"
And going to the university and the University of Florence in particular, it came out that Professor Ruggiero – that’s myself – was in absolute terms the Best Professor in the Entire University... and not only in biology and medicine but overall, concerning all the professors of the entire university" - Dr Marco Ruggiero, Professor of Molecular Biology at the University of Florence.

"Derrida's method consisted in demonstrating the forms and varieties of this originary complexity, and their multiple consequences in many fields. He achieved this by conducting thorough, careful, sensitive, and yet transformational readings of philosophical and literary texts, to determine what aspects of those texts run counter to their apparent systematicity (structural unity) or intended sense (authorial genesis)."
- Wikipedia: Jaques Derrida (and also copy-pasted to 2,520 other websites)

"I have long ago given up looking at anything from Snout... He has no credentials at all to discuss the things he talks about, yet feels free to denigrate a long-established, peer-reviewed Italian journal, and highly competent, even distinguished scientists and scholars. If anyone prefers to take his opinion rather than mine, I think that shows rather poor judgement in view of the curriculum vitae posted on my website and the anonymity and missing C.V. of Snout…"

- Henry H. Bauer. Professor Emeritus of Chemistry, Science Studies and Dean Emeritus of Arts and Sciences, Virginia Polytechnic Institute and State University.

Thursday, January 22, 2009

Bauer’s basic factual howlers II: “Very few HIV positive people ever become ill”

ANYONE HOPING to follow the strange thought processes of Henry Bauer around HIV and AIDS will soon observe that his thesis rests on a number of profoundly wrong fundamental premises. In the last post we examined his conviction that “very many HIV-positive people spontaneously revert to HIV-negative” which has remained entirely unshaken by being totally contrary to evidence, and which is central to his fallacy-ridden ruminations about the significance of patterns of HIV test results.

Another of his odd beliefs is that:

It has become increasingly clear over the years that only a very few HIV positive people ever become ill [77].
-
“Demographic Characteristics of HIV:II. What Determines the Frequency of Positive HIV Tests?” page 82
This statement summarises Bauer’s basic misapprehension of the natural history of HIV infection, or as he would put it the natural history of the "HIV positive" state. The natural history of a disease or condition is what happens between initial exposure to the causative agent until either death or resolution of the condition occur, without interruption by treatment. Understanding the natural history of a disease is absolutely foundational to making sense of its epidemiology. But Bauer’s grasp of the natural history of HIV is a completely false, as even a cursory examination of US epidemiological surveillance reports reveals.

By 2006, of the approximately 1.6 million Americans infected with HIV since the beginning of the epidemic (including those diagnosed with AIDS prior to the availability of diagnostic testing)
566,000 had died and 449,000 were then living with AIDS.

More than one million out of 1.6 million is not “only a very few”. Of the remaining 600,000 there are undoubtedly some who have maintained good general health without treatment for two decades or more, but the majority have been infected too recently for AIDS to have developed given the median latency between infection and AIDS of a decade or so, or else are maintaining their immune health using antiretrovirals.




WHEN THE FIRST HIV tests became widely available in the West in the mid 1980s, it became possible to begin to answer two very important questions about HIV’s natural history: what proportion of people infected with HIV will go on to get AIDS, and over what time period? By the late 1980s it was possible to provide some basic answers: about half of young adults with untreated HIV infection develop AIDS within about a decade of seroconversion.

The natural history of AIDS untreated by antiretroviral therapy was well known before that: annual mortality was 62-70% following a diagnosis of AIDS between 1982 and 1986, and few survived more than two years, with the exception of a small number whose AIDS defining condition was the more indolent forms of Kaposi’s sarcoma that can appear in relatively immunocompetent individuals.

There are various ways of modeling the period between seroconversion and AIDS, but the most reliable is to take a cohort whose time of seroconversion is known and follow them year by year to see what proportion have developed AIDS within what particular timeframe. It was possible to produce 10 year data within a few years of the development of the HIV antibody tests, because there existed banks of stored blood samples from studies of various populations going back many years: it was possible to restrospectively identify seroconversions that occurred 5 to 7 years before the tests were developed. One of the best known of such studies examined blood samples from gay men recruited to a
study in San Francisco between 1978 and 1980. Other similar natural history studies have followed cohorts with a variety of risk factors for HIV infection and in a variety of countries.
From 1987 on there was increasing use of the antiretroviral zidovudine (AZT) initially to treat AIDS and then in subsequent years to try to delay the progression to AIDS – recall that “natural history of a disease” means the course uninterrupted by treatment. 1987 saw an appreciable drop in annual risk of mortality from HIV/AIDS and an increase in survival with AIDS. The introduction of AZT monotherapy was not the only reason for this, and even its most ardent defenders acknowledge that monotherapy in itself had only a modest survival benefit: also of importance were earlier diagnosis and better prophylaxis and treatment of opportunistic disease.

However the claims by Duesberg, Bauer and other denialists that AZT monotherapy was both a major cause of AIDS and hastened death in people with AIDS is contrary to the basic facts: the roughly ten year median AIDS-free survival was established
prior to the introduction of AZT, AIDS mortality was substantially higher before than after 1987, and in the early years at least, AZT was mostly reserved for people already diagnosed with AIDS or ARC.



THE TEN YEAR MEDIAN AIDS-free survival period following infection and serconversion and without antiretroviral treatment is of course a ballpark figure, and varies from population to population. Untreated perinatally infected infants typically progress much faster, as do older adults. The natural history also varies somewhat from study to study and country to country: for example the median latency from seroconversion to AIDS has often been found to be shorter in Thailand than in other countries, for as yet unknown reasons, but perhaps related to the prevalence of different subtypes in different parts of the world.

A “median” latency of ten years does not mean that everyone develops AIDS at ten years, or even that ten years is necessarily the
average “latent” period between infection and the development of AIDS. What it means is that half of infected people will have developed AIDS by ten years, and half won’t have. The half that don’t may develop AIDS after 10 to 15 years, or between 15 and 20 years after infection, or later, or possibly never. Over time, the proportion of HIV infected people who progress to AIDS continues to increase. By fifteen years it is of the order of 75 to 80%.
Even after many years there is a small group of people with HIV (perhaps a few per cent) who show little sign of progressing toward AIDS, either clinically or on measurements of immune function. The reasons for long term non progression have not been fully established, but in some cases there is defective virus , or fortuitous mutations in the cell receptors that inhibit HIV binding and entry, or unusually potent cell mediated and humoral immune responses. What is known about the small proportion of long term non-progressors confirms rather than refutes the role of HIV in the development of AIDS.

BAUER’S SOLITARY REFERENCE supporting his claim that “very few [untreated] HIV positive people ever become ill [77]” is not an epidemiological study: it is Christine Maggiore’s “What if everything you thought you knew about AIDS was wrong”. It is grossly and patently incorrect.

Further reading: It's about ten years old now, but the HIV Insite page on the Epidemiology of Disease Progression in HIV is detailed and well referenced.


9 comments:

Anonymous said...

Hey Snout. I am not quite following you here.

You said: "the roughly ten year median AIDS-free survival was established prior to the introduction of AZT,"

How could a "ten year median aids free survival" have possibly been determined prior to 1987, when the first primitive hiv tests that could even supposedly detect HIV infection, that used only 2 bands by the way, instead of the 5 bands used today, had only been released to the public two years before in 1985? And the original hiv test was only used for testing the blood donation supply for quite some time, and was not even in general use to diagnose anyone as hiv positive until 1987.

Then you said: "aids mortality was substantially higher before azt than after".

This is a completely false claim, and here is the proof: In 1986, although many were experimenting with various drug treatments, there were only 12,000 deaths, including AZT by the way. AZT came out for general public use in 1987. By 1989, two years after AZT's introduction, there were 28,000 deaths in that year alone.

So two years after AZT, there were more deaths in one year than in all the years prior to AZT combined.

The highest numbers of deaths, as well as the highest yearly percentages of cases/mortality, as well as the greatest number of deaths were immediately following the introduction of AZT.

And you said "1987 saw an appreciable drop in annual risk of mortality from HIV/AIDS and an increase in survival with AIDS."

Oh really, Snout? 1987 saw an increase of more than 4000 deaths over the year before. And the annual risk of mortality INCREASED over the next 3 years to even higher levels than pre-azt:

http://www.avert.org/usastaty.htm

1981 with 339 cases/130 deaths: approximately 38% mortality.

Followed by 1982 with 1200 cases and 449 deaths (37% mortality)

1983 with 3153 cases/1511 deaths (48% mortality)

1984 with 6368 cases/3526 deaths (55% mortality)

1985 with 12,044 cases/6996 deaths (58% mortality)

1986 with 19,404/12,183 deaths (63% mortality)

1987 29,105 cases/16,488 deaths (56% mortality)

AZT INTRODUCED LATE 1987;

1988 with 36,126 cases/21,244 deaths (58% mortality)

1989 with 43,499 cases/28,054 deaths (64% mortality)

1990 with 49,546/31,836 deaths (64% mortality)

1991 with 60,573/37,106 deaths (61% mortality)

1992 with 79,657/41,849 deaths (52% mortality)

1993 with 79,879 cases/45,733 deaths (57% mortality

Can't you get anything right Snout?

Anonymous said...

You said: "the epidemic (including those diagnosed with AIDS prior to the availability of diagnostic testing) 566,000 had died" (out of 1.6 million)

But more than 362,455 during AZT monotherapy alone.

Leaving 203,500 that died during other years, both pre-azt and post azt. Lets tally up those years!

There were 24,000 deaths prior to AZT and a whopping 176,000 that died AFTER the "life saving" and "life extending" drugs were introduced.

Are you bright enough to do the math here Snout? This means that 542,000 of your 566,000 deaths came during your "life saving" and "life extending" drug years!

How lovely!

Anonymous said...

One more time, Snout, just so we can be sure it sinks in:

542,000 of the 566,000 so called "AIDS" deaths came occurred during the exact years of the so called "life extending" drugs being given to those who test as hiv positive.

542,000

I realize you are a bit slow, even for a gay man, so I will spell it out for you:

FIVE HUNDRED AND FORTY TWO THOUSAND DEATHS OCCURRED IN THOSE WHO TOOK THE AIDS DRUGS.

Anonymous said...

One more time, Snout, just so we can be sure it sinks in:

542,000 of the 566,000 so called "AIDS" deaths came occurred during the exact years of the so called "life extending" drugs being given to those who test as hiv positive.

542,000

I realize you are a bit slow, even for a gay man, so I will spell it out for you:

FIVE HUNDRED AND FORTY TWO THOUSAND DEATHS OCCURRED IN THOSE WHO TOOK THE AIDS DRUGS.

Anonymous said...

One more time, Snout, just so we can be sure it sinks in:

542,000 of the 566,000 so called "AIDS" deaths came occurred during the exact years of the so called "life extending" drugs being given to those who test as hiv positive.

542,000

I realize you are a bit slow, even for a gay man, so I will spell it out for you:

FIVE HUNDRED AND FORTY TWO THOUSAND DEATHS OCCURRED IN THOSE WHO TOOK THE AIDS DRUGS.

Anonymous said...

Snout, the CDC currently estimates 1 million hiv positives in the US, of which you also said: "449,000 were then living with AIDS".

The CDC also currently estimates that fully 50% of American HIV positives DO NOT TAKE ANY AIDS DRUGS.

That would mean that your 449,000 actual "AIDS" cases, are the ones who DO take the AIDS drugs and are also the ones that also have "AIDS" defining illnesses, while the remaining 50,000 that also take the aids drugs have not yet progressed to AIDS.

But that still leaves the remaining 500,000 that also DO NOT TAKE THE AIDS DRUGS, and, those are the ones who are remaining primarily symptom free, while it is primarily those who take the drugs that also are the ones who progress to aids.

That's right Snout, the 500,000 hiv positives who are symptom free, are also the very ones who do not take the drugs, and are also the ones who are and always have been the LONG TERM NON PROGRESSORS.

Snout said...

Anonymous,

Please note that as I have made clear elsewhere this is not a site for AIDS denialists to make multiple posts spamming the same old logical fallacies and rhetorical nonsense.

My post explains clearly how median latency was estimated within a few years of the development of HIV testing.

The worth or otherwise of AZT monotherapy cannot be evaluated simply by looking at raw numbers of deaths over different periods without considering the total prevalence of AIDS (which was increasing rapidly) and more specifically the outcomes in treated versus untreated individuals at comparable levels of disease.

Mortality in a given year is not a function of incident diagnoses in that year but of prevalent disease.

The numbers of long term non progressors cannot be calculated by the proportion of HIV+ people using antiretroviral therapy or not. Untreated HIV+s include hundreds of thousands who acquired their infection in the last ten years, as well as those progressing more slowly than the median, and also those who have progressed significantly but have yet to be diagnosed because they have not yet presented with opportunistic disease (25% of HIV diagnoses are made on presentation with AIDS defining illnesses)


All of these have been explained to you people repeatedly. If you cannot grasp this, then please go waste your time elsewhere, because I have better things to do with my time than waste it playing whack-a-mole with the same old denialist canards.

Genuinely informed comments and corrections are welcome on this site. Denialist rubbish that has been repeatedly answered elsewhere will be moderated. If you want to debate denialist talking points, then open your own websites to comments from the Reality Based Community

jtdeshong said...

Snout,
You must have the patience of a saint. I went to the link you provided regarding Bauers "lecture notes" and I just could not get past the obvious initial craziness. He wrote the following statement that lead him to initially research the "scientific fallicies of AIDS": "A couple of years ago I read a statement about HIV that just could not be true."
OK, if it is so egregious and blatantly wrong that it set him on this major quest, why not share it with us? Then he is so arrogant to think that HE is the ONLY one to discover the truth. Then he goes on to say that many voices are not being listened to because they dissent from accepted science.
Geez, how can you read his utter shit and not vomit all over your keyboard?
As for Aonymous. Don't even bother. He/She is obviously retarded and possibly a serial killer. He/She is transparent in their complete lack of understanding on this subject and is tilting at windmills.
J. Todd DeShong

Snout said...

Hi Todd.

The “statement about HIV that just could not be true” that Bauer regularly refers to as setting him off on his Quixotic journey into AIDS denialism was about the per capita rates of HIV diagnoses among male and female teenage military applicants between 1985 and 1989, which turned out to be more or less equal.

This is an entirely unsurprising finding once you grasp the basic epidemiology of HIV in that population, but it remains an enduring mystery to Henry to this day, and has convinced him (somehow) that HIV cannot be the cause of AIDS.

See my new post, The Origin of Bauer’s Persistently Failing HIV/AIDS Theory -The Argument from Incredulity for more on this, and thanks for the idea.