HIV Gap in National AIDS Statistics
Vol. 11, pp. 955-956, August 1993
Peter H. Duesberg
hypothesis rests on the assertion that all AIDS cases are associated
with HIV (Confronting AIDS-Update 1988, Natl. Acad.
Sci. Press, Wash., D.C.; Blattner, W., et al., 1988, Science
241, 514-515; Weiss, R. and Jaffe, H., 1990, Nature 345,
659-660; Duesberg, P.H., 1992, Pharmacol. Ther. 55, 201-277).
Therefore, the Centers for Disease Control (CDC) groups American
AIDS cases in its HIV/AIDS Surveillance into "exposure
(to HIV) categories." However, there are no national AIDS statistics
that document the natural coincidence between AIDS diseases and
HIV. Contrary to its title, the HIV/AIDS Surveillance of
the CDC does not report HIV tests. Correlations between HIV and
AIDS can only be determined from individual studies and from those
CDC AIDS case report forms that include HIV tests.
But most "HIV
tests" measure antibodies against HIV rather than the virus
itself. And antibodies are not unambiguous evidence for the presence
of a virus, nor are they rational predictors for viral disease.
Instead antibodies neutralize HIV and restrict the virus to latency.
This is the reason that leading AIDS researchers have had notorious
difficulties in isolating HIV, even in people dying from AIDS (Weiss,
R., 1991, Nature 349, 374; Cohen, J., 1993, Science
antibody tests generate false-positive results if an epitope is
shared between different organisms. According to a recent review
entitled "HIV testing: State of the Art," "depending
on the population tested, 20 to 70% of ... two successive positive
ELISAs (enzyme-linked immunosorbent assay) are confirmed by Western
blot (an alternative antibody assay)." (Sloand, E.M., et
al., 1991, JAMA 266, 2861-2866).
In a population
with a low probability of infection, the false-positive rate is
high. According to the widely cited study of applicants to the U.S.
Army by Burke et al., 83% of all initially positive ELISAs
(10,000/12,000) were false-positives (New Eng. J. Med. 319,
In a population
with a high incidence of infection, however, the false-positive
rate is expected to be low. Therefore the CDC assumes that "the
tiny proportion of possibly false-positive screening tests in persons
with AIDS-indicative diseases is of little consequence" (Confronting
AIDS-Update 1988). But this is not observed.
one study documented 131 repeatedly ELISA-positive homosexual men
with negative Western blots in a cohort of 4,994 homosexuals of
which 37% were HIV-positive (Phair, J., et al., 1992, J.
AIDS 5, 988-992). Another study "found HIV-1 infection
in only 4 (12.5%) of 32 high-risk cases" with repeatedly positive
ELISAs (Celum, C.L., et al., 1991, J. Infect. Dis.
164, 656-664). HIV infection was negative by Western blot, provirus
amplification with the polymerase chain reaction (PCR), and virus
isolation tests. Another study identified 33 ELISA-positive and
even Western blot-positive subjects who were HIV-negative based
on the PCR test for HIV DNA (Schechter, M., et al., 1991,
AIDS 5, 373-379). These subjects were from a group of 316
homosexuals of which 158 (50%) were PCR-positive.
high incidence of false-positive HIV antibody tests in these HIV
risk groups probably reflects the presence of antibodies to other
viruses and microbes that may cross-react with HIV. For example,
7 out of 10 blood donors treated with an influenza virus vaccine
in 1991 became HIV ELISA-positive. Each of these proved to be false-positives
upon confirmation with a Western blot (Mac Kenzie, W.R., et al.,
1992, JAMA 268, 1015-1017). Since the CDC " ...
accepts a reactive screening test for HIV antibody without confirmation
by a supplemental test ..." (Confronting AIDS-Update 1988)
and does not request a repeatedly positive antibody test in its
"AIDS adult confidential case report" forms, it includes
false-positives in its HIV/AIDS Surveillance.
In fact, the
CDC even includes AIDS cases in its HIV/AIDS Surveillance
"without laboratory evidence regarding HIV infection"
(Confronting AIDS-Update 1988). Upon request, the CDC's director
of the HIV/AIDS division, Harold Jaffe, stated that the HIV status
of 43,606 out of the 253,448 American AIDS cases recorded by the
end of 1992 was "not tested" (per. com., 1993). However
this figure seems to be an understatement. Obviously, all 10,360
American AIDS cases diagnosed before the HIV antibody test, i.e.,
before 1985, were not tested (HIV/AIDS Surveillance, February
1993). In addition, the CDC published that "Approximately one
third of AIDS patients in the United States have been from New York
and San Francisco, where, since 1985, <7 % have been reported
with HIV-antibody test results, compared with >60 % in other
areas." (Confronting AIDS-Update 1988). Thus, between
1985 and 1987, 58% (93% x 1/3 + 40% x 2/3) of the 56,807 AIDS cases
recorded in that period, or 32,948, have not been tested. For 1988,
the CDC reported that 27% or 9,039 of the 33,480 AIDS cases recorded
for that year were not tested for HIV (Selik, R. M., et al.,
1990, J. AIDS 3, 73-82). According to the CDC's Technical
Information Activity, 3682 AIDS cases without an HIV-test were recorded
in 1989, 2888 in 1990, 1960 in 1991, and 1395 in 1992 (per. com.,
1993). Thus, at least 62,272, or 18,666 more than Jaffe reports,
were not tested.
of the HIV-AIDS correlation is further obscured because HIV-free
AIDS cases are not recorded in the CDC's HIV/AIDS Surveillance.
By 1993, at least 4621 HIV-free AIDS cases had been documented in
the U.S., Europe, and Africa with the clinical AIDS definition (Table
1). Even Jaffe, again upon request, reported 89 HIV-free AIDS cases
(per. com., 1993). The cases recorded in Table 1 suffered from one
or more of the over 25 heterogeneous AIDS-defining diseases and
from AIDS-defining immunodeficiencies without diseases. Some of
these proved to be HIV-free even by PCR amplification of viral RNA
Table 1 includes
some American and European immunodeficiencies that may not exactly
fit the current definition of AIDS-defining immmunodeficiency without
disease, which is <200 T-cells per microliter (CDC, 1992, MMWR
41, RR 17, 1-19), as for example, HIV-free male homosexuals on various
recreational drugs with "<600 T-cells per cubic millimeter"
(Table 1, ref. 14) or HIV-negative hemophiliacs with T4/T8 cell
ratios of about 1 or <1 (Table 1, refs. 46-61). But even if not
all of these cases fit the current definition of AIDS-defining immunodeficiency
exactly, they do so prospectively. This is because their T-cells
typically continue to decline either because of risk behavior, such
as the consumption of recreational drugs, or because of clinical
AIDS risks, such as chronic transfusion of foreign proteins as prophylaxis
against hemophilia (Duesberg, P.H. 1992, op, cit.).
Since a clinical
definition is used in Africa, statistics from this continent are
not biased against HIV-free AIDS. For example, 2215 out of 4383
(50.5%) African AIDS patients from Abidjan, Ivory Coast, Lusaka,
Zambia, and Kinshasa, Zaire, were HIV-antibody negative (Table 1,
ref. 70, 71). Another study using antibody tests and supplementary
PCR tests for HIV reports 135 (59%) HIV-free AIDS patients from
Ghana out of 227 suffering from weight loss, diarrhea, chronic fever,
tuberculosis, and neurological diseases (Table 1, ref. 72). Only
37 (30%) of a group of 122 African tuberculosis patients were HIV-positive,
according to a study published in 1993 (Table 1, ref. 73). An earlier
study documents 116 HIV-negatives among 424 African patients, and
Montagnier et al., diagnosed HIV in four out of eight (Table
1, ref. 26, 69). It follows that about 50% of the African AIDS cases,
or 65,000 of the 129,000 diagnosed by 1992 (Duesberg, P.H, 1992,
op. cit.), maybe HIV-free and thus not caused by HIV.
considering the potential usefulness of HIV-free AIDS cases in the
search for the cause of AIDS, the CDC and the NIH's director for
AIDS research hid in 1992 the then rapidly growing numbers of HIV-free
AIDS cases (Duesberg, P.H., 1992, op. cit.) under a new name, "idiopathic
CD4 lymphocytopenia" or ICL. Indeed, the new name has sent
HIV-free AIDS cases into obscurity. But efforts to set apart HIV-free
from HIV-positive AIDS cases by the new term are not based on clinical
or scientific arguments. According to an editorial by Anthony Fauci,
HIV-free AIDS or ICL cases are unlike the HIV-positive cases because
(1) "Given the heterogeneity of the [ICL] syndrome, it is highly
likely that there is no common cause," and because (2) "Approximately
one-third of the patients are women, as compared with 11% among
those with HIV ... [in America]" (Fauci, A., 1993, New Eng.
J. Med. 328, 429-431). Yet proponents of the HIV hypothesis,
including Fauci, insist that HIV is the common cause of the more
than 25 heterogeneous AIDS diseases and that HIV causes African
AIDS, although about 50% of the African patients are women (Duesberg,
P.H., 1992, op. cit.).
In view of
the above, I submit that the natural coincidence between HIV and
AIDS in America and Europe remains unknown, and is certainly less
than perfect. Thus arguments for the etiological role of HIV in
AIDS, which assume a perfect correlation, are fundamentally flawed.