New findings defy AIDS research fundamentals

Medical establishment resisting AIDS discoverer's latest studies

By COLMAN JONES

The controversial debate over what causes AIDS has taken on a new significance now that the original discoverer of human immuno-deficiency virus (HIV) admits that HIV alone can't explain the destruction of the immune system associated with AIDS.

"At first, we thought we had the best candidate, for this virus to be the cause of AIDS," said Luc Montagnier of the Pasteur Institute in Paris on a recent British TV program. But, he continued, "I would agree that HIV by itself, or some strains of HIV, are not sufficient to induce AIDS."

Montagnier's change of heart came after some test-tube experiments he conducted earlier this year. He showed that when the antibiotic tetracycline was added to a culture of HIV-infected T-cells (a key component of the immune system that is depleted in AIDS), HIV no longer killed those cells. He speculated that another organism was likely killing the T-cells.

The significance of this finding, which Montagnier announced at the international AIDS conference in San Francisco last summer, has gone largely unnoticed by the AIDS medical establishment in North America, led by doctor Robert Gallo of the National Cancer Institute. But this development threatens to undermine the fundamental direction of research, which assumes that there is a single agent, HIV, that causes AIDS.

"This is a major step backwards for the HIV proponents," says Michigan State University biologist Robert Scott Root-Bernstein.

Syphilis absent

Root-Bernstein's work, suggesting the involvement of multiple infections and other risk factors in causing AIDS, has been published in the Pasteur Institute's journal, Research In Immunology. Root-Bernstein sees Montagnier's changing stance as a turning point in the scientific model for AIDS. "This suggests that an HIV infection, by itself, does not doom one to developing AIDS."

Relatively little AIDS research is conducted in Canada compared to the U.S. But officials at the provincial health ministry's blood-testing branch have been unexpectedly confronted with this debate.

They've discovered some unusual abnormalities in the blood of people with AIDS previously exposed to syphilis. A curious disappearance of syphilis antibodies, usually maintained for life, has been noted, and the finding has been confirmed by a leading Toronto immunologist. As well, end-stage syphilis is strangely absent in the population of AIDS patients, despite the presence of almost every other sexually-transmitted disease.

Leading syphilis experts around the world privately admit there may well be a relationship between syphilis and AIDS, but there has been no pressure from AIDS researchers and activists to fund further research in this area.

As an indication of the tension surrounding this issue, doctor Bob Notenboom, who is the chief blood tester for the province and who first discovered these irregularities, was willing to be interviewed about his work, but the interview was inexplicably cancelled at the last minute.

Notenboom has analyzed blood samples taken from people tested for sexually transmitted diseases at Toronto's Hassle Free Clinic since 1981.

Health ministry media relations officer Maurice Jones would only say "the received, standard position, as taken by the ministry, is that AIDS is caused by HIV. We're aware of correlative evidence with syphilis, but none that persuades us that syphilis on its own causes AIDS."

Doubts about the role of HIV in AIDS have persisted for years. The most outspoken critic of the HIV hypothesis has been Peter Duesberg, a 20-year veteran in the field of retrovirology (the study of a special family of viruses, retroviruses, of which HIV is a member). Duesberg worked alongside Gallo in the Nixon administration's virus-cancer program in the 1970s.

In 1987, Duesberg started directly questioning the HIV theory, insisting the virus could not possibly cause AIDS, in papers published in the respected journals Cancer Research and the Proceedings of the National Academy of Sciences.

To this day, Duesberg's challenge has yet to receive a comprehensive response from the AIDS research establishment.

And Duesberg is not alone in his doubts. He has since been joined by even more eminent scientists, including University of California cell biologist Harry Rubin, widely considered to be the father of retrovirology.

"I don't think the cause of AIDS has been found," says Rubin. "I think, in a disease as complex as AIDS, that there are likely to be multiple causes. In fact, even to call it a single disease, when there are so many multiple manifestations, seems to me to be an over-simplification."

One of the manifestations is the skin condition known as Kaposi's Sarcoma (KS), one of the first two opportunistic infections seen in AIDS patients. However, recent reports have uncovered cases of KS in people who show no trace of HIV whatsoever. Scientists are now speculating that a separate, as yet unidentified, virus is responsible for KS.

Molecular biologist and Nobel prize-winner Walter Gilbert of Harvard University is also skeptical about the HIV theory. "One of the difficulties with ascribing the virus to the cause of AIDS is that one has not demonstrated, clearly, that the virus will cause AIDS in experimental animals, and that gap in our findings at the moment produces a question," says Gilbert.

In fact, scientists have discovered the existence of disease-causing retroviruses in chimpanzees and cats, named simian and feline immuno-deficiency viruses (SIV and FIV), and they are often cited to prove that HIV causes AIDS in humans.

However, the disease symptoms are markedly different than seen in AIDS. As well, a much greater number of white blood cells are infected in the animals, and furthermore, anti-viral therapies, immunization and bone-marrow transplants work very well in improving the conditions. The same is not true, unfortunately, for the human immuno-deficiency virus, HIV.

Equally paradoxical is the varying rates at which different groups of HIV-positive people develop AIDS. Uganda and the U.S. each have an estimated 1 million HIV-positive individuals. In Uganda, only 8,000 cases of AIDS have been reported; in the U.S., over 100,000 cases have occurred.

As a result, most leading AIDS scientists now concede that various co-factors may be necessary for an HIV-positive person to develop full-blown AIDS. "It may be genetics, it may be the type of virus, we don't know what it is," says doctor Norbert Gilmore, an immunologist at Montreal's Royal Victoria Hospital. "We don't really know what all those factors are, and I think that people are now starting to say this."

HIV target

Currently, the federal government's AIDS strategy is centred on HIV as the target for anti-AIDS treatments. When asked about how Montagnier's changing stance will affect the distribution of drugs such as AZT and DDI, federal health minister Perrin Beatty says he'll rely on the advice of his advisors.

"But what I will not be doing, at this point, is pulling back on the availability of drugs based on what doctor Montagnier has said," Beatty says, "because it's just one piece of evidence, one element, I suppose, of a very complex jigsaw that we're trying to put together."

One argument frequently brought up in favour of focusing on HIV is the almost uniform presence of HIV antibodies in AIDS cases. This appears to be a powerful argument, but critics of the HIV theory offer two responses.

First, while there exists a correlation between AIDS and the presence of the HIV antibody, there is no actual correlation between the activity of the virus itself in the blood (as measured by tests such as p24 antigen and polymerase chain reaction) and the extent of disease progression.

Secondly, the critics point out, a mere correlation does not in itself prove a cause-and-effect relationship, and the exact mechanism by which HIV attacks the immune system has never been demonstrated, only speculated on. There is no evidence to suggest that HIV isn't merely another of the opportunistic infections seen in AIDS, akin to reactivated herpes viruses such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

"The appearance of HIV anti-bodies may merely be a consequence of the immune suppression, rather than associated with the cause," maintains doctor Joseph Sonnabend, a New York physician who has treated hundreds of people with AIDS. Sonnabend, also a world-renowned microbiologist and expert on interferon (a naturally occurring substance in the body that has been developed as a cancer treatment), co-founded what is now the American Foundation for AIDS Research and also founded the leading journal AIDS Research (now renamed AIDS Research and Human Retroviruses).

He says his strong doubts about the HIV hypothesis cost him his positions at those organizations, but he has since gone on to pioneer landmark efforts such as the Community Research Initiative. He is deeply concerned about the consequences of accepting the HIV hypothesis as fact.

"In 1984, when it was announced the cause of AIDS had been found, other aspects of research into other causes became impossible to fund," says Sonnabend. "There were many aspects to AIDS as a disease that were known already in the early 1980s that have not been explored even to this day."

"I don't think we should discard HIV," cautions Gilmore. However, he adds, "I think it's very valuable to look for these other things, because the more we understand about it, the more we can start to try to stop the process."

But how is this complex scientific debate relevant to people who are now living with AIDS?

The exclusive focus on finding an effective treatment for HIV not only affects government-sponsored research but also the community-based initiatives that have recently sprung up. Michael Hulton, a primary-care doctor who heads the Community Research Initiative of Toronto, is well aware of the implications of this debate.

"Obviously, it's relevant, because we're only likely to test agents that have some commercial backing," says Hulton. "At the moment, I don't know anybody that's dealing with any therapy that does not rest on the hypothesis that HIV is the cause of AIDS."

Colman Jones is a freelance journalist who is producing an eight-part video documentary on this debate, The Cause of AIDS: Fact and Speculation, airing on Rogers and Maclean Hunter Cable TV. The first episodes will be screened at 1 pm this Sunday (October 14) at the Euclid theatre, followed by a panel discussion with doctors Sonnabend, Root-Bernstein and others.

NOW OCTOBER 11-17, 1990

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