @hardnose – I will voice everyone else’s sentiment that you offer little proof or facts to support your positions on this topic.

    Being new to skepticism, I will defer to others who have been at this longer to correct me if I get this wrong… but I believe you conflate the term skepticism – as I once did – with general incredulity about topics and positions (especially ones your worldview disagrees with), rather than with the philosophical skepticism advocated on this site (a read on the Wikipedia page might serve you well).

    I USED to think I was a skeptical person in my younger years. Full disclosure: I was a hardcore evangelical Christian who was “skeptical” of evolution, believed the world was 10,000 years old (I even counted the genealogies in the Bible to add it up myself before I ever heard that other people had already done the same) and was “skeptical” about the geology, astronomy, and radioactive dating that said otherwise, and once postulated that maybe AIDS was a punishment from God for gay people and those who had pre-marital sex. To be clear to everyone here… I no longer hold these views, but I grew up in a culture where it was acceptable and others agreed with me.

    But as I came to true philosophical skepticism slowly over the years. I realized that most of the positions I held were not based in any facts whatsoever (unless I continued to somehow hold the belief that the Bible was “historical fact”). As a result my “skepticism” was just dogmatic belief and incredulity simply because it didn’t fit my worldview… not based on objective facts or science. My interest in science in general, and chemistry specifically, throughout high school and college slowly taught me to think critically and I realized my beliefs were not tenable with the actual evidence and scientific facts.

    Your definition of being a “skeptic” (from what I can tell based on your post above that you “question everything”) may be the more common idea of what being “skeptical” is… much like the general public misconstrues the word “theory” with “hypothesis”… But it is not the kind of philosophical skepticism advocated or represented here. While that kind of questioning everything isn’t necessarily bad… but at best what you really mean is that you are exceptionally curious, or at worst just needlessly contrarian.

    Philosophical skepticism is about not accepting what others “say” as truth, or even what WE feel is truth, but withholding or suspending judgement and belief until you can base your opinions on scientifically verified facts or consensus. It also means recognizing that our own personal “feelings”, beliefs, opinions, and even experiences on a topic are subject to biases, fallacies, and outright falsehoods that our brain subjects us too. All the more reason why you need scientific method to tease out the truth (or at least the most likely scenario) to base your opinions on.

    And that’s just it, you provide a lot of opinion on this topic, and a claim to have a lot of “personal experience” researching or following this topic… but continually fail to cite actual scientific research, studies, or evidence for your positions. You simply offer your opinion that it is too “complex” for humans to understand… and that isn’t evidence.

    I also take issue with your label of being “hardnosed” since I associate that with being realistic and pragmatic, and denying established science on a topic in favor or your own personal narrative doesn’t seem particularly realistic to me at all.

    I’ve learned enough to know nothing I say is gonna change your mind. I was in your shoes once. But you are fooling yourself if you think your “skepticism” on this topic is somehow you just being more realistic than everyone here and that you somehow know better than all the scientific evidence that says otherwise. And everyone here is trying to point you to the evidence (not just their opinion) but you aren’t having any of it.

    And at the very least, you aren’t being very hardnosed if you think anyone here is gonna take anything you say without a grain of salt unless you start providing real evidence for your positions beyond just your say so that you’ve “looked into it”.

  52. grabulaon 09 Mar 2014 at 11:37 pm

    @Everyone

    keep in mind hardnose was this guy:

    “I am not an AIDS researcher, but have followed this subject carefully for years.”

    He’s apparently one of those guys who’s so entrenched in his delusions that he will continue to fight you, regardless of any real data or ability to provide data supporting his stance. His delusion includes an assumption we will take him on his word as ‘someone who has followed this subject carefully for years’

    @Hardnose

    “This is not a question of smartness. Like so many current medical problems, AIDS is extremely complex, and beyond anyone’s understanding. A researcher might understand something about the limited area they specialize in, but no one is capable of grasping the big picture. This is not because we aren’t smart enough — it’s because the world is just too complex.”

    Probably one of the most stupid things I’ve seen said on this blog in a long time. A lot of the guys who comment on this blog use their kid gloves when dealing with narrow-minded and delusional individuals such as yourself but I’m going to call your BS for what it is. You’re not the first to come to this place claiming to be a “true skeptic” while others are not, someone who realizes the truth of things, while in the same breath claiming the truth is too hard for any one person to understand. You didn’t come here for any sincere discourse, you came here to hear yourself talk. I find this type of intellectual lazyness and disingenuousness to be dull. You should find a location for like minded individuals such as yourself so that you may all continue to feed your smugness.

  53. etatroon 10 Mar 2014 at 2:19 am

    Hardnose: I am genuinely interested in what your information is, where you got it, and who disseminated it. I promise that I will not attempt to refute or argue. I just want to know, out of intellectual curiosity, where this information is coming from. If you answer my questions above or provide any other answers, I would be grateful and won’t argue.

  54. hardnoseon 11 Mar 2014 at 6:55 pm

    elatro,

    If you are genuinely interested, you could use the internet access which you obviously have. I didn’t get my information from one person or group, but from reading various perspectives.

    If a homeopath claimed to have a cure for AIDS, based mostly on clinical observations and mathematical models, they would be ridiculed at this blog.

    Yet they have rapturous praise for ARV drugs, based primarily on correlations, clinical observations and modeling.

    I was only able to find one placebo-controlled experiment to support the ARV hypothesis. AZT had been developed as a treatment for cancer, but HIV researchers decided to try it on AIDS patients. After a few months, the AZT group seemed to be doing better than the control, so the experiment was stopped and AZT was accepted as the standard treatment.

    AZT was never shown to have a long term benefit, and it was known to be very toxic.
    What if the model is wrong, or partly wrong?

    Newer drugs were developed, and tested against AZT, not against placebo (AIDS patients could not be deprived of a treatment that was “known” to be effective and safe).

    The dependent measurement in these experiments, very often, is the count of certain immune system cells. and the actual health status of the patient might not be measured at all. The certainty is profound that the entire AIDS model is correct — HIV kills certain T cells, which results in AIDS, and ARV drugs kill HIV, allowing the immune system to recover.

    You can read articles on both sides of the controversy, and try to figure out why they so strongly disagree. Are the HIV skeptics all completely crazy hallucinating idiots? Are the HIV advocates all sane and rational? Could politics or money be involved at all?

    I think if you do this reading, you will end up much more confused on the subject than you are now.

  55. Bill Openthalton 11 Mar 2014 at 7:18 pm

    hardnose –

    A couple of URLs (which your browser conveniently saves in its “history” facility) would be very welcome. Somehow, I don’t get the idea there is a HIV/AIDS controversy when I am searching the interwebz ;-)

  56. Bruceon 11 Mar 2014 at 8:24 pm

    Hardnose,

    “If a homeopath claimed to have a cure for AIDS, based mostly on clinical observations and mathematical models, they would be ridiculed at this blog.”

    Massive straw man, but I will bite, because this is easy… They would be ridiculed because there is no mechanism for the efficacy of Homeopathy!

    A simple google search, which apparently you are capable of bring up many many sites which show how ARVs work.

    “You can read articles on both sides of the controversy”

    False balance, there is NO controversy.

    “Are the HIV skeptics all completely crazy hallucinating idiots? Are the HIV advocates all sane and rational? Could politics or money be involved at all?”

    Just asking questions again? In order, probably, probably and probably (but not as much as you think).

    “The dependent measurement in these experiments, very often, is the count of certain immune system cells. and the actual health status of the patient might not be measured at all. The certainty is profound that the entire AIDS model is correct — HIV kills certain T cells, which results in AIDS, and ARV drugs kill HIV, allowing the immune system to recover.”

    What the hell is that supposed to mean? This paragraph seems to acknowledge that ARVs work, what is your point? I thought you were trying to tell us ARVs don’t work…?

    You are incoherent and give the impression you have read far too many conspiracy theories credulously. You are being so open minded your brain has fallen out. Either define your position coherently, spell out what the evidence is, with links to credible studies or please please stop making yourself look like a jibber-jabbering idiot. If you are retired, then you have the time to pull it all together, make one long post, allow us to have a look at the evidence that has so swayed you, and maybe, perhaps we might be able to have a discussion. Until then, I am out!

  57. steve12on 11 Mar 2014 at 11:42 pm

    @ HArdnose

    This is just silliness!

    You seem to have some scientific training – at least you’re more coherent re: stats than most. So you should understand why you can’t just make claim after claim w/o evidence!

    You’ve made many questionable statements, and you’ve been asked specifically for links and refused. It just doesn’t work that way.

  58. grabulaon 12 Mar 2014 at 1:29 am

    @Hardnose

    “If a homeopath claimed to have a cure for AIDS, based mostly on clinical observations and mathematical models, they would be ridiculed at this blog.”

    Considering homeopathies past record, it would be hard to take any claims they make in general, as reasonable. If they did show up with clinical observations and mathematical models and all the other science legitimate medicine uses to provide proofs, than they could, and would be taken more seriously. The problem is they don’t, and never do.

    @steve12 – there’s no science training there. He’s basically spitting out what he’s picked up from conspiracy sites – notice he hasn’t posted a single link to any evidence backing his claims up? He knows they’d be torn to pieces in moments by commenters here for the shams they are.

  59. hardnoseon 12 Mar 2014 at 9:00 am

    “What the hell is that supposed to mean? This paragraph seems to acknowledge that ARVs work, what is your point? I thought you were trying to tell us ARVs don’t work…?”

    I said the “certainty is profound” that the current model is correct. I meant the researchers who advocate this model are certain; I did not mean they are right.

  60. steve12on 12 Mar 2014 at 12:31 pm

    Grabula:

    “@steve12 – there’s no science training there. He’s basically spitting out what he’s picked up from conspiracy sites – notice he hasn’t posted a single link to any evidence backing his claims up? He knows they’d be torn to pieces in moments by commenters here for the shams they are.”

    Not here, but in another thread he evinced some working knowledge of statistics – beyond what would be expected from an undergrad. Not that this in any way makes the other stuff make sense, but it’s in sharp contrast to many of the other cranky folks who talk about stats and have no idea what they’re talking about.

  61. etatroon 12 Mar 2014 at 4:42 pm

    I genuinely have an academic interest in this line of thinking. It’s actually the mirror image of another line of potentially dangerous actions. Huff Po published an article recently called “Undetectable is the new Negative,” vis a vis dating and hookup apps / ads. The idea is that if someone knows their HIV status, takes ARVs, and has undetectable viral load, that person is at a much lower transmission risk than the person who a) lies and is positive but says they’re neg, b) Tested neg at some point in the recent past but has had unsafe sex between then and now, c) Has never been tested buts says they’re neg because they don’t have symptoms. Articles like that, I think are designed to take the social stigma away because HIV positive people deserve a socially and sexually fulfilling life but with caveats about safety and if people are open and honest, it overall leads to more safety. The problem I have with this is that people who are undectable VL engage in unsafe sex (I have anecdotal evidence that this logic and practice is happening in the wild). The limit of detection in the clinic is 50 copies per microliter in the blood. For several reasons, fluids from sexual organs sometimes have higher VL than blood, and … <50 is not zero. So from my perspective as a researcher in mental health and HIV, I am concerned about the the success of ARV paradoxically having this negative effect on behavior.

    The things that hardnose is talking about are some old school claims that I didn't know we're still around. I am still interested in where, specifically, this information is coming from. Steven Epstein wrote a book in 1996 called Impure Science, available free at http://ark.cdlib.org/ark:13030/fts20045x/ , which explores the crisis of credibility, expertise, advocacy groups, the nature of how issues of causality are decided in science and medicine as it relates specifically to HIV/AIDS. It is less dramatic than And The Band Played on. I am interested in what information hardnose has access to and who is communicating it because Epstein covered this 20 years ago (I was in high school) and it's resurfacing here. I admit my initial reaction was to be a bully, but I really want to know the source of this line of thought.

  62. etatroon 12 Mar 2014 at 4:48 pm

    Link was wrong. Stupid tablet…. http://ark.cdlib.org/ark:/13030/ft1s20045x/

  63. BillyJoe7on 12 Mar 2014 at 4:50 pm

    Hardnose doesn’t want to answer your question.
    He said he is retired. Perhaps he retired 20 years ago.

  64. hardnoseon 12 Mar 2014 at 7:12 pm

    I

  65. BillyJoe7on 12 Mar 2014 at 11:43 pm

    No excuse then.

  66. grabulaon 13 Mar 2014 at 1:04 am

    I notice a pattern with guys like Hardnose. They stick to their story with absolutely no give. When we ask for any sort of evidence to back them up, we get nothing. Hardnose has absolutely refused to post anything resembling evidence of his claims and that leads me to believe he’s yet another troll. Either that or he knows his claims have no ground to stand on and just doesn’t want the specific sources challenged.

  67. hardnoseon 13 Mar 2014 at 9:00 am

    ” I really want to know the source of this line of thought.”

    You think there is A SOURCE??

    When I read a website like aidstruth.org, for example, I see claims made with absolutely certainty supported with weak evidence at best.

    The “source” of my noticing this is SCIENCE and LOGIC.

    No one is giving me information that makes me skeptical. You think that if anyone ever questions the status quo they must be brainwashed by some evil organization?

  68. hardnoseon 13 Mar 2014 at 9:09 am

    “The things that hardnose is talking about are some old school claims that I didn’t know we’re still around.”

    Maybe because people dared to question the theory at the beginning. But now questioning the mainstream consensus is forbidden.

    Your initial reaction was to be a bully? Of course, that’s how mobs react to anyone who questions their cherished mythology.

  69. hardnoseon 13 Mar 2014 at 9:38 am

    By the way, I disagree with most of what HIV deniers say also. I think AIDS is contagious, for one thing.

    However I agree with them, partially, because I think HIV might not be the primary cause. And I also am very skeptical about the current standard treatment, and I think it is extremely harmful to patients’ overall health. And even if it does kill HIV, I am not convinced that is the solution to the immune deficiency.

  70. Bill Openthalton 13 Mar 2014 at 10:20 am

    hardnose –

    I think HIV might not be the primary cause. And I also am very skeptical about the current standard treatment, and I think it is extremely harmful to patients’ overall health. And even if it does kill HIV, I am not convinced that is the solution to the immune deficiency.

    And your thoughts and convictions are based on what? Gut feel?

    Please present the evidence.

  71. etatroon 13 Mar 2014 at 11:01 am

    To clarify, none of the drugs actually kill or destroy the virus, they prevent it from replication or becoming part of the host genome at different stages of the life cycle. The NNRTIs and NRTIs (AZT), prevent it from transcribing from RNA when it enters a cell to DNA, the integrase inhibitors prevent it from intregrating its DNA into the host genome and becoming latent “provirus”, the reservoir I mentioned. The protease inhibitors prevent the mature viral capsid from forming if an infected cell begins to produce viral proteins. Maraviroc is an cell entry inhibitor.

    I would encourage you to read Epsteins book that linked to. Our tendency is to look back in time through the lens of what we are certain about now (I’m talking about myself and your dissenters), as if the path to scientific truth were an inevitable straight line. And it clearly is not. But he gives equal weight to competing ideas at the time (e.g., immune overload hypothesis) and describes how, why, and who decided on the causation, even exploring the possibility that the debate was closed too early.

  72. hardnoseon 13 Mar 2014 at 11:43 am

    You can’t summarize briefly whether he thought the debate was closed to early? We have to read the book? No, I am not opposed to reading books, but we don’t all necessarily have time to read every book someone recommends. Especially if you could easily summarize certain points we would probably like to know about.

    etatro, ok the ARV drugs don’t kill HIV. They do make it wind up dead, however, if it can’t reproduce. And the mechanisms for destroying HIV can be EXTREMELY harmful to normal cells.

    How can you interfere with important cell mechanisms without damaging health?

  73. steve12on 13 Mar 2014 at 12:05 pm

    “The HIV drugs are extremely toxic and cause serious side effects, especially after prolonged use.”
    cite?

    “The original AZT trials never showed any benefit after 2 years.”
    cite?

    “The “source” of my noticing this is SCIENCE and LOGIC.”
    It doesn’t work that way. YOu don’t invoke the names science and logic like you’re casting a spell. I’ve pasted in the claims that you make that REQUIRE sources to be taken seriously.. You have provided many POV that differ from the established science. This is fine – but requires some evidence. That you want to turn several fields on their head w/o evidence is absurd – and you know it. Because if you did provide evidence, the perpetual naturalistic fallacy your perpetrating would be exposed for what it is.

    Here’s some example of your proclamations w/o evidence, just from this thread:

    “AIDS was originally a death sentence because only very sick patients arrived at the clinics. Now all that is required is a positive HIV test and low counts of certain immune system cells. “
    cite?

    “You did not link anything showing that AIDS patients treated with HAART live normal lives. That seems very unlikely given the toxicity of the drugs.”
    cite?

    Pretty much all of on 07 Mar 2014 at 11:49 pm – cite?

    “And the mechanisms for destroying HIV can be EXTREMELY harmful to normal cells.”
    cite?

    “I was only able to find one placebo-controlled experiment to support the ARV hypothesis.”
    And you still won’t cite it? Ahhhh!

  74. hardnoseon 13 Mar 2014 at 1:15 pm

    [“I was only able to find one placebo-controlled experiment to support the ARV hypothesis.”
    And you still won’t cite it? Ahhhh!]

    It was the original AZT study, that was discontinued because the AZT group was doing better than the control group. I am citing this from memory, but should be easy to find it, or summaries of it.

    And yes, I am continuing to claim that AZT and other ARV drugs are extremely damaging to health. They stopped using AZT mainly because of its toxicity.

    Newer drugs are considered less toxic than AZT. That does NOT imply the newer drugs are harmless, just not as harmful as something that was known to be very harmful.

    Very often, the AIDS industry blames HIV for the damaging effects of ARVs. It is hard for anyone to know for sure whether the disease or the treatment was to blame, but sometimes we can fall back on good old common sense. Chemicals that interfere with important cell processes just might be harmful in some ways. And knowing that some of the supposed HIV problems were never seen in the original AIDS patients might give you a hint that the ARVs might be at least partly responsible.

    I have read a lot of articles about this, but never made a reference list (this is NOT my job!) I know that at least one article was in the NY Times.

  75. BillyJoe7on 13 Mar 2014 at 4:45 pm

    “I know that at least one article was in the NY Times”

    Well then, I guess that we are just going to have to believe that what you know about HIV/AIDS/ARVs from totally reliable sources such at the above is totally the correct way to look at things, and that the consensus of experts, who spend their whole lives researching this subject, has gotten it completely wrong.

  76. hardnoseon 13 Mar 2014 at 7:36 pm

    http://www.nature.com/labinvest/journal/v94/n2/full/labinvest2013142a.html

    Well I guess you don’t think Nature is a reliable source, since this article admits that HAART damages health, especially when taken for a long time.

    They can’t say exactly which symptoms result from AIDS and which are from HAART, but they admit that at least some are from HAART.

    So at least read the abstract, and then you can stop saying ARVs are harmless, and that only lunatic conspiracy theorists would think so.

  77. hardnoseon 13 Mar 2014 at 7:45 pm

    For those of you who can’t believe ARVs could possibly be harmful, and can’t figure out how to do an internet search, I spent 5 minutes and did one for you:

    http://www.nature.com/labinvest/journal/v81/n11/full/3780366a.html

    http://www.nature.com/labinvest/journal/v85/n8/full/3700301a.html

    http://www.nature.com/labinvest/journal/v81/n6/full/3780288a.html

    http://www.nature.com/labinvest/journal/v89/n5/full/labinvest200914a.html

  78. etatroon 14 Mar 2014 at 4:01 am

    Dude, if you can’t be bothered to read a (short and freely available) book on the topic you are discussing, or provide some sort of source of where you’re getting your information …. How can we possibly find common ground or an agreed upon basis for discussion? I really thought I was being charitable in taking the time to find a resource that addressed the very issues you raise and you refuse to look at it. Seriously? I looked at the paper you linked to. It is an opinion piece. It operates under the assumption that HIV causes AIDS and that ARV suppresses HIV and prevents AIDS. It discusses long term consequences of HIV infection and ARV use. It does not support the claims you’ve made. But Epsteins book does address the claims you’ve made … from a more, thorough, objective and sympathetic point of view than what you’ll find here. Best of luck to you.

  79. Bill Openthalton 14 Mar 2014 at 4:34 am

    hardnose –

    How can you interfere with important cell mechanisms without damaging health?

    As long as the damage of the treatment is less than the damage caused by the disease, it benefits the patient. Hardly any medication (including “natural” plants) is free of side effects.

    The article in Nature deals with the fact that HAART has increased the life expectancy of HIV/AIDS sufferers to the point that they start to suffer from age-related diseases. These age-related diseases occur earlier in HIV/AIDS sufferers treated with HAART than in healthy people.

    We know that without treatment, HIV/AIDS sufferers die (from opportunistic infections, mostly) long before they start to suffer from age-related diseases, so the HAART treatment benefits them. The treatment improves their health, even if that same treatment would reduce the health of a healthy person. Is that so difficult to understand?

  80. rezistnzisfutlon 14 Mar 2014 at 4:46 am

    How can you interfere with important cell mechanisms without damaging health?

    The question should also be, what is the result of not doing anything at all? Is the “damage” from treatment preferable to the damage of inaction? Many treatments have effects, sure, but they’re better than death, and better than the far worse effects of inaction. Honestly, where do you get this stuff from?

    Is that so difficult to understand?

    Apparently so, because it’s been explained several times by different people to no avail. I’m not even sure that it’s so much difficult to understand as it is committed ideology and motivated reasoning propping up cognitive dissonance.

  81. hardnoseon 14 Mar 2014 at 9:20 am

    “The article in Nature deals with the fact that HAART has increased the life expectancy of HIV/AIDS sufferers to the point that they start to suffer from age-related diseases. These age-related diseases occur earlier in HIV/AIDS sufferers treated with HAART than in healthy people.”

    Of course you can say that, but you can’t provide any evidence. AIDS patients are suffering these terrible diseases because HAART is wonderful and allows them to reach old age?? That is more marketing BS. We can’t tell if it’s true, or partly true, or complete BS.

    Imagine if you put a cancer patient on chemotherapy drugs for decades? If they became sick from the chemo, would you say it was because the chemo prolonged their life into old age, and old age causes horrible diseases? Or would you have to admit that chemo is toxic?

    By the way, old age does not necessarily cause horrible diseases in everyone.

  82. Steven Novellaon 14 Mar 2014 at 10:58 am

    hardnose – classic strawman. No one is saying that ARVs have no side effects or cannot cause harm.

    When assessing any therapy the standard is to evaluate risk vs benefit. All treatments cause some harm or potential harm. Just pointing to harm is not a rational assessment. You need to figure out the net benefit vs harm.

    With HAART it is clear that, while they do cause side effects and potential toxicity, their benefit is dramatically greater, including significantly longer survival and reduced opportunistic infections.

    Studies show HAART prolongs survival, reduces spread of HIV, reduces progression within a patient, is more effective when started early, and the HAART programs introduced into other countries are also associated with improved outcomes.
    http://cid.oxfordjournals.org/content/46/4/507.long
    http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(08)70180-4/abstract
    http://www.ncbi.nlm.nih.gov/pubmed/16123689
    http://www.ncbi.nlm.nih.gov/pubmed/23221765
    http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1003982

    Most of the published studies also look at specific opportunistic infections, cancers, and direct effects of HIV, showing consistent benefit from HAART.

  83. steve12on 14 Mar 2014 at 11:19 am

    Thanks Hardnose. If I’m going to give you shit about not provding links, I’ll give you credit for doing so. Now there’s something to talk about!

    To echo Steve’s objection, have you found anything that looks at risk : benefit? All drugs have side effects…

  84. hardnoseon 14 Mar 2014 at 1:11 pm

    I will read Steve N’s links, steve12.

    But it is very hard for researchers to determine risk vs. benefit for AIDS treatments. They are not allowed to withhold the standard treatments, so controls are not possible, for one thing.

    It is very important to consider long-term as well as short-term results. Maybe you get short-term reductions in infections, cancer, etc., from ARVs, (But, as I said before, ARVs damage all cells, so they might kill bacteria, fungus, cancer, etc. You can’t be sure if the benefits of ARVs result entirely from reducing HIV).

    The toxic effects of ARVs build up over the years, so the worst effects may not show up in the beginning.

    And researchers are, understandable, confused about what problems may be caused by HIV vs the treatment. Especially since at the beginning of the AIDS epidemic, patients did not survive long enough to get long-term effects of HIV infection.

    No one knows, for example, if HIV-related dementia results from HIV or ARV drugs.

    The term “HIV-related” is intentionally ambiguous, because no one knows. However, it does strongly imply that HIV is the cause. Everyone wants to think HIV is the cause, and that the treatments do more good than harm. But, as I said, no one can be sure.

  85. steve12on 14 Mar 2014 at 1:41 pm

    Hardnose:

    “But, as I said, no one can be sure.”

    I thinkyou need to read those links above . This sounds a little like we can’t be sure smoking causes lung cancer because we can’t do a real experiment. Drug trials are often compared to standard of care. What do you think would happen to these patients if they took nothing? Why wouldn’t they die like AIDS patients pre-treatment era?

  86. Bronze Dogon 14 Mar 2014 at 2:00 pm

    Humans aren’t RPG characters. Disease isn’t a set of binary flags representing the presence or absence of status ailments. There are no magic spells or potions that simply toggle the flags from “on” to “off” without doing anything else. The human body is a complex array of interconnected entities. Because of that, any intervention we perform is likely going to produce side effects of some kind or another. You can’t just turn a human body “off” to fix it or reboot it to a factory default. You’re modifying something incredibly complex while it continues to run. Living organisms are messy like that.

    We don’t get to feel entitled to health by default. Everyone dies of something, eventually. Risks are chances of dying sooner or experiencing greater suffering. Benefits come in the form of the chance at reduced suffering and delayed death. We accept human mortality and complexity, which is why we accept that any medical solution is going to fall short of perfection. Medicine isn’t a strategy that lets us “win the game,” it’s a strategy that lets us hang on longer and enjoy playing more than we otherwise would. You can complain that it’s unfair or unjust, but you can’t blame medical science for it. Doctors and scientists just try to make the best of the imperfect universe we found ourselves in.

  87. hardnoseon 14 Mar 2014 at 7:34 pm

    I didn’t see anything in Steve N’s links showing, in any kind of convincing scientific way, that an adult diagnosed with AIDS (not just HIV) is likely to be in better health and to survive longer with HAART.

    I realize it would be difficult or impossible to demonstrate this conclusively. But all I am asking is that people admit when they are not sure.

    Sometimes, in their desperation to know the answer to an important problem, researchers will grab on to an idea that seems promising. Cops sometimes do this with murder cases. After announcing victory, problem solved, it’s hard to ever turn back and re-evaluate. It would be too embarrassing and costly to start over.

    I am not saying the AIDS/HIV theory is wrong, only that we don’t have good convincing data. People believe whatever they find more consoling, or more profitable.

  88. hardnoseon 14 Mar 2014 at 7:38 pm

    Bronze Dog, I certainly don’t expect miracles from modern medicine. But I do expect people who call themselves skeptics to be skeptical. When the evidence is weak and based mostly on wishful thinking, we are supposed to restrain our natural tendency to believe.

  89. steve12on 15 Mar 2014 at 12:55 am

    “I didn’t see anything in Steve N’s links showing, in any kind of convincing scientific way, that an adult diagnosed with AIDS (not just HIV) is likely to be in better health and to survive longer with HAART.”

    I realize it would be difficult or impossible to demonstrate this conclusively. But all I am asking is that people admit when they are not sure.”

    We’re never “sure” in science. That’s just not how it works. Those papers are very compelling – and dismissing them because they’re not some sort of absolute proof is invoking a standard that is, by your own admission, unrealistic.

    And again, I ask you:
    What do you think would happen to these patients if they took nothing? Why wouldn’t they die like AIDS patients pre-treatment era?

  90. Steven Novellaon 15 Mar 2014 at 6:52 am

    I gave some representative examples of studies showing HAART efficacy.

    As I mentioned, most of the individual studies are looking at individual complications. What we have are many indepenent lines of evidence showing HAART efficacy from many different perspectives. The evidence is not weak, or “wishful thinking.” The evidence, in fact, is robust. Hardnose is simply ignorant of the evidence and is engaging in particularly stubborn motivate reasoning.

    If you search PubMed for “HAART, Efficacy” you get >1500 results. Of course, these are not all relevant, but most are.

    Here’s another http://www.ncbi.nlm.nih.gov/pubmed/24307741
    showing 9-10 year increased survival in 8 different cohorts in South Africa with the introduction of HAART. That’s 9-10 years of survival specifically attributable to HAART – and these are not under optimal treatment conditions.

    Here’s another from India showing that starting HAART with CD4 counts < 350 still produce >5 years of extra survival. http://www.ncbi.nlm.nih.gov/pubmed/17620747

    Keep looking. The evidence is there.

  91. hardnoseon 15 Mar 2014 at 8:08 pm

    How can you learn about what really happens in the real world from simulation models? Especially when there are huge amounts of money to be made by companies that might have funded the “research?”

    If the model is complicated enough, no one will really understand how it works. And you can adjust parameters to get results you like.

    If parapsychologists were using simulation models to prove the existence of ghosts, you would, understandably, laugh at them.

    And showing >5 years of extra survival does not back up the claim that AIDS patients now live almost normal lives.

    The AIDS propaganda says that AIDS patients used to die within months, but now they can live into old age. Adding 5 years of survival is not giving someone a normal life.

    And as I said we can’t take simulation data very seriously, so we don’t even know if HAART extends life by >5 years.

  92. steve12on 16 Mar 2014 at 1:55 am

    Hardnose:

    What do you think would happen to these patients if they took nothing? Why wouldn’t they die like AIDS patients in the pre-treatment era?

  93. steve12on 16 Mar 2014 at 2:08 am

    Also, Hardnose:

    You couldn’t address ANY of the original papers that Steve cited re: HAART, but you did mange to invoke a conspiracy theory with no evidence. That’s just poor. You can’t ignore the evidence.

    Another technique of denial I’ve noticed that you use is to individuate the different lines of converging evidence. That different lines of evidence converge on the same explanation is itself powerful evidence. You simply ignore this and poke holes in the lines one at a time.

    E.g. – “How can you learn about what really happens in the real world from simulation models?”
    If the evidence was only work you might have a point, but this isn’t the case. Steve cited you empirical studies, but you ignored them!

    This kind of thing is not going to fly here, I can tell you that.

  94. Steven Novellaon 16 Mar 2014 at 11:04 am

    hardnose- you are demonstrating you unfamiliarity with the evidence. The 5 year extra survival is in patients with CD4 counts less than 350 at start of treatment – so they already have advanced disease. The evidence showing near normal life expectancy is in patients who start HAART early, while asymptomatic.

    Steve12 is correct, we need to look at multiple lines of converging evidence. We cannot do one definitive study, because we cannot withhold standard therapy from HIV patients to see how quickly they die. But we do have studies that show that HAART reduces viral load, improves CD4 counts, delays progression of disease, reduces the incidence of opportunistic infections, cancers, and HIV related complications, and reduces spread of HIV. People who start HAART early and are compliant live longer and do better.

    We further have epidemiological evidence that over time improvements in HAART therapy have lead to a steady increase in survival with those with HIV.

    Here’s a good summary of some of this evidence: http://www.aidstruth.org/science/arvs

  95. Bruceon 16 Mar 2014 at 11:21 am

    “How can you learn about what really happens in the real world from simulation models? Especially when there are huge amounts of money to be made by companies that might have funded the “research?””

    Conspiracy thinking, not a valid argument, especially when looking at multiple studies done by different companies and multiple real life examples of statistical efficacy.

    “If the model is complicated enough, no one will really understand how it works. And you can adjust parameters to get results you like.”

    Argument from incredulity… I cannot understand it, therefore it cannot be so.

    “If parapsychologists were using simulation models to prove the existence of ghosts, you would, understandably, laugh at them.”

    Straw man.

    “And showing >5 years of extra survival does not back up the claim that AIDS patients now live almost normal lives.
    The AIDS propaganda says that AIDS patients used to die within months, but now they can live into old age. Adding 5 years of survival is not giving someone a normal life.”

    This is data from third world countries in which a) life expectancy is much lower than the rest of the world (some under 50 years as opposed to over 80), so 5 to 10 years of extra life can be significant, and b) access to regular treatment is not easy. You also miss a significant point where the 5 years is where CD4 counts are < 350. If you have a knowledge of AIDS from extensive reading then you will know the significance of this.

    Steve12 pretty much hit the nail on the head though, you completely ignore different lines of converging evidence.

  96. hardnoseon 16 Mar 2014 at 2:09 pm

    “The evidence showing near normal life expectancy is in patients who start HAART early, while asymptomatic.”

    Ok, that is my central concern. Researchers might be fooled by over-diagnosis. A person who is HIV positive might never get AIDS. Or they might get AIDS, but only decades later. It is known that the latency period can be very long.

    The original AIDS patients had AIDS, not just HIV infection. Now an HIV positive person might be considered an AIDS patient, even if they have no symptoms.

    This is a very serious problem which is found in a lot of the research. And the research has other serious problems, such as over-reliance on simulation models and correlations. And the very serious confusion about which symptoms are caused by AIDS and which might be caused by the ARV treatment.

  97. Steven Novellaon 16 Mar 2014 at 2:41 pm

    Lead time bias is very well known to researchers and is taken into account.

    No one is confusing HIV infection with AIDS. Research carefully categories patients into their stage of infection and disease, for example studying the progression of HIV to AIDS.

    Your concerns are based on nothing but your own ignorance of the research and of medical research in general. Your specific points have all been addressed, you just ignore those responses and return to your premise.

  98. hardnoseon 16 Mar 2014 at 6:25 pm

    If you want to “win” the argument by calling me ignorant, then I can’t really respond with logic. Everyone is ignorant to some degree. You aren’t a medical researcher either. At least I have research experience.

    We could go down the road of trying to prove who is more ignorant, but I prefer not to.

  99. hardnoseon 16 Mar 2014 at 6:26 pm

    You aren’t a medical researcher either. At least I have research experience.

    I don’t want to waste time trying to prove who is more ignorant. Everyone is ignorant to some degree.

  100. Bill Openthalton 16 Mar 2014 at 6:42 pm

    hardnose –

    The term “HIV-related” is intentionally ambiguous, because no one knows. However, it does strongly imply that HIV is the cause. Everyone wants to think HIV is the cause, and that the treatments do more good than harm. But, as I said, no one can be sure.

    You sound like Thabo Mbeki.

    Criticism is easy. Given that you think HAART is doing more bad than good, what would you propose as treatment for HIV positive people?

  101. hardnoseon 17 Mar 2014 at 8:57 am

    “Given that you think HAART is doing more bad than good, what would you propose as treatment for HIV positive people?”

    I said we don’t know if the treatments do more harm than good. We don’t know how much good they do, and how much harm. It is the kind of thing researchers should try to findout.

    As for what I propose as a treatment — I propose that AIDS researchers open their minds to other possibilities. Maybe their theory is not 100% correct. Maybe it is, maybe it isn’t, and maybe it is only partly correct.

    Closed minds prevent progress. But no AIDS researcher dares question or criticize any aspect of the mainstream theory, because their careers would be ruined. They would even be called immoral for questioning treatments that are “known” to be life-saving.

  102. BillyJoe7on 17 Mar 2014 at 9:03 am

    “Closed minds prevent progress”

    Yes, I’m still open to the suggestion that the Earth may be flat.
    You never know what progress might lie in that direction.

  103. Bruceon 17 Mar 2014 at 9:28 am

    “As for what I propose as a treatment — I propose that AIDS researchers open their minds to other possibilities. Maybe their theory is not 100% correct. Maybe it is, maybe it isn’t, and maybe it is only partly correct.

    Closed minds prevent progress. But no AIDS researcher dares question or criticize any aspect of the mainstream theory, because their careers would be ruined. They would even be called immoral for questioning treatments that are “known” to be life-saving.”

    I have a family friend who is a prominent doctor involed in AIDS research and education in Botswana. She would be extremely insulted by your implications.

    The assumptions you make of those researching HIV/AIDS and their motivations is really quite astounding. They are doing the research to save lives directly and it is your kind of “just asking questions” that results in funds being cancelled or delayed that ultimately costs lives and feeds the witch doctors and their peddling of snake oil (quite literally in some cases). You have no data to support your “just asking questions” and while nothing is 100% correct, saving 95% or even 50% of those lives is much better than saving none.

  104. BillyJoe7on 17 Mar 2014 at 9:33 am

    Yes, the consensus of experts may be wrong and that fringe dweller may be right.
    What’s a betting man to do? Flip a coin?

  105. Bill Openthalton 17 Mar 2014 at 9:46 am

    hardnose –

    As for what I propose as a treatment — I propose that AIDS researchers open their minds to other possibilities.

    I see, you haven’t got a clue, and you are criticising HIV/AIDS researchers for not following your gut feel. Have you no shame?

  106. Steven Novellaon 17 Mar 2014 at 10:45 am

    Ignorance means lack of knowledge. It is not necessary an insult and is not name-calling.

    You are claiming that the research does not exist, when it clearly does. I have already given plenty of references and links to summaries. You are clearly ignorant of the research, but it also seems like you just don’t want to see it because it conflicts with your preferred narrative.

    Further, I am not the one claiming that the expressed consensus of expert opinion is wrong. I am simply trying to understand and communicate the consensus of expert opinion. I don’t need to be an expert myself to do this.

    You are arguing that expert opinion is hopelessly wrong, naive, overly simplistic, and misguided. Overturning expert consensus requires a far greater degree of knowledge and expertise than just understanding the consensus. And yet you make basic mistakes in interpreting the research and do not seem to be aware of what has been published.

    Further, you are not truly engaging with the arguments and evidence presented in these comments. This is a pattern with which the commenters here are very familiar, as their comments demonstrate.

  107. steve12on 17 Mar 2014 at 11:28 am

    Hardnose:

    You’re too annoying to have a discussion with. You’re unempirical, you selectively answer points only when you think you have an advantage, and you have an axe to grind that you don’t want to fully divulge.

    Quite the trifecta.

  108. Bronze Dogon 17 Mar 2014 at 12:13 pm

    Ignorance by itself is not a character flaw. It’s a simple matter in that it can be cured with education and research. Humility often means being willing to acknowledge your ignorance, set aside your existing biases, listen to the best evidence, and learn. Being able to do that is praiseworthy.

    Willful ignorance is something else entirely. There are none so blind as those who will not see. The willfully ignorant start with their biases and cherrypick to reinforce their arrogant presumptions. They typically assume humanity as a whole is limited by their individual ignorance. Often, they see a few obvious difficulties or confounding factors in researching an issue. They don’t see any way to work around it, so they presume that no other human was ever aware enough to recognize the problem, much less devise a method to fix it.

    One related factor: There is the desire to be right and the desire to have been right. Someone with the former will change his position if he’s given sufficient evidence to convince him. That means acknowledging ignorance and mistakes made. They’d rather be wrong due to missing important evidence than be right because they made an irrational leap and got lucky. Those with the latter desire are more interested in “told you so!” and will cling to unsupported beliefs in hopes of future vindication, rather than feel their ego diminished by acknowledging they ever held a mistaken position. They’re often more interested in keeping the faith or toeing the line because they commonly tie in their belief with their identity.

  109. hardnoseon 17 Mar 2014 at 7:16 pm

    My desire is to understand. I don’t have a reverence for experts, and we know that the consensus of experts has often been wrong. Once a consensus has formed, it can be very hard to question it. The questioner is often mobbed and ostracized.

    I do not understand how lead-time bias and over-diagnosis are accounted for, for example, and no one here has bothered trying to explain.

    There is nothing at all wrong with questioning this. Except it bothers people who need to have faith in scientific expertise.

  110. BillyJoe7on 20 Mar 2014 at 8:29 am

    hardnose,

    “My desire is to understand”
    But you have shown a distinct desire to not understand and to cling to the views with which you entered this discussion, as the rest of your post clearly demonstrates.

    “I don’t have a reverence for experts…”

    So who are you going to back? The consensus of experts who spend their whole working lives reseaching HIV/AIDS/ARVs? Or the fringe dweller?
    It really isn’t a coin toss.

    “…and we know that the consensus of experts has often been wrong”

    Knowledge grows with continued research. The concensus is often strengthened (the error bars are shortened) as a result of this increased knowledge. Sometimes it is modified. Occasionally it has to change. This is how science works!
    But, just because the consenus of experts has had to change in the past, doesn’t mean you back the fringe dweller against the consensus of experts.
    (BTW, this is very close to the Galileo fallacy: http://rationalwiki.org/wiki/Galileo_gambit)

    “Once a consensus has formed, it can be very hard to question it”

    And rightly so.
    The consensus is based on the accumulated facts garnered by scientists up to the time they arrive at their consensus. It’s not going to be overturned easily. It would take a substantial amount of counter-evidence to overturn an evidence based consensus. This is not going to happen quickly

    “The questioner is often mobbed and ostracized”

    False characterisation.
    More commonly, when their evidence is examined and found wanting they are ignored. If they do have evidence to bring to the table, they will be listened to. If their evidence is vindicated, it is incorporated into the consensus. And, hey, in due course, and with due deliberation, it may even effect a change the consensus.
    But the process is peer review, not flinging stones from the fringe.

  111. hardnoseon 20 Mar 2014 at 11:59 am

    You described the ideal scientific process. But every human endeavor is also political, which means it inevitably falls short of the ideal.

    The scientific consensus is supposed to be what you described. However, human nature determines that those who belong to the mainstream consensus will become a “mob,” and will not tolerate too much dissent.

    The dissenters cannot get as much research funding as the mainstream, and sometimes they get very little. So they are severely disadvantaged in their ability to gather evidence.

    And when the mainstream consensus happens to be a giant money-maker, the politics is even more intense.

    Science has always had these problems, but not nearly as much as now. Science gained the trust of the public, and there are giant corporations whose profits depend on continued scientific research (thinking of Big Drug especially).

    Researchers who criticize the “HIV is the only cause of AIDS, and ARVs reduce AIDS symptoms by lowering HIV levels” theory have their careers destroyed. They lose the ability to get funding and gather counter-evidence.

    I am NOT saying the dissenters are correct. But I am saying that some of them might be partly correct. And, as they say, we might never find out until the current generation of researchers has all died.

  112. steve12on 20 Mar 2014 at 1:24 pm

    “There is nothing at all wrong with questioning this. Except it bothers people who need to have faith in scientific expertise.”

    The problem isn’t your questioning. It’s your refusal to take the answers head-on.

    You ignore the answers you don’t like because they don’t fit into your naturalistic fallacy.

  113. Steven Novellaon 20 Mar 2014 at 1:33 pm

    hardnose – you are relying on broad general principles. Even if I agree with those principles, you have not provided any evidence to indicate to what degree they apply in this specific case.I and others have provided evidence to the contrary, but you reject them with more general principles.

    Sure, the old guard will tend to defend their theories. But how much of an effect is that having in HIV research. The entire area is so new (as scientific institutions go) that there has hardly been time for an “old guard” to develop.

    Also – you ignore the fact that there is actually a bise in favor of studies that have the potential to reverse established ideas or demonstrate new ideas. That generates impact factor for journals and makes careers for scientists.

    So your broad claim that dissidents won’t get funding and their careers will be ruined does not actually fit the reality of science today. It’s overly simplistic to the point of being wrong.

    You are also just assuming, without evidence, that the consensus is not deserved. Rather, the evidence suggests that it is in proportion to the evidence, exactly as it should be. Those who oppose the consensus are not getting traction – because they are cranks, or have terrible ideas. If they had good ideas they would get funding.

    No – it’s not a perfect world. But there is a lot of real estate between perfect and hopelessly flawed, real estate you are leaping over because it fits your ideology.

  114. hardnoseon 20 Mar 2014 at 2:04 pm

    I don’t have an ideology.

  115. Hosson 20 Mar 2014 at 2:17 pm

    “I don’t have an ideology.”
    lol Holy crap that’s funny.

  116. Bronze Dogon 20 Mar 2014 at 3:46 pm

    Everyone has an ideology. Everyone has an agenda. It’s part of being human. They’re the consequences of trying to understand the world and having values. The problem is letting those things override rational assessments of the evidence. That’s why skeptics point out logical fallacies and why scientists use systems like peer review. If you’re blind to your own biases, you need other people who lack your particular biases to point out how they’re producing mistakes.

    There’s no end to the people who only have a passing familiarity with a field but think they know better than the experts worldwide who spend their lives researching and conducting experiments. On rare occasions, they might actually be right, but never bet on it.

  117. hardnoseon 20 Mar 2014 at 7:19 pm

    I think it’s because I don’t have an agenda about AIDS that I can see it a little more objectively. I am not an AIDS researcher, so my ego and income isn’t tied up with it.

    I guess I do have an agenda about the veneration of Big Science, which is increasingly funded by Big Drug and Big AG. The potential market for ARV drugs is enormous in Africa, Asia, etc.

    I think most AIDS researchers and ARV manufacturers have somewhat good intentions, at least consciously.

    But there is a real temptation to over-simplify AIDS and to believe the answer is around the corner. We have seen that happen with many types of cancer, for example.

    Very often, in the history of science, things start to look more complicated the longer they are studied.

  118. Bill Openthalton 20 Mar 2014 at 7:41 pm

    hardnose –

    I guess I do have an agenda about the veneration of Big Science, which is increasingly funded by Big Drug and Big AG. The potential market for ARV drugs is enormous in Africa, Asia, etc.

    Actually, using disparaging terms like “Big Drug”, etc. shows you clearly have an ideology, if only “small is beautiful”.

    The market in Africa and Asia is not that enormous, money-wise, given the poverty of the AIDS sufferers (and the countries in which they live) in those parts of the world. Don’t forget that countries like India reserve the right to ignore patents on lifesaving drugs, and allow local companies to manufacture them cheaply ( http://www.forbes.com/sites/johnlamattina/2013/04/08/indias-solution-to-drug-costs-ignore-patents-and-control-prices-except-for-home-grown-drugs/ ).

    There is plenty evidence for HIV being the cause of AIDS, and for HAART being successful, but you choose to ignore it because you don’t like it. Maybe because you bought into the propaganda of gay rights groups who maintain there is never enough money going into AIDS research, maybe because you have something against large corporations, or whatever. You use the lack of evidence for your position to justify it, like all conspiracy theory believers.

    That’s not what I would call “a desire to understand”.

  119. grabulaon 21 Mar 2014 at 5:35 am

    @hardnose

    ” (thinking of Big Drug especially)”

    You mean Big Pharma…that’s how our checks are signed here on Neurologica Commentators Inc anyway.

  120. grabulaon 21 Mar 2014 at 5:48 am

    @Hardnose

    “I don’t have an ideology.”…

    “I think it’s because I don’t have an agenda about AIDS that I can see it a little more objectively. I am not an AIDS researcher, so my ego and income isn’t tied up with it.

    I guess I do have an agenda about the veneration of Big Science, which is increasingly funded by Big Drug and Big AG. The potential market for ARV drugs is enormous in Africa, Asia, etc.

    I think most AIDS researchers and ARV manufacturers have somewhat good intentions, at least consciously.

    But there is a real temptation to over-simplify AIDS and to believe the answer is around the corner. We have seen that happen with many types of cancer, for example.

    Very often, in the history of science, things start to look more complicated the longer they are studied”

    You’ve literally tripped all the red flags that indicate not only that you have an agenda, but what tha agenda is:

    1 – Referring to anything as BIG … is a huge sign you’re on the fringe and that you’ve already painted yourself into a corner you can’t get out of.
    2 – Claim to understand science better than scientists
    3 – Conspiracy mongering
    4 – Refusal to engage in actual conversation. You can’t just continue to spit out the same garbage, fail to back it up with any evidence and then throw in everyone’s face they don’t know what they’re talking about when they DO provide all the evidence in the world (see #3 for your denial channels)

    Ultimately hardnose, you’re not here to discuss anything. After being provided with countless examples of scientific evidence that has formed the consensus over time. After having several very intelligent, very cogent individuals very directly explain how you’re thinking is off the mark. After having all of this stuff given to you, you’re only real response is ‘you can’t trust BIG Science’.

    There’s no substance to your argument. I’m guessing you have a circle of friends who are easily impressed by a very little evidence. That convinced you you must be right and so you traveled here, met resistance to your ignorance (do I need to explain why that isn’t ad hominem again?) you’ve painted yourself into a corner you cannot allow yourself to get out of.

  121. hardnoseon 21 Mar 2014 at 9:04 am

    I was shown “evidence” from correlations, simulation models and clinical anecdotes. I was never shown how over-diagnosis and lead-time bias were ruled out.

  122. hardnoseon 21 Mar 2014 at 9:06 am

    “The market in Africa and Asia is not that enormous, money-wise, given the poverty of the AIDS sufferers (and the countries in which they live)”

    AFAIK, a lot of the money to provide AIDS drugs in Africa is taken from American taxpayers by our loving government.

  123. Steven Novellaon 21 Mar 2014 at 10:04 am

    Hardnose – you are not fairly characterizing the evidence that exists, or the evidence you have been show. But here is one more:

    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081355

    Lead time bias is controlled by doing a prospective study using the same methods over time. Also, this is comparing 2000-2002 with 2006-2007. This is long after HIV was well established and known. You would be hard pressed to argue for a dramatic increase in lead time between these time intervals.

    The study shows increased life expectancy among those taking HAART. It also shows that starting early has an advantage over starting after the CD4 count has already dropped < 350.

  124. hardnoseon 21 Mar 2014 at 11:46 pm

    That article is a good example of some of the things I have been criticizing. For example:

    The patients are HIV positive, but we are not told if they have any AIDS symptoms. We are told the death rates, but nothing about the causes of death.

    We are supposed to assume the later group had a lower death rate because the effectiveness of HAART increased. But the same result might have occurred if HAART became less toxic, even if it did not become more effective. We just can’t tell from this article.

    We are supposed to assume there were no important differences between the 2 groups, aside from which year they started treatment. But HIV testing may have increased over time, possibly resulting in a larger number of relatively healthy HIV patients. That alone could cause the death rate to be lower in the later group.

    They estimate patients’ life expectancy based on mortality rates during only the first year of treatment. There is no way to know if this estimate is reasonable or realistic. Toxic effects of HAART are more likely to show up after many years of treatment. They actually acknowledge this problem, but don’t seem to think it’s important.

    The evidence from this study is very weak and contains some obvious confounds. The writing seems designed to confuse and to obscure the weaknesses. I got the impression the only reason it was published was because it supposedly supports HAART.

    A lot is said about gender and race — which don’t seem all that important in this context. But things we really should care about — like whether HAART actually made patients healthier — are not mentioned at all. The study only measured HIV and CD4 levels.

    We are expected to infer that lowering HIV and raising CD4 means improved health and longer life. But nothing in this research — or any other I have seen — demonstrates that. Maybe better health correlates with lower HIV and higher CD4 in certain types of patients. But I have not seen anything demonstrating that lowering HIV and raising CD4 with ARVs improves health in the long run. There is certainly nothing in this article showing that.

    They conclude that HIV patients now have an almost normal life expectancy, if they are on HAART. You would have to make a lot of unscientific inferences to get from their evidence to that conclusion.

    If this is one of the most convincing examples you have found, then I am less convinced than ever.

  125. Hosson 22 Mar 2014 at 12:49 am

    Hardnose
    It’s difficult for me to interput medical studies. Unfortunately, due to my ignorance, I have to rely upon experts for understanding(I’m not sure that the right way to say it). I find the evidence belongs firmly with the link of causality between HIV and AIDS. I noticed experts claiming otherwise have to deny evidence and ignore counter-arguments to maintain their position, just like you. Let the fallacies your making be an indicator of you’re biases. With the best of intentions, I hope you’re able to change your mind about this.

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