Bauer’s basic factual howlers I: “Very many HIV positive people spontaneously revert to HIV negative”

IT CAN BE DIFFICULT for a newcomer to get a grasp of the fundamentals of Henry Bauer’s evolving and eccentric belief system surrounding HIV and AIDS. In a nutshell, he claims that his study of the results of HIV testing in various groups at various times and places in the United States shows these are incompatible with HIV being an infectious entity, let alone a sexually transmissible one, and that at the group level the rate of HIV diagnoses bears no relationship to the subsequent development of AIDS. This is, of course, arrant nonsense, but before exploring the fallacies in his analysis here, it’s important to recognise his erroneous assumptions about what an HIV positive diagnosis actually is.

A good introduction to Henry’s thinking is a seminar he delivered in September 2007 at the Virginia School of Osteopathic Medicine. History doesn’t record the reactions of the audience (at least as far as I could determine), but Bauer has thoughtfully posted lecture notes on his website.

This paper is full of bizarre gems, but notably, Bauer claims to his presumably medically literate audience:

“Many HIV-positive people remain positive; but very many HIV-positive people spontaneously revert to HIV-negative: drug addicts who kick the habit, and, most important, I think--among HIV-positive newborn children, about 90% typically become HIV-negative within a few years, about 75% in the first year.
So: HIV-positive marks exposure and reaction to a NON-SPECIFIC challenge to health.”

This extraordinary belief in widespread spontaneous seroreversion following an HIV diagnosis is so fundamentally wrong that it deserves a more thorough parsing, even leaving out the strange non-sequitur at the end (that an antibody response’s alleged transience indicates that it is “non-specific”).



ANECDOTAL STORIES of claimed or hoped for “seroreversion” (returning a negative HIV antibody test after a confirmed HIV diagnosis) are a mainstay of internet discussions among AIDS denialists, but in almost all cases they are a result of wishful thinking or a failure to understand the diagnostic testing process.

Sometimes a viral load result below the limits of detection is misunderstood as “HIV negative” although this is not uncommon during the period of clinically latent infection, even without antiretroviral treatment. Sometimes people mistake a single unconfirmed reactive preliminary screening test for a positive diagnosis. An increasing problem is the availability of fake tests or unapproved tests of dubious reliability illegally and unscrupulously marketed on the internet for self diagnosis at home.

In his 2005 “review” article in the Journal for Scientific Exploration, Bauer writes:

There have been many anecdotal reports of individuals reverting to HIV negative even after confirmed HIV positive tests [41; pp 425-426 in 42; pp 50-55 in 43]
“Demographic Characteristics of HIV: How Did HIV Spread” p 576

Actually, there haven't.

Reference 41 is Christine Maggiore’s notorious What if Everything You Thought You Knew About AIDS Was Wrong, and 42 is Duesberg’s Inventing the AIDS virus, both highly questionable sources for a “review” article with pretensions to scientific credibility. Worse, as he later admits, Maggiore and Duesberg provide testimonials not of people seroreverting but remaining clinically well for a period after diagnosis - many of whom have since become ill and died after the publication of Duesberg’s and Maggiore’s books, as has Maggiore herself. Mistaking the period of clinical (not virological) latency for seroreversion is a howler so basic it should raise serious concerns about the competence of the author.

Reference 43 is Root-Bernstein’s 1993 book Rethinking AIDS – The Tragic Cost of Premature Consensus. Root-Bernstein cites a number of intriguing cases reported by Tenenbaum in 1993 where a brief partial seroreactivity occurred in five haemophiliacs exposed to contaminated factor VIII but who never had a confirmed HIV positive diagnosis, together with a number of cases of exposure to infected blood products that did not result in any seroreactivity at all. In other words there was no confirmed diagnosis of HIV positive status to revert from.

A more comprehensive investigation of purported seroreversions among 5.5 million tests including 4911 positives concludes that:

Review of this database demonstrates no evidence for true seroreversion of
HIV-1 antibody status. We conclude that if seroreversion occurs at all, it is
exceedingly rare. In fact, most (if not all) cases of apparent seroreversion
represent errors of attribution or testing.

- Roy et al 1993: Absence of true seroreversion of HIV-1 antibody in
seroreactive individuals

BAUER EITHER DOES not grasp the significance of HIV antibodies in neonates, or he is being deliberately misleading when he writes of “HIV positive” neonates who subsequently test “HIV negative”.

Antibodies can come to be present in an individual in a number of ways: they can be a product of the individual’s own adaptive immune system in response to an infection or other source of antigen or alternatively they may be transferred from another individual: this is called passive immunity. Examples of the latter include specific immunoglobulins (such as those against hepatitis B or tetanus toxin derived from human blood donations) administered to prevent or treat various infections, and antibodies naturally transferred across the placenta from mother to fetus, or in some cases through breast feeding.

So babies born to HIV infected mothers will frequently have HIV antibodies whether they are themselves infected or not. Antibody tests cannot distinguish between antibodies produced by the baby’s own adaptive immune system, and thus indicative of active infection, and those passively acquired from the mother and indicative only of the mother’s infection. Generally, passively acquired HIV antibody levels decay to undetectable levels by around 6 to 12 months of age, but can take as long as 18 months or more. During that time other alternative tests (mainly nucleic acid tests) are used to diagnose “HIV positive” status in infants, not antibody tests.

Bauer has tried to claim (citing the so-called “Perth Group”) that there is a hard and fast rule in paediatric immunology that all passively acquired antibody will become undetectable by 9 months, and that any antibody found after that time cannot be of maternal origin. Thus, if antibody is present at 9 months and becomes undetectable at 18, he says, this represents “true seroreversion” of antibodies produced by the baby's adaptive immune system rather than the decay of passively acquired maternal IgG (or “1”gG as Bauer insists on calling it, demonstrating his level of familiarity with elementary immunology). This supposed “rule” is nonsense. The point at which passively acquired antibody becomes undetectable depends on the initial titre, the rate of decay, and most importantly, the sensitivity of the the particular assay for very low levels of antibody.

THERE ARE AT MOST a handful of individual case reports of apparent seroreversion following a confirmed diagnosis of HIV infection in the entire medical literature, and while some are intriguing, most are somewhat doubtful. Bauer’s insistence – in print and on his blog - that seroreversion is common speaks volumes about his capacity for reading and understanding scientific evidence. More importantly, Bauer’s misapprehension that the development of a diagnostically valid set of HIV antibodies is often temporary is critical to his misreading of patterns of test results in populations: indeed, his "analysis" falls apart almost immediately without this key misconception.

More on this in following posts.