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South Africa takes pressure off Manto


Baltimore, Gallo, TAC manage to force concession

Committee will oversee AIDS program

But Mayo Clinic study backs Dr. Beetroot as correct – beetroot very relevant

Apparently the AIDS drug friendly, activist Treatment Action Campaign (TAC) in South Africa, having enlisted Baltimore, Gallo and 79 other scientists loyal to the “HIV is the only cause of AIDS” cause, have scored a success with the asinine letter they sent to Mbeki this week.

They have managed to force Mbeki’s hand and have him remove overall responsibility for the country’s AIDS program from the relatively enlightened Health Minister Dr. Manto Tshabalala-Msimang to a commission headed by the Deputy President.

Government spokesman Themba Maseko defended the minister, but said Friday the Cabinet had appointed a committee headed by Deputy President Phumzilie Mlambo-Ngcuka to oversee the implementation of the country’s AIDS program…

Maseko, the government spokesman, said the health minister had made it clear that South Africa’s program included anti-retrovirals and nutrition, but that she might have given the impression the focus was on nutrition and specific nutrients.

”Nutrition is not an alternative to anti-retrovirals or forms of treatment. This has always been the government approach on this matter,” Maseko said. ”Equally, the misconception that anti-retrovirals are a cure for AIDS is not only misleading but dangerous as it creates false hopes.”

We imagine this is just a sop to ease the political pressure and remove Manto as a target for the TAC and its scientist friends, which won’t have much effect on South African policy in practice.

For that policy appears to be to allow people to have ARVs if that is what they insist on, but to point out they do not save anyone’s life (the Lancet having confirmed that only last month) and that nourishing food may be more appropriate, according to the overall scientific review of mainstream HIV∫AIDS that is denied by Gallo, Baltimore and the other not unbiased people in the roll call of infamy that is the List of 81.

The statement of the government spokesman seems to embody this fudged position, which arises out of the involvement of Mbeki with the rethinker view which started before the AIDS Conference in Durban in 2001, when he was tipped off to the dissident position by a female journalist and reviewed the matter on the Web, and was suitably impressed.

Mbeki is an intelligent man (he is an economist with an English university degree – Sussex MA – in the field) and one of the few politicians who are capable of thinking for themselves when faced with this issue. Here is Thabo Mbeki’s CV if you would like to read it:

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Thabo Mvuyelwa Mbeki

President of South Africa

President, ANC

Member, National Executive Committee, ANC

Member, National Working Committee, ANC

President of South Africa

People like to identify Thabo Mbeki as an independent and original thinker, but one who remains close to the more visible leadership. His profile as a policy shaper and mediator in the movement has been built up over a lifetime of involvement. “I was born into the struggle,” he says. His birth took place in Idutywa, Transkei, in June 1942.

Both his parents were teachers and activists. His father is a university graduate and there were many books in his home which Thabo read at an early age. Govan Mbeki was a leading figure in ANC activities in the Eastern Cape. Believing that sooner or later they would be arrested, Mbeki’s parents decided that family and friends would also be responsible for bringing up the children. Mbeki therefore spent long periods away from home.

He joined the Youth League at 14 and quickly became active in student politics. After his schooling at Lovedale was interrupted by a strike in 1959, he completed his studies at home. Thereafter he moved to Johannesburg where he came under the guidance of Walter Sisulu and Duma Nokwe.

While studying for his British A-levels he was elected secretary of the African Students’ Association (ASA). He went on to study economics as a correspondence student with London University. The ASA collapsed following the arrest of many of its members, at a time when political movements were coming under increasingly severe attack from the state. Mbeki’s father was arrested at Rivonia and sentenced to life imprisonment.

He left the country in 1962 under orders from the ANC. From Tanzania he moved to Britain where he completed a Masters degree in economics at Sussex University in 1966. Remaining active in student politics, he played a prominent role in building the youth and student sections of the ANC in exile.

Following his studies he worked at the London office with the late Oliver Tambo and Yusuf Dadoo before being sent to the Soviet Union in 1970 for military training. Later that year he arrived in Lusaka where he was soon appointed assistant secretary of the Revolutionary Council. In 1973-74 he was in Botswana holding discussions with the Botswana government about opening an ANC office there. In 1975 he was acting ANC representative in Swaziland. Appointed to the NEC in 1975, he served as ANC representative to Nigeria until 1978.

On his return to Lusaka he became political secretary in the office of Oliver Tambo, and then director of information. From this position he played a major role in turning the international media against apartheid. His other role in the ’70s was in building the ANC in Swaziland and underground structures inside the country.

During the ’80s Mbeki rose to head the department of information and publicity and co-ordinated diplomatic campaigns to involve more white South Africans in anti-apartheid activities. When delegations of sports, business and cultural representatives visited Lusaka for talks they all expressed surprise to meet a man deeply engaged in the issues they brought to the table.

From 1989 Mbeki headed the ANC Department of International Affairs, and was a key figure in the ANC’s negotiations with the former government.

Mbeki was hand-picked by Nelson Mandela after the April 1994 general election to be the first Deputy President of the new Government of National Unity.

At the 50th Conference of the ANC at Mafikeng, from 16-20 1997, Thabo Mbeki was elected as the new President of the African National Congress.

Thabo Mbeki was elected President of South Africa on 14 June 1999 and was inaugurated as President on 16 June 1999.

Profile of Thabo Mvuyelwa Mbeki

Personal

Date of birth: 18 June 1942, Idutywa, Queenstown, one of four children of Govan and Epainette Mbeki

Marital status: Married to Zanele Dlamini (1974)

Academic Qualifications

* Attended primary school in Idutywa and Butterworth

* Acquired high school education at Lovedale, Alice

* Expelled from school as a result of student strikes (1959) and forced to continue studies at home

* Sat for matriculation examinations at St John’s High School, Umtata (1959)

* Completed British “A” levels examinations (1960 and 1961)

* Undertook first year economics degree as an external student with the University of London (1961 – 1962)

* Master of Economics degree, University of Sussex (1966)

Career details

* Joined ANC Youth League (ANCYL) while a student at Lovedale Institute (1956)

* Involved in underground activities in the Pretoria-Witwatersrand area after the ANC was banned in 1960

* Involved in mobilising the students and youth in support of the ANC call for a stay at home in protest against the creation of a Republic (1961)

* Elected Secretary of the African Students Association (December 1961)

* Left South Africa together with other students on instructions of the ANC (1962). Went to the then Southern Rhodesia (now Zimbabwe), the then Tanganyika (now Tanzania) and the United Kingdom to study

* Continued with political activities as a university student in the UK, mobilising the international student community against apartheid

* Worked for the ANC office in London (1967 – 1970). Underwent military training in the then Soviet Union during this period

* Served as Assistant Secretary to the Revolutionary Council of the ANC in Lusaka (1971)

* Sent to Botswana (1973). He was among the first ANC leaders to have contact with exiled and visiting members of the Black Consciousness Movement (BCM). As a result of his contact and discussions with the BCM, some of the leading members of this organisation found their way into the ranks of the ANC

* The focus of his activities during this time was to consolidate the underground structures of the ANC and to mobilise the people inside South Africa

* Engaged the Botswana government in discussions to open an ANC office in that country. Left Botswana (1974)

* Sent to Swaziland as acting representative of the ANC. Part of his task was the internal mobilisation and the creation of underground structures

* Became a member of the National Executive Committee (NEC) of the ANC (1975)

* Sent to Nigeria (December 1976) as a representative of the ANC. Played a major role in assisting students from South Africa to relocate in an unfamiliar enviroment

* Left Nigeria and returned to Lusaka (February 1978)

* Political Secretary in the Office of the President of the ANC (1978)

* Director of the Department of Information and Publicity (1984 – 1989)

* Re-elected to the NEC (1985). Served as Director of Information and as Secretary for Presidential Affairs

* Member of the ANC ‘s political and military council

* Member of the delegation that met South African business community led by the Chairman of Anglo American, Gavin Relly, at Mfuwe, Zambia (1985)

* Led a delegation of the ANC to Dakar, Senegal, where talks were held with a delegation from the Institute for a Democratic Alternative for South Africa (Idasa) (1987)

* Led the ANC delegation which held secret talks with the South African government from 1989 and which led to agreements about the unbanning of the ANC and the release of political prisoners

* Part of the delegation which engaged the government in “talks about talks”. He participated in the Groote Schuur and Pretoria deliberations, which resulted in the agreements which became known as the Groote Schuur and Pretoria Minutes (1990)

* Participated in all subsequent negotiations leading to the adoption of the interim Constitution for the new South Africa

* Elected chairperson of the ANC (1993). The election to this post meant succeeding the late former President and chairperson of the ANC, OR Tambo, with whom he had a close working relationship over the years

* Executive Deputy President of the South African Government of National Unity (May 1994 – June 1999)

* Elected President of the African National Congress, 18 December 1997

* Inaugurated as President of South Africa, 16 June 1999

Source: Office of the Deputy Executive President, 26 August 1994 (Confirmed, 13 September 1996)

One of the questions he reportedly asked early on was, why was there a sudden switch from urban gay AIDS in Africa, which is what it started out as, to poor rural heterosexual AIDS? This inexplicable switch, according to our informants, is what made Mbeki take the dissidents seriously from the start.

Whatever the truth in that, it is clear that Mbeki is possibly the only international politician with his head screwed on straight as far as AIDS is concerned, and whatever concessions he has to make to the TAC led mob, he is not going to stop offering healthy atlernatives to the drugs the activists love so much.

Dr Beetroot is a name to be proud of

One of the more ridiculous things about this lunatic affair is that the ignorant activists’ label for Health Minister Dr. Manto Tshabalala-Msimang, Dr Beetroot, is, truth be told, nothing to be ashamed of, according to the scientific literature, for the important ingredient in beetroot is betaine, and mainstream researchers have found it is indeed very beneficial to the liver, which is the chief organ attacked by HAART, the resulting deterioration being the cause of death or transplant in many AIDS cases in the US. Liver damage is not an AIDS symptom.

For example, the paper at the top of the pile at NAR HQ is “Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study”, from the American Journal of Gastroenterology, September 2001 (96.:2534-6).

Drs Abdelmalek et al from the Mayo Clinic found that the vile condition of fatty liver (steato means fat) was significantly improved if patients (ten of them in this study over 12 months) were given betaine orally in two doses daily. Their conclusion: Betaine is a safe and well tolerated drug that leads to a significant biochemical and histological improvement in patients with NASH (nonalcoholic steatohepatitis). This novel agent deserves further evaluation in a randomized, placebo controlled trial.

Of course, that placebo controlled trial wouldn’t be possible in the grim fairy tale kingdom of HIV∫AIDS, since no placebo-controlled trials have ever been carried out in the era of HAART, since “ethics” bar the witholding of HAART from anyone with “AIDS”.

So it would not be much good the Mayo group buying tickets from Rochester to South Africa and conducting a trial for Dr Beetroot in the very agent she recommends and they have tested and found beneficial. TAC and the generous and ethical NIAID trial administrators wouldn’t allow anyone to try betaine on any of the hapless Africans without making sure they got liver damaging ARVs in the bargain.

(show)

By THE ASSOCIATED PRESS

Published: September 9, 2006

Filed at 10:53 p.m. ET

JOHANNESBURG, South Africa (AP) — South Africa’s government scaled back the influence of its minister for AIDS policy, pilloried for questioning the effectiveness of anti-retroviral drug treatments and promoting beetroot, garlic and African potatoes as ways to fight AIDS.

A group of international scientists called for Health Minister Dr. Manto Tshabalala-Msimang, nicknamed ”Dr. Beetroot,” to be fired and they labeled South Africa’s program ”inefficient and immoral.”

Government spokesman Themba Maseko defended the minister, but said Friday the Cabinet had appointed a committee headed by Deputy President Phumzilie Mlambo-Ngcuka to oversee the implementation of the country’s AIDS program.

”We need to shift focus from saying the problem in the program is the minister of health,” Maseko said.

In an open letter to President Thabo Mbeki on Wednesday, 81 international AIDS scientists called the health minister an embarrassment to South Africa who has undermined HIV science and who has no international respect.

The scientists include American Nobel Laureate David Baltimore and Dr. Robert Gallo, a co-discoverer of the virus that causes AIDS and developer of the first HIV blood test. They called for an end to South Africa’s ”disastrous, pseudoscientific policies” and urged Mbeki to remove the health minister immediately.

With the letter the scientists joined mounting calls by AIDS activists and opposition parties for the president to fire Tshabalala-Msimang.

South Africa has an estimated 5.5 million people infected with HIV, a number second only to India and one that amounts to about an eighth of estimated cases worldwide. On average, more than 900 people die of the disease each day in South Africa. The government said Thursday that the adult death rate had climbed significantly over a seven-year period, largely because of AIDS.

Mbeki previously has expressed doubts about the connection between HIV and AIDS, and along with Tshabalala-Msimang has questioned the effectiveness of anti-retroviral drugs in treating the disease.

Tshabalala-Msimang’s office said in a statement Friday that there was a campaign aimed at deliberately misrepresenting the government’s program to fight the disease.

Her statement and the Cabinet reacted not only to the scientists’ letter, but also to other attacks on its policies at the International AIDS conference in Toronto last month, including a scathing one by Stephen Lewis, the U.N. special envoy for AIDS in Africa.

”It is the only country in Africa … whose government is still obtuse, dilatory and negligent about rolling out treatment,” Lewis said. ”It is the only country in Africa whose government continues to promote theories more worthy of a lunatic fringe than of a concerned and compassionate state.”

The scientists noted that at the AIDS conference, the South African exhibition featured garlic, lemons and African potatoes, ”with the implication that these dietary elements are alternative treatments.”

Maseko, the government spokesman, said the health minister had made it clear that South Africa’s program included anti-retrovirals and nutrition, but that she might have given the impression the focus was on nutrition and specific nutrients.

”Nutrition is not an alternative to anti-retrovirals or forms of treatment. This has always been the government approach on this matter,” Maseko said. ”Equally, the misconception that anti-retrovirals are a cure for AIDS is not only misleading but dangerous as it creates false hopes.”

The government, which did not provide AIDS drugs until forced to do so by a 2002 court ruling, said its AIDS program is now the largest in the world. It estimates it treats 140,000 people with anti-retroviral drugs.

However, that number is less than half of the target of 380,000 the government set in 2003 and well below the 500,000 South Africans that the scientists estimate now need the drugs to survive.

106 Responses to “South Africa takes pressure off Manto”

  1. Dan Says:

    For that policy appears to be to allow people to have ARVs if that is what they insist on, but to point out they do not save anyone’s life (the Lancet having confirmed that only last month) and that nourishing food may be more appropriate

    I really do keep wondering…

    If “HIV activists” like Mr. Baltimore were truly concerned about helping, why are they publicly dead-set against approaching this from other angles? Why this pharmaceutical tunnel vision? Is this really the best we can do? “Virological response after starting HAART improved over calendar years, but such improvements has not translated into a decrease in mortality since 1996”. This quote from the Lancet article is self-explanatory. The so-called “live-saving” drugs are not live-saving. An announcement as profound as this is begging for alternatives to the current pharmaceutical myopia.

    Is this allopathic medicine’s “last stand”? Does it make any sense to continue to attack “HIV” and the body itself to win the war against “HIV”? And it’s obviously not being won.

    Would it make more sense to nourish people, give them treatment for the illnesses they have, and to support their immune systems with simple, affordable, non-toxic vitamins, minerals and micronutrients? Why not? Their immune systems are producing antibodies to HIV, correct?Why not just give it a little more (non-toxic) help? It just seems to make sense to want to strengthen a body, rather than do more to weaken it.

    This is why a layperson such as myself questions the motivations of so-called scientific “AIDS activists”. They should have the courage to open up to more points of view, and support others in their decisions to take charge of their own health. Like I commented in the article from Ms. Rosenberg, she should support the Africans who desire to do what they think best for their health. But she and the Baltimorean AIDS activists are blinded by the idea that something must be destroyed, and the body is the battlefield – rather than nourishing and strengthening the body so it can be allowed to heal.

  2. McKiernan Says:

    First Barnesworld got it wrong Re: Goofiness/Lancet on August 28, 2006

    Second, The DeansWorld got it wrong re: Lancet Study on Sept 1, 2006.

    Third, then NAR got it wrong re: Lancet study demonstrated death rates have not improved…” on Sept 2, 2006.

    Fourth, then Moment of Science corrected Dean on Sept 1, 2006 re: Which shows that even though improvements to HAART have continued to decrease HIV viral load and increase CD4+ T-cell counts over the past ten years. There has not been a corresponding reduction in deaths or progression to AIDS during the first year of treatment.

    Fifth, then Moment of Science provided factual data on Sept 1, 2006 that indeed “…the drugs do increase lifespan versus placebo, even in the first year of treatment.

    Sixth, Moment of Science informed on Sept 8, 2006:

    The definitive statement the authors made:

    “Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.”

    is referring only to the first one year of HAART in treatment naive patients. Compared to no treatment, HAART has reduced mortality even in just the first year of treatment. What they found in the Lancet paper is that first year mortality has not continued to decrease since the introduction of HAART in 1995, even though improvements have resulted in better virological control.”

    It would appear then that this statement by NAR:

    “For that policy appears to be to allow people to have ARVs if that is what they insist on, but to point out they do not save anyone’s life (the Lancet having confirmed that only last month)…” is false and mis-information.

    And as well, this by NAR is inconsistent with the facts:

    “…the recent Lancet study that demonstrated death rates have not been improved in ten years of expanded use of HAART.”

  3. pat Says:

    “…the drugs do increase lifespan versus placebo, even in the first year of treatment. ”

    Versus placebo? It has been drilled into my head that there are no placebo studies because they are considered “unethical”. Shit my head is spinning in contradiction. Which is it now?

  4. Richard Jefferys Says:

    The Lancet paper contains two analyses of mortality, one just looking at one year after starting ART and a second analysis (available in a supplemental table on the Lancet website) looking at two years after starting ART.

    Here are the data for the different time periods.

    One year after starting ART:

    1995/96: total n=1232 / #deaths=27 (2.2%)

    1997: 4785 / 98 (2.1%)

    1998: 4583 / 85 (1.9%)

    1999: 3699 / 67 (1.8%)

    2000: 3203 / 63 (2.0%)

    2001: 2783 / 49 (1.8%)

    2002/03: 1932 / 25 (1.3%)

    Two years after starting ART:

    1995/96: 1232 / 53 (4.3%)

    1997: 4785 / 151 (3.2%)

    1998: 4583 / 144 (3.1%)

    1999: 3699 / 109 (3.0%)

    2000: 3203 / 99 (3.1%)

    2001: 2783 / 69 (2.5%)

    So, in fact, mortality has declined in the later periods whether you look at the one or two year mark (although, predictably, the difference is more evident after two years) The reason that the authors state that it’s unchanged is based on the hazard ratios where the differences weren’t large enough to be statistically significant (the hazard ratios were also based on the data from 98 which was picked as the reference year). Given that people in the later period were starting with around 200 CD4s, you can compare the two-year mortality data with that from natural history studies of untreated HIV infection. You will find that the number of untreated people surviving at two years after the CD4 drops below 200 is >10 fold less than the number surviving in this cohort study of people on ART (~97.5% of people still alive at two years).

    So, as McKiernan points out, the people that have claimed that the Lancet article shows that ART does not reduce mortality have just got it wrong. This includes Hank Barnes, TS, Neville Hodgkinson and Celia Farber.

    [Insulting language removed (“are just plain lying”) and names where pseudonyms preferred by combatants. – Ed.]

  5. john-2 Says:

    Let me be john(1) and ask Mr. Jeffreys for a reference or three for this:

    “Given that people in the later period were starting with around 200 CD4s, you can compare the two-year mortality data with that from natural history studies of untreated HIV infection. You will find that the number of untreated people surviving at two years after the CD4 drops below 200 is >10 fold less than the number surviving in this cohort study of people on ART (~97.5% of people still alive at two years).”

    I am sure they will demonstrate, that just as he claims, they are solid enough to use to predict what would have happened had a real placebo control been included in this Lancet study, if only to keep TS, who loves the literature so, at least a little happy. He has suffered many outrageous slings and arrows and spitballs these past weeks.

  6. McKiernan Says:

    So, as McKiernan points out, the people that have claimed that the Lancet article shows that ART does not reduce mortality are just plain lying.

    Richard,

    For the record, McKiernan has never called anyone a liar nor is it his intent to do so now or in the future.

  7. Richard Jefferys Says:

    Apologies McK, I should have stated it as fact and not referred to your post (which, I see upon closer inspection, makes the gentler assertion that they “got it wrong”).

    In response to the question, here are a few references:

    Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH.
    Natural history of human immunodeficiency virus disease in southern India.
    Clin Infect Dis. 2003 Jan 1;36(1):79-85. Epub 2002 Dec 9.

    – median survival of untreated people with
    Osmond D, Charlebois E, Lang W, Shiboski S, Moss A.
    Changes in AIDS survival time in two San Francisco cohorts of homosexual men, 1983 to 1993.
    JAMA. 1994 Apr 13;271(14):1083-7.

    – median survival of people with
    Pathipvanich P, Ariyoshi K, Rojanawiwat A, Wongchoosie S, Yingseree P, Yoshiike K, Warachit P, Sawanpanyalert P.
    Survival benefit from non-highly active antiretroviral therapy in a resource-constrained setting.
    J Acquir Immune Defic Syndr. 2003 Feb 1;32(2):157-60.

    – looking at the Kaplan Meier curves (Fig 1), ~50% of untreated people with a CD4 count of
    Schim van der Loeff MF, Jaffar S, Aveika AA, Sabally S, Corrah T, Harding E, Alabi A, Bayang A, Ariyoshi K, Whittle HC.

    Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia.

    AIDS. 2002 Sep 6;16(13):1775-83.

    – again, looking at the Kaplan Meier curves (also Fig 1), ~75% of the group with a CD4 count
    French N, Mujugira A, Nakiyingi J, Mulder D, Janoff EN, Gilks CF
    Immunologic and clinical stages in HIV-1-infected Ugandan adults are comparable and provide no evidence of rapid progression but poor survival with advanced disease.
    J Acquir Immune Defic Syndr. 1999 Dec 15;22(5):509-16.

    – “Median survival with a baseline CD4+ T-cell count
    Natural history and mortality in HIV-positive individuals living in resource-poor settings: A literature review

    – This review by Matthias Egger contains an analysis of the Swiss HIV Cohort data showing a median survival of 24 months (no people on ARVs are included in the analysis).

    Bakari M, Urassa W, Pallangyo K, Swai A, Mhalu F, Biberfeld G, Sandstrom E.
    The natural course of disease following HIV-1 infection in dar es salaam, Tanzania: a study among hotel workers relating clinical events to CD4 T-lymphocyte counts.
    Scand J Infect Dis. 2004;36(6-7):466-73.

    Rangsin R, Chiu J, Khamboonruang C, Sirisopana N, Eiumtrakul S, Brown AE, Robb M, Beyrer C, Ruangyuttikarn C, Markowitz LE, Nelson KE.
    The natural history of HIV-1 infection in young Thai men after seroconversion.
    J Acquir Immune Defic Syndr. 2004 May 1;36(1):622-9.

    – These last two are natural history studies of untreated HIV that don’t include analyses based on the CD4 thresholds, but the data on risk of death and the comparisons between HIV positive and negative participants are relevant (particularly the CD4 count comparisons).

  8. john-2 Says:

    Thanks Dick,

    Exactly as I thought, you have googled a bunch of rigorous studies that more than fulfill the requirements of surrogate placebos from which you can rescue the dire conclusions of the most recent Lancet study.

    But you might want to Read this for some HISTORICAL perspective.

  9. Richard Jefferys Says:

    What “dire conclusions?”

  10. Chris Noble Says:

    What “dire conclusions?”

    I think John is referring to the false and inaccurate conclusions made by Hank Barnes, TS, Neville Hodgkinson and Celia Farber after they read (or didn’t read) the Lancet article.

    I also wonder why people demand references and then subsequently discount them without even bothering to read them.

    [Names removed where pseudonyms preferred by combatants. – Ed]

  11. john Says:

    It seems to me evident that the decrease of the rate of CD4 is directly connected to the increase of the mortality. And here, it seems to me that the position of the duesbergians cannot be supported.

    On the other hand, it is not because the HAART has an indisputable efficiency that the decline of the CD4, the increase of the viral load and the appearance of certain proteins are owed to a virus, but the application of simple concepts of biochemistry allows to conceive it.

  12. noreen martin Says:

    Dan, I like your thinking, add vitamins, supplements and other health-building agendas to the treatment plan. The thing that I find disturbing about any study is that the only thing that is given any credit is the drugs. Whose to say that a combination of things such as better diet, herbs, vitamins, supplements and overall health habits did not contribute greatly to any successes? Why don’t they compare a group of strickly HAART and those on HAART who do take supplements and see who fairs the best?

    I would like to throw a monkley-wrench into the HAART statistics, I am a Class IV Aids person who has been off the anti-virals for going on 7 months and have no clinical symptoms.

  13. noreen martin Says:

    Correction, I may be a Category 3, and B classification. I find all the changes in all of this quite confusing. Bottom line, I was a sick puppy so to speak and less than 200 CD4’s presently and reiterate, doing well without Aids’s meds.

  14. German Guest Says:

    @noreen

    Don’t let yourself be fooled! Orthodox science is not as clear-cut as Chris Noble, McKiernan and Richard might suggest.

    antibiotics and nutrition are much more life-saving than any antiretroviral therapy – highly active or not…

    1)
    using the antibiotic cotrimoxazole in HIV+ children reduces mortality from 42 % to 28 %
    CHAP-study 2004

    2)
    very low weight and malnutrition: pedictor of death in HIV+ patients independent of immunosupression!
    CHAP-study 2006

    I really like the sentence quoted by Dan and Celia Farber and TS and Hank Barnes:
    “Virological response after starting HAART improved over calendar years, but such improvements has not translated into a decrease in mortality since 1996.”
    Sounds right to my ears 😉 It sounds right because it is the truth. This is the real “aidstruth”!

  15. Dan Says:

    Noreen,
    Why don’t they compare a group of strickly HAART and those on HAART who do take supplements and see who fairs the best? “Ethical reasons”.

    In my view, if they were serious about helping people, they would try this. If AIDS is the crisis that it’s made out to be, then other avenues should be actively explored, including a non-pharmaceutical approach. We’ll never know, unless we try.

  16. Dan Says:

    Whoops,
    typing faster than my brain is working.

    I thought Noreen was suggesting a study of folks taking HAART vs. those not taking HAART, but taking supplements.

  17. Richard Jefferys Says:

    German Guest, in your view is 1.3% greater or lesser than 2.2%? Is 2.5% greater or lesser than 4.3%?

    Noreen, the natural history studies cited above involved people that never took antiretrovirals, your personal situation is in no way incompatible with the published data.

    Thank you to TS for editing the “insulting language,” perhaps you can now go and apply the same standard to the attacks that have been launched on Chris Noble.

  18. Plummet C. Nobel Says:

    Ah I see an addition to the Noble Vision of HIV science by internet has been added. First it was the brillant “Test Mama” experiment, and in the newest version co-developed with Richard Jefferys (no Dr. Noble don’t be greedy now, Mr. Jefferys deserves his share of the ice cream here), low cost googling of previous studies will make placebo controls all but redundant in the future.

    Why has the academic world slighted this genius so long?

    PS Duesberg sucks.

  19. Plummet C. Nobel Says:

    PPS. How’s the language suit ya Dick?

  20. Truthseeker Says:

    SPECIAL NOTE TO COMMENTATORS Re the use of the word “lying” by distinguished poster Richard Jefferys and the use of real names instead of pseudonyms of other distinguished posters by Jefferys and Chris Noble above:

    When drawing attention to misapprehension of the meaning and significance of the scientific literature on the part of yourself or others, please observe the conventions of this site and not the lower standards of other sites in the Wild West of the Web, that is, the Blogosphere.

    The law here which is strictly enforced at the point of a gun (offending remarks will be edited in the comment by NAR staff as above) is that serious insults of other distinguished commentators are barred, and that barbs and jibes at the expense of other distinguished commentators must be mildly amusing to onlookers as well as to the writer.

    Also all posters have the right to use pseudonyms if they wish and exposure of real names by others in the know is unwarranted and verboten.

    —-

    HAART

    So, as McKiernan points out, the people that have claimed that the Lancet article shows that ART does not reduce mortality have just got it wrong. This includes Hank Barnes, TS, Neville Hodgkinson and Celia Farber.

    Clearly Richard you have been given a false impression as regards the HAART study in the Lancet, which is odd, since as Oscar Wilde remarked, it is the business of dentists to give false impressions, and dentists are not involved here as far as we can see.

    Perhaps you should read the text for yourself, and do a little arithmetic on the back of your napkin before posting on the topic again.

    The HAART era, according to the study, has seen first year mortality increase 10 per cent since 1995. As the hazard ratios show, first, deaths rose 15% from 1995 to 1998, presumably because they had prepared this witches brew of different drugs so clumsily that the dosages included too much AZT or similar crudities. Since then deaths have floated down somewhat by 4%, presumably because they got the dosage combination better sorted out.

    Whether you accept that speculation or not (we are sure you won’t, of course), clearly the stuff is not good for you, judging from this record. First year deaths are up ten cent in the HAART era. Did you hear that? RISK OF DEATHS IN THE FIRST YEAR IS UP TEN PER CENT. That is why the authors felt bound to give some excuse for the terrible results, which they FUDGE or GLOSS OVER in saying that mortality has not improved despite improvement in surrogate markers.

    Not improved? “Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.” No, it hasn’t resulted in a decrease in mortality, MORTALITY HAS INCREASED in the first year. People are dying quickly more often.

    In other words, folks, surrogate markers are meaningless when it comes to death in the first year. Your viral count goes down, how wonderful – but you die sooner anyway. Which would you choose – viral count down, or to live longer? Get with the program, Richard. HAART kills. That is our conclusion, anyway. You are welcome to yours. (Perhaps you cannot read hazard ratios. The hazard ratio for death was 0.87 for 1995/8, so by 1998 you had a jump of 13/87 which is 15 per cent. 2003 is 0.96 – a decrease of 4% from 1995 to 1998).

    Meanwhile, let’s note that yes, they are sicker too. The morbidity ie sickness and death (they include deaths they say) of AIDS patients rose too after 1998, after falling 7 % from 1995 to 1998. From 1998-2003 it ROSE 35%. Gee, could that be because people felt better as they reduced the AZT doses from 1992 to 1998? And then felt worse and died because HAART didn’t help any and there were more coming in from Africa with TB, as the authors themselves surmise? Speculation, again, but the plain fact is AIDS morbidity is UP 26% from 1995.

    As for Chris saying that none of these figures are statistically significant, the 35% is sure significant. Look at the 95% confidence interval given for it at the end of the abstract – 1.06-1.71. Sorry, guys, this is bad news. HAART is bad news. You don’t think so? Want to try some? You remind us of Thomas “Yes, Resist Paradigm Change to Test It” Kuhn. He once told us he thought it was just fine that Duesberg was getting trashed politically and unfairly. That’s how paradigm revolutionaries have to prove themselves. Right, we thought afterwards, you would certainly stop waffling and show an interest in whether Duesberg was right if your HIV test was positive.

    What the HAART study is in line with is that health has nothing to do with viral load, that HAART does the sickening and the killing, and that the initial improvement in first year sickness+death morbidity rate was due to easing off on the AZT. HAART immediately helped kill off the sickest faster, and then did its dirty work slightly less effectively because they fiddled with the combinations and made them less lethal.

    And by the way, what were those papers that just came out? A couple of studies showing that with HAART knocking out one or more of the drugs in the combination made no difference, right?

    Gee who’da thought it? Have to check that and then post on HAART, after the silence that we hope will follow this post, but fear will not, owing to the commitment and enthusiasm of our two distinguished posters for very unpleasant and frequently lethal drugs (how many is it now die from nonAIDS symptoms, ie drug symptoms? about half the gays, if we recall correctly) from the very companies that support their campaign so helpfully in so many places with sums of money made from the very same drugs.

  21. Truthseeker Says:

    One more transgression on pseudonyms and Richard Jefferys will be banned from this site.

  22. German Guest Says:

    @Richard: it would be much more interesting to look at the numbers of a 5-10 years follow up, because HAART was introduced in 1996.

    Well, we have very detailed epidemiological data in Germany. Guess what: HAART-adherence is widely decreasing – as well as the number of new AIDS-cases! Inconsistence or not???

    The funny thing (or rather: alarming thing) is to watch the Robert-Koch-Institut (similar to the CDC in the U.S.) struggling hard to explain the real numbers.

    At page 14 of this report, you can have look at the data as well as the number of “missing AIDS-cases” that should have appeared in accordance to the rising number of HIV+ people without treatment (black columns from year 2000-2005).

  23. Richard Jefferys Says:

    TS, the hazard ratios are derived from the 1998 data! Figure it out, please.

    I posted both the one and two year mortality data from the Lancet paper above, in both cases the number of deaths has decreased.

  24. Truthseeker Says:

    TS, the hazard ratios are derived from the 1998 data! Figure it out, please.

    Precisely. You cannot read?

    I posted both the one and two year mortality data from the Lancet paper above, in both cases the number of deaths has decreased.

    You cannot read?

  25. noreen martin Says:

    Truthseeker, this site is so important because I believe that more and more people will come out of the wood work, have the courage to speak up and say that they do not take HAART and are fine. I know that there are out there!

  26. pat Says:

    “PS Duesberg sucks”

    Try: “Duesberg’s science sucks”
    …unless of course you know him personally well enough to suggest that indeed, as a human being, he sucks. Which then leads me to ask: what does Duesberg suck?

  27. john-2 Says:

    pat,

    I really, really think that Plummet C. Noble has his very sarcastic tongue firmly planted in his cheek when he adds his now signature P.S.

  28. Richard Jefferys Says:

    I can read the mortality data, as can anyone.

    These are the calendar years, followed by the number of people starting ART included in the analysis, followed by the number of deaths that occurred after one year of follow up and two years of follow up.

    One year after starting ART:

    1995/96: total n=1232 / #deaths=27 (2.2%)
    1997: 4785 / 98 (2.1%)
    1998: 4583 / 85 (1.9%)
    1999: 3699 / 67 (1.8%)
    2000: 3203 / 63 (2.0%)
    2001: 2783 / 49 (1.8%)
    2002/03: 1932 / 25 (1.3%)

    Two years after starting ART:

    1995/96: 1232 / 53 (4.3%)
    1997: 4785 / 151 (3.2%)
    1998: 4583 / 144 (3.1%)
    1999: 3699 / 109 (3.0%)
    2000: 3203 / 99 (3.1%)
    2001: 2783 / 69 (2.5%)

    You seem to be suggesting that, based on a hazard ratio calculated using the 1998 data as the reference, we should interpret these data to mean that “deaths rose 15% from 1995 to 1998” and that “”The HAART era, according to the study, has seen first year mortality increase 10 per cent since 1995”!!

  29. Dan Says:

    Richard,
    a question for you…

    are people still dying while taking HAART?

    If so, then HAART isn’t saving lives.

    This can really be quite simple and easy to understand, that is, if some of us are willing to allow it to be.

  30. Truthseeker Says:

    Yes, mortality in the first year rose 15 per cent 1995-98, floated down 4% from 1998-2003, and for the entire HAART era from 1995 to 2003 gained about ten per cent.

  31. pat Says:

    Could it be that in the first year the weaker ones were killed off leaving the tougher ones to ride out the storm?

  32. Richard Jefferys Says:

    This is remarkable. Truthseeker wrote:

    “Yes, mortality in the first year rose 15 per cent 1995-98”

    This is the data from table 4 of the Lancet paper:

    1995/96: total n=1232 / #deaths=27 (2.2%)
    1997: total n=4785 / #deaths=98 (2.1%)
    1998: total n=4583 / #deaths=85 (1.9%)

    So, based on a hazard ratio calculated using 1998 as the reference year, Truthseeker is arguing that in 1998 more than 85 people should have died! About 788 people, in fact.

    “for the entire HAART era from 1995 to 2003 gained about ten per cent.”

    Again, data from table 4 of the Lancet paper:

    1995/96: total n=1232 / #deaths=27 (2.2%)
    2002/03: total n=1932 / # deaths=25 (1.3%)

    So, again based on a hazard ratio calculated using 1998 as the reference year, Truthseeker is arguing that in 2002/03 more than 25 people should have died (about 236 in this case).

    In other words, Truthseeker appears to be arguing that the raw data should be reinterpreted based on Truthseeker’s understanding of the hazard ratios that were derived from that raw data.

  33. Dan Says:

    Truthseeker, this site is so important because I believe that more and more people will come out of the wood work, have the courage to speak up and say that they do not take HAART and are fine. I know that there are out there!

    You may be right, Noreen. Supposedly there are thousands of people in the U.S. that are “positive”, but don’t know it, therefore they aren’t taking HAART.

    Of course, those non-HAART-taking positives should be easy to find, at least by African standards – they would be the emaciated people (most likely Paris Hilton, Nicole Richie and Maria Shriver). But HIV-positivity in the U.S. is different from that in Africa, so finding the positives in the U.S. requires a non-specific, non-standardized antibody test, since most positive folks in the U.S. appear to be just as healthy as the next person.

  34. German Guest Says:

    Could someone please confirm the existence of the following statement taken from this highly controversial Lancet-article? Unfortunately I don’t have the original paper at hand:

    “The results of this collaborative study, which involved 12 prospective cohorts and over 20,000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period.”
    May MT et al. HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet. 2006 Aug 5;368(9534):451-8.

  35. Richard Jefferys Says:

    These are the data on AIDS events (also from table 4)

    1995–96 total n=1096 / AIDS events=103 (9%)
    1997 4460 / 287 (6%)
    1998(reference)4222 / 222 (5%)
    1999 3328 / 192 (6%)
    2000 2873 / 204 (7%)
    2001 2421 / 172 (7%)
    2002–03 1656 / 105 (6%)

  36. noreen martin Says:

    I was referring to actual Aids cases which have by definition kicked it up a notch. If I can forgo the drugs, others must be doing it too.

  37. Truthseeker Says:

    German guest, this paragraph starts the Discussion phase of the paper on p454:

    “The results of this collaborative study, which involved 12 prospective cohorts and over 20,000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period.”

    The paragraph continues by noting that in the early years, most of the patients were gay men, and by 2002-3 most patients starting HAART were heterosexual – “had been infected with heterosexual transmission” (which as we have pointed out is a very unlikely if not impossible story) – with an increasing number from areas like sub-Saharan Africa “with a high incidence of tuberculosis”.

    Another sentence in the discussion: “We noted that the median time to the first AIDS event after starting HAART decreased over time.”

    What a mess. They are getting sicker heterosexual patients with TB to feed into the pot, and HAART is not saving them, or even noticeably improving their “virological response”, which is “most pronounced” in gays. Meanwhile they interpret TB as AIDS, saying “we note that tuberculosis largely accounted for the reported increase in AIDS events.”

    But their conclusion as to what they should do? Find HIV+ patients earlier, while their CD4 cell count is higher!

    Yeah sure, that should move the sickness and death along a bit, stop it happening quite so soon. Early diagnosis! Earlier HAART! Expand voluntary and cost effective screening!

    Questions for Richard:

    1) is HAART an appropriate medication for TB?

    2) Also, what do you suppose “has not translated into a decrease in mortality” means?

    3) Are you aware that the hazard ratios are adjusted for whatever variables have to be compensated for year by year, and that eyeing the crude percentages will mislead you?

    When you write

    Truthseeker appears to be arguing that the raw data should be reinterpreted based on Truthseeker’s understanding of the hazard ratios that were derived from that raw data.

    it appears that you do not know this. Our argument draws not on our understanding but the authors’ understanding of the hazard ratios, which they have adjusted to “reinterpret” the raw data. The raw data is not something you can eye and see how the risk of death or of AIDS has changed over time.

    As we explained very simply, the risk ratios show that the risk of mortality in the first year has gone up overall by about ten per cent, because “corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51)”.

    This line in the abstract follows the sentence, “Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-3.”

    Work it out yourself. It’s as we stated. Mortality risk up 15 per cent fom 1995 to 1998, then down 4 per cent to 2002/3, which is still about ten per cent GAIN since HAART came in. AIDS morbidity risk (sickness and death from AIDS symptoms) down 7 per cent to 1998, then up 35 per cent to 2002/3, for an overall GAIN of 26 per cent.

    In the era of HAART, mortality risk up 10 per cent, AIDS risk up 26 per cent, for the first year of HAART treatment.

    HAART good or bad, Bwana? Good, Bwana? Ndio, Bwana. Santa sana, Bwana Jefferys. (means Yes Bwana. Thank you very much, Bwana Jefferys.)

    All this refers to the HAART Lancet paper, conceived by Egger, which is listed as May MT et al. HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet. 2006 Aug 5;368(9534):451-8.

  38. Richard Jefferys Says:

    “As we explained very simply, the risk ratios show that the risk of mortality in the first year has gone up overall by about ten per cent, because “corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51)”.”

    Gone up compared to what? Where does the comparator hazard ratio of 1 come from Truthseeker?

  39. Truthseeker Says:

    Gone up compared to what? Where does the comparator hazard ratio of 1 come from Truthseeker?

    The 1 is 1998, as you have emphasized, but the rough comparison (ours) is 1995/6 to 2002/3, a 10 per cent jump in risk of mortality. Not statistically significant, perhaps, but the AIDS decline is, at 35% since 1998, in morbidity.

    Mortality UP, morbidity UP. What is it about the words sickness and death you don’t understand, my brainy, attractively ectomorphic friend?

    This stuff makes you sick, alright And by the way we notice we were wrong to imply there was a CD4 count improvement:

    As the Lancet commented, “The major findings are that, despite improved initial HIV virological control (there were no significant improvements in early immunological response as measured by CD4-lymphocte count, no reduction in all-cause mortality, and a significant increase in combined AIDS/AIDS related death risk in more recent years”.

    Which of course reflected the rising number of TB carriers from the sub-Sahara, welcomed into the West with the additional burden of ARVs to cope with, or not, as the case may be.

    “Improved virological control” of almost entirely inert retrovirus at vanishingly low levels, is that it?

    Another little sentence: “An intriguing finding was a reduction in the median time to AIDS, with half of AIDS events in the 2002-3 cohort occurring in the first two months of the 12 month period.”

    How intriguing. More AIDS sooner! Thank you, Bwana!

    Hey, but it’s all worth it, right? You get buffalo humps on your neck and back, your face drains of fat so it needs artificial replacement, you have to stay within five feet of a lavatory at all times, your liver goes south and you get a heart attack and die, but it’s all worth it – it keeps the Virus and Peter Duesberg at bay and the AIDS meme alive and healthy to pass to future generations!

    Will Fauci or Boehringer pay for your headstone, in honor of your undying faith in ARVs, or is that too much to ask?

    Wait a minute, shouldn’t that be dying faith in ARVs?

  40. Richard Jefferys Says:

    “The 1 is 1998, as you have emphasized, but the rough comparison (ours) is 1995/6 to 2002/3, a 10 per cent jump in risk of mortality.”

    Can you explain how it’s meaningful to compare the hazard ratios for 2002/3 and 1995/6 when both are derived from a comparison with 1998?

  41. noreen martin Says:

    Right on Truthseeker, The drugs do just what you described. One almost needs a portable toilet because of diarrhea, some turn one green, drugged as hell if eaten with food,liver enzymes constantly elevated, but hey we are adding profits to someone pockets at our expense. These are the good side effects, the one’s who don’t make it, pay the ultimate price with their lives. We are called denialists, I think we are realists.

  42. Richard Jefferys Says:

    In answer to one of the questions, ART is a critical component of TB therapy for people who are co-infected.

    JAIDS Journal of Acquired Immune Deficiency Syndromes. 43(1):42-46, September 2006.

    Survival Rate and Risk Factors of Mortality Among HIV/Tuberculosis-Coinfected Patients With and Without Antiretroviral Therapy.

    Manosuthi, W, Chottanapand, S; Thongyen, S; Chaovavanich, A; Sungkanuparph, S

    Background: The impact of antiretroviral therapy (ART) on survival among patients coinfected with HIV and tuberculosis (TB) has not been well established.

    Methods: A retrospective cohort study was conducted among HIV-infected patients with TB between January 2000 and December 2004. Patients were categorized into ART+ group (received ART) and ART- group (did not receive ART) and were followed until April 2005.

    Results: A total of 1003 patients were identified; 411 in ART+ group and 592 in ART- group. Median (interquartile range) CD4 count was 53 (20-129) cells/mm3. Survival rates at 1, 2, and 3 years after TB diagnosis were 96.1%, 94.0%, and 87.7% for ART+ group and 44.4%, 19.2%, and 9.3% for ART- group (log-rank test, P less than 0.001). Cox proportional hazard model showed that ART was associated with lower mortality rate; gastrointestinal TB and multidrug resistant TB were associated with higher mortality rate (P less than 0.05). Among patients in ART+ group, the patients who delayed ART >=6 months after TB diagnosis had a higher mortality rate than those who initiated ART less than 6 months after TB diagnosis (P 0.018, hazard ratio = 2.651, 95% confidence interval = 1.152-6.102).

    Conclusions: Antiretroviral therapy substantially reduces mortality rate among HIV/TB-coinfected patients. Initiation of ART within 6 months of TB diagnosis is associated with greater survival.

    AIDS Res Ther. 2006 Apr 7;3:10.

    Antiretroviral therapy at a district hospital in Ethiopia prevents death and tuberculosis in a cohort of HIV patients.

    Jerene D, Naess A, Lindtjorn B.
    Arba Minch Hospital, Ethiopia.

    BACKGROUND: Although highly active antiretroviral therapy (HAART) reduces mortality in the developed world, it remains undocumented in resource-poor settings. We assessed the effect of HAART on patient mortality and tuberculosis incidence rate under routine clinical care conditions in Ethiopia. The objective of this study was to assess the effect of HAART on patient mortality and tuberculosis incidence rate under routine clinical care conditions in a resource-limited setting in south Ethiopia. Starting in January 2003, we followed all consecutive adult HIV infected patients who visited the HIV clinic. Since August 2003, we treated patients with HAART. Only basic laboratory services were available. RESULTS: We followed 185 patients in the pre-HAART cohort and 180 patients in the HAART cohort. The mortality rate was 15.4 per 100 person-years of observation (PYO) in the HAART group and tuberculosis incidence rate was 3.7 per 100 PYO. In the pre-HAART group, the mortality rate was 58.1 per 100 PYO and the tuberculosis incidence rate was 11.1 per 100 PYO. HAART resulted in a 65% decline in mortality (adjusted hazard ratio [95%CI] = 0.35 [0.19-0.63]; P < 0.001). Tuberculosis incidence rate was lower in the HAART group (adjusted hazard ratio [95%CI] = 0.11 [0.03-0.48]; P < 0.01). Most of the deaths occurred during the first three months of treatment. CONCLUSION: HAART improved survival and decreased tuberculosis incidence to a level similar to that achieved in the developed countries during the early years of HAART. However, both the mortality and the tuberculosis incidence rate were much higher in terms of absolute figures in this resource-limited setting. Attention should be paid to the early weeks of treatment when mortality is high. The high tuberculosis incidence rate, when coupled with the improved survival, may lead to increased tuberculosis transmission. This highlights the need for strengthening tuberculosis prevention efforts with the scale-up of treatment programmes.

  43. Richard Jefferys Says:

    Truthseeker wrote:

    “In the era of HAART, mortality risk up 10 per cent, AIDS risk up 26 per cent, for the first year of HAART treatment.”

    The difficult thing about this thread is trying to figure out how to make the idiocy of this claim most obvious. It’s probably best to go back to the data:

    1995/96: total n=1232 / #deaths=27 (2.2%)
    2002/03: total n=1932 / # deaths=25 (1.3%)

    For Truthseeker’s interesting take on hazard ratios to be meaningful, we have to accept that there were really about 236 deaths in 02/03 (10% increase). It is presumably good fortune that a couple of hundred people were able to avoid the untoward effects of Cox proportional hazard models (as understood by Truthseeker) The same principal applies to AIDS events.

  44. Truthseeker Says:

    “idiocy”

    Jefferys, your manners are slightly lacking here. The accepted practice here on this blog is to treat the intellectually challenged with infinite respect and tact, since it is so hard to introduce light into their vision of reality. Are you not aware that is the way the well bred behave? Did you not observe it in the kindly and respectful manner with which you are treated here? Well, now you have, so please try and observe the manners of the intellectual aristocracy, even if unfamiliar with them.

    You seem unfamiliar with the meaning of the word adjusted, as in adjusted hazard ratios. May one recommend the use of any good dictionary? That same dictionary will also apprise you of the correct spelling of “principle”.

    As for your tortuous restatement of what we said, the joke is that if you are right, and there was a meaningful inconsistency betwen the crude figures and the (non)adjusted risk ratios, it would be an error in the paper, not in our explanation. However, there is one in your explanation already quite visible to all.

    1995/96: total n=1232 / #deaths=27 (2.2%)

    2002/03: total n=1932 / # deaths=25 (1.3%)

    For Truthseeker’s interesting take on hazard ratios to be meaningful, we have to accept that there were really about 236 deaths in 02/03 (10% increase)

    But 1932/1232 x 27 x 1.10 is not 236. It is 46.

    We have another question for you. What is the proportion of your organization’s annual funding that comes directly or indirectly from companies that make AIDS relevant drugs and similar?

    We hope it is low. But what is it?

  45. McKiernan Says:

    Excuse me if I may interrupt the ongoing analyses of yet another analysis of statistical analyses of the Lancet article which apparently no one has yet been privy to read and as well the moving of the goals posts from my first inquiry re: “what does Lancet really say since NAR and others got it all wrong.”

    In lieu of any serious discussion thereof, McK proceeds to ask Richard, a question of a personal nature:

    Would you, Richard, recommend that ARV’s be given to any person, adult or child whose only clinical symptom or sign is that they tested HIV seropositive ?

    The answer does not require statistics nor reference to p-reviewed literature.

  46. Richard Jefferys Says:

    My math is indeed terrible, quite possibly worse than your statistics. To reveal my shortcomings in this regard even further, I was thinking that instead of 2.2% of people dying, you were suggesting that 12.2% should have died. But rather you’re saying that 46 deaths in 02/03 would represent a 10% increase, based on a hazard ratio of 1.10 you came up with based on subtracting the difference in hazard ratio from 98-2002/03 (1 vs. 0.96) from the difference in hazard ratio between 98 and 1995/96 (1 vs. 0.87). Is that correct? Have you considered asked a statistician about this at all?

    Your argument, presumably, is that the adjustments to the Cox proportional hazards model (which were for age, sex, transmission risk group, baseline CD4 cell count and viral load, and pre-HAART CDC disease stage) suggest there really should have been 21 additional deaths after one year of ART in 2002/03, even though there weren’t.

    I can’t help but imagine what kind of a response I’d get if I argued that people should ignore the number of deaths in a study in favor of my interpretation of a Cox proportional hazards model.

    To answer McK’s question: No, never.

  47. Truthseeker Says:

    my first inquiry re: “what does Lancet really say since NAR and others got it all wrong.”

    Please do not leave factual error on the blog, if you don’t mind, McK. Once let loose, it is sometimes impossible to retrieve.

    Good question though.

  48. HankBarnes Says:

    Let’s not forget the other side of the equation with these dangerous drugs — their highly dangerous side effects.

    Of course, I cite the Reisler paper in JAIDS from 2003.

    Salient Data:

    1. ~3000 HIV/AIDS patients on HAART for 5 years
    2. No. of AIDS “events”: 332
    3. No. of Grade 4 “events: 675

    Grade 4 events were life-threatening illnesss, attributed to the drugs, not the virus. The most common were:

    1. Liver damage
    2. Neutropenia (white blood cell loss)
    3. Anemia (red blood cell loss)
    4. Cardiovascular, including heart attacks
    5. Pancreatitus
    6. Psychiatric
    7. Kidney problems
    8. Thrombocytopenia
    9. hemorrhage

    Nice drugs, huh? And, these killer side-effects occur more than twice as often as full-blown AIDS.

    With medicine like this, who needs disease?

    Barnes

  49. Richard Jefferys Says:

    Truthseeker, the statement that you got the Lancet study wrong is factually correct. You claimed the Lancet study showed that ART does not reduce mortality, the Lancet study shows no such thing. Your exact statement was:

    “For that policy appears to be to allow people to have ARVs if that is what they insist on, but to point out they do not save anyone’s life (the Lancet having confirmed that only last month)”

    The two year survival in the Lancet study was 97.5% in people that started with a CD4 count around 200. The three year survival was 87.7% versus 9.3% in the above-referenced study of people co-infected with TB. Your statement is completely untrue.

  50. Truthseeker Says:

    My math is indeed terrible, quite possibly worse than your statistics.

    Terrible? What makes you say that? We just didn’t make it clear what we were saying. Anyone can misunderstand what is said here. Or in a paper. But we are merely going by what the paper reports, and if there is a true inconsistency then you have exposed the error, not us, and deserve congratulations. All we are saying is that a rough calculation produces some indication that things have gone South overall since 1995/6 in morbidity and mortality. It is not important to be totally precise and track all the adjustments they made. But the risk ratios clearly show that there have been overall declines, as far as we can see, and trusting their adjustments (which account for differences from the raw data) that is the story.

    You cannot contradict it from the raw data. That is why you have to trust their adjustments. Frankly the whole picture is a huge mess statistically, anyway, we would imagine. But as it stands it sure doesn’t back up the helpfulness of the ARVs which in effect pay your salary – or is that too rude an assumption? You haven’t answered the query, after all, so we have to guess at reality here, based on what is public.

  51. Truthseeker Says:

    “For that policy appears to be to allow people to have ARVs if that is what they insist on, but to point out they do not save anyone’s life (the Lancet having confirmed that only last month)”

    The two year survival in the Lancet study was 97.5% in people that started with a CD4 count around 200. The three year survival was 87.7% versus 9.3% in the above-referenced study of people co-infected with TB. Your statement is completely untrue.

    Which statement is untrue? That they do not save anyone’s life? Or that the Lancet confirmed it?

    These drugs are not claimed to have saved lives, are they? Just to have extended them? That is a statement hard to believe given the evidence of people dying at high rates from ARV liver damage in the US gay community, and of the disgusting side effects that people put up with. If you imagine that HIV is somehow a threat and they rescue the patient from low CD4 counts or somesuch, then you have a hard time asserting this against all the contradictory evidence in general and in the Lancet study in particular (CD4 counts not improved). So where are you looking for the positive effects cancelling death? Even putting off death is probably due to the wide spectrum antibiotics and other drugs added against specific problems, is it not? These drugs improve nutritional factor balance, oddly enough, so you could quote that.

    But these reports of wholesale improvement in outlook go against all logic and evidence, whether you believe in HIV or not.

    To answer McK’s question: No, never.

    So we take it that you take the point, then. despite the Lancet study? Hardly evidence that ARVs save lives, that, unless you have better evidence that the same people without ARVs would have died in greater numbers. And that’s just what everyone is careful enough not to find out – no pure placebo groups in HAART trials since the era began, folks. Not one. Some groups just take more drugs or different drugs than others.

  52. Richard Jefferys Says:

    “It is not important to be totally precise and track all the adjustments they made.”

    They list the adjustments in the paper. And ultimately, you still appear to be arguing that your interpretation of the adjusted Cox proportional hazards model is a more reliable quantifer of the number of deaths that occurred in 2002/03 than the number of deaths that actually occurred.

    Perhaps you should look at the two year analysis, where the 95/96 adjusted hazard ratio is also 1.

    I’ve answered the TAG query before on multiple occasions so feel free to make whatever insinuations or assumptions you want. It is the data that gives the lie to what you’re saying, anyone can read that for themselves thankfully.

  53. Richard Jefferys Says:

    Are you seriously arguing that a similar group of people given a placebo would have had a two year survival rate of 97.5% or greater? If so, the natural history data does not support your argument.

  54. Truthseeker Says:

    I’ve answered the TAG query before on multiple occasions so feel free to make whatever insinuations or assumptions you want. It is the data that gives the lie to what you’re saying, anyone can read that for themselves thankfully.

    That is not an answer. So one presumes that you have some reason to shy away from answering. Is it a secret? If not, why not state who funds your organization and what sums they produce. Do you think they would support NAR? If not, why not? Perhaps they prefer to fund you. Why would that be? Do they ever pat you on the back and say Good job, Jefferys!? If so, why? Does it hinge on your total and consistent support for the solution of AIDS symptoms by knocking out HIV? Would they be as approving if you gave Duesberg a platform to speak, as a way of clarifying and refining your ideas? Would they continue to support you if you suddenly decided to be rational and deplore more drugs as a route to health when people are HIV positive and their intestines, neck, back, and heart are exploding with drug toxicity, without any evidence that HIV has any means of attacking the immune system or that it actually does at all?

    Are you seriously arguing that a similar group of people given a placebo would have had a two year survival rate of 97.5% or greater? If so, the natural history data does not support your argument.

    A normal group would have a normal life span. With ARVs as a lifetime medication, are you seriously saying they would have a normal lifespan? Or are you saying the “similar” group are ill with “AIDS” symptoms already? Then we have to know what the symptoms are that they have, and whether they are being attended to, in the absence of ARVs. No ARVs plus proper conventional treatment for “AIDS” symptoms would yield a longer lifespan, yes, we would predict that.

    Richard, are you in fact capable of examining the evidence and the “natural history” of whatever groups you have in mind without the assumption that the virus is the culprit, then with that assumption, and comparing the two?

    Can you methodically reassess your assumption? If not, then what is the use of your engaging in hand to hand combat over the details? It;s the premise which is at issue, not the details.

    What on earth is “the natural history data”?

  55. Richard Jefferys Says:

    Natural history data compares outcomes between groups of people based on HIV seropositivy, it tells you whether testing positive provides meaningful prognostic information. Same goes for the natural history studies cited above that look at the relationship between CD4 T cell count and prognosis. If you look at the Gambian study, for example, survival is longer in untreated HIV-2 infection compared to untreated HIV-1 infection, but if you restrict the analysis to people with a CD4 count
    These are also examples of natural history studies:

    Bakari M, Urassa W, Pallangyo K, Swai A, Mhalu F, Biberfeld G, Sandstrom E.
    The natural course of disease following HIV-1 infection in dar es salaam, Tanzania: a study among hotel workers relating clinical events to CD4 T-lymphocyte counts.
    Scand J Infect Dis. 2004;36(6-7):466-73.

    43/196 (21.9%) people that were HIV-positive at the time of entering the study died (median CD4 count at last sampling prior to death, 90 cells)

    22/133 (16.5%) people that seroconverted during the study died (median CD4 count at last sampling prior to death, 186 cells)

    20/1558 (1.2%) people that remained seronegative died (median CD4 count at last sampling prior to death 634 cells)

    Rangsin R, Chiu J, Khamboonruang C, Sirisopana N, Eiumtrakul S, Brown AE, Robb M, Beyrer C, Ruangyuttikarn C, Markowitz LE, Nelson KE.
    The natural history of HIV-1 infection in young Thai men after seroconversion.
    J Acquir Immune Defic Syndr. 2004 May 1;36(1):622-9.

    Abstract:

    The natural history and progression of HIV-1 infection in Thailand and other developing countries in Asia and Africa have not been well defined. Nevertheless, valid data are needed to evaluate the effects of interventions, which are designed to delay progression. We evaluated the progression to AIDS and death in 235 men who seroconverted during their 2 years of service in the Royal Thai Army. The men were conscripted at age 21 and seroconverted within a 6-month window during follow-up while in the military. The seroconverters were matched with men who were seronegative when discharged. Of the HIV-positive men, 156 (66.4%) were alive, 77 (32.8%) had died, and 2 (0.8%) could not be located 5-7 years after their seroconversion and discharge from the military. The 5-year survival rate was 82.3%; the median times to clinical AIDS and a CD4 cell count of less than 200/microL was 7.4 years and 6.9 years, respectively. The mortality rate was 56.3 deaths per 1000 patient-years for HIV-positive men and 6.1 deaths per 1000 patient-years for HIV-negative men. Our data suggest a more rapid progression to AIDS and death after HIV-1 infection in young men in Thailand than has been reported for similarly aged cohorts in developed countries.

    – In addition to the mortality and clinical data, this study also contains a table comparing the CD4 counts of HIV positive and negative participants. None of the seronegative particpants had CD4 counts below 200, compared to 37.2% of the positive men. For 201-500 it was 50.8% versus 12.6%, for 501-1000 11% versus 72%.

    Mean CD4s for the two groups were 291.2 versus 767. ‘

  56. German Guest Says:

    Thank you Truthseeker, for giving us some important details of the Lancet Paper, esp. the Discussion part of the paper beginning on p454:

    “The results of this collaborative study, which involved 12 prospective cohorts and over 20,000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period.”

    “An intriguing finding was a reduction in the median time to AIDS, with half of AIDS events in the 2002-3 cohort occurring in the first two months of the 12 month period.”… “We noted that the median time to the first AIDS event after starting HAART decreased over time.”
    May MT et al. HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet. 2006 Aug 5;368(9534):451-8.

    I’d like to hear Richards comment on this matter…

  57. john Says:

    It seems to me that you speak in no way about the same matter.
    Richard speaks about the phenomenon which followed the implementation of certain molecules called tritherapy, at sick persons without treatment said “antiretroviral” or under AZT.
    TS and the others scrutinize the intrinsic evolution in the tritherapy.
    What annoys me, it is that neither some nor the others do not make case of the nature of every used substance.
    All the substances introduced from 1996 lower the viral load and increase the CD4, because they are antioxidizers, oxidation being, according to the Professor Montagnier himself the inescapable passage of the disease.
    But these drugs are different some of the others.
    The lamivudine, one of the most effective new medicines, will certainly be metabolized in cytosine and in miscellaneous little toxic aldehydes, while the emtriva will doubtless form of the much more toxic fluorocytosine.
    That to say aromatic compounds oxidized in phenols (névirapine, lopinavir), which certainly are capable of lowering the viral load, but which metabolites are hypertoxic.
    The last straw doubtless returns to tenofovir, which is an antioxidizer by its connection carbon phosphorous, but the toxicity of which connected to the phosphonate group is not to be any more demonstrated.
    So, in this blind research (because by screening) of substances capable of reducing the viral load, we finally have deteriorated the situation, by misunderstanding of the chemistry of these compounds.

  58. German Guest Says:

    @john

    It seems to me that you speak in no way about the same matter.

    I was just referring to TS and Richards dispute about the results of this controversial collaborative analysis.

    So, in this blind research (because by screening) of substances capable of reducing the viral load, we finally have deteriorated the situation, by misunderstanding of the chemistry of these compounds.

    Thank you for this one!
    Lamiduvine – you regard this as one of the most effective new medicines – has absolutely no effect in a big number of HIV+ patients and should therefore only be used with “closed meshed supervision”. You know, in Germany we have those Red-Hand-Letters in case of sudden and unexpected side effect of drugs. One of those letters was concerning Lamiduvine. One important comment in this letter was, that Glaxo had absolutely no clue why Lamiduvine is ineffective so often and whether this might (or might not) be attributed to cross-reactions with NRTIs or NNRTIs.

    Just in case you want to have a look at the letter: “wichtige Mitteilung über ein Arzneimittel”

  59. john-2 Says:

    Noble, Jeffreys, Trrll (or however you spell it)et al.

    I think you all had better READ THIS to see what a REAL MISTAKE in A PRESTIGIOUS ecclesiastical publication by a bishop of your church looks like.

    And you sad sack clowns dump on Duesberg all over the net for ten years about whether 400 or 40 angels can dance on the head of a pin.

    If so many hadn’t died, you would only be a bad joke. As it is, the whole bunch of you are criminals and deserve the same fate as Rumsfield, Cheney and Bush.

  60. Wilhelm Godschalk Says:

    One thing that strikes me is the heavy emphasis on statistics with regard to the Lancet article.
    Of course this is understandable if you’re hellbent on proving something that’s not supported by controlled studies.
    Under “controlled studies” I don’t just mean there should be a control group (which is usually not done on the pretext of being “unethical”), but also keeping all variables not directly related to the study constant. Now this last requirement for a valid study is often ignored in the magic and wondrous science of HIV/AIDS.
    Aaron Katchalsky, a well-known biophysicist (who become even more well-known later on as A. Katzir, president of Israel) once said about the then popular curve-fitting techniques: Give me 5 parameters, and I can fit an elephant. And he was right (I tried it in my spare time).
    If we talk about “mortality”, what do we mean? Dying from what? AIDS? AIDS-defining diseases? Or liver failure and other uncontrolled catastrophes caused by the drugs?
    The same holds true for morbidity: Being sick and feeling lousy can have many causes, not the least of which are the direct result of the drugs themselves.
    T4-counts have not been found to bear any relationship to any kind of disease. Not even a correlation, let alone causation.
    It is also (to put it mildly) questionable to compare a cohort with a population of earlier years. What changed in those years? Did the way patients were treated change over time? Were the drugs different then? Mono- or combi-therapie? What about dosage? At what point did treatment start, in terms of CD4-count? Were the patients of yesteryear on the average sicker when they started to be treated than they were in later years?

    Naturally, ignoring all these variables, and only presenting the results that seem to confirm a preconceived notion, is an art, not a science. And in that art the HIV/AIDS proponents have reached incredible heights. And I mean the word “incredible” literally.

  61. McKiernan Says:

    So Wilhelm, your conclusion is that Lancet got it wrong and so does NAR And Richard for bringing us all up to date on how convoluted the statistical wizardry can spin it to suit ones pet theories. Right ?

  62. john Says:

    German Guest

    Unless I do not more know how to read german, it seems to me that it is rather tenofovir which is questioned in this study, no?

    Ausser wenn ich deutsche Sprache nicht mehr lesen kann, scheint es mir, daß eben tenofovir lieber in diesem Studium gezweifelt ist, nein?

    Here is a publication which shows that the 3TC works better than HAART to persons to whom the “virus” underwent a “mutation” which would make it resistant to the 3TC exactly.

    Link

    We can logically deduct from it taht the “mutation” M184V is a chemical marker of the presence of lamivudine, rather than a hypothetical mutation of the virus.

  63. German Guest Says:

    @john:

    I must admit my logical thinking ability is probably way too restricted to understand the meaning of such statements:

    “CONCLUSION: In HIV-1-infected patients harbouring a lamivudine-resistant virus, lamivudine monotherapy may lead to a better immunological and clinical outcome than complete therapy interruption.”

    I’m somehow more convinced by your german language skills!

  64. john Says:

    Thank’s.

    Yes, German Guest, this sentence seems completely inept, but if we study well the publication, we realize that what what they calls lamivudine resistant-virus is in fact a “virus” which became resistant in the lamivudine-AZT combination. And that the suppression of the AZT allowed the clinical improvement.

    However, the “mutation” M184V who had appeared when lamivudine was added to AZT, remained in this place after the suppression of the AZT; that is why I say that this “mutation” is in fact a chemical marker of the presence of lamivudine, and that it is AZT (of course), that make these peoples sick, and not the “resistance” of one “virus”

  65. john Says:

    I forgot to say that, in this study, lamivudine well seems to thwart the long-term lethal effects of AZT

  66. Dan Says:

    German Guest,

    I’ll have to join you in not understanding a statement that appears to contradict itself.

    But…I don’t understand a lot of statements coming from HIV/AIDS research. Maybe I’m just too literal.

    Here’s another quote from an earlier post of yours: The results of this collaborative study, which involved 12 prospective cohorts and over 20,000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up

    Now, how do I read this? Well, without the friendly “help” of some of our AIDS promoters, I would say that it looks like folks’ numbers are “good”, but they’re still getting “AIDS” and dying. Then, my simple, logical deduction would be that it’s time to try something else. Of course, maybe I just don’t “understand”. Maybe my view is just too simple. But I thought the idea was to keep people from getting sick and dying.

    Richard, hi. Can you avoid answering a question again? If people are dying while on HAART, is HAART saving lives? Is this question too simple and straightforward for you? Do we need to cite a study now from Dar Es Salaam and run away from the truth?

  67. noreen martin Says:

    Dan, alot of us have this simple view and are flushing these meds down the toilet so to speak. When the cure is as bad as the disease, something is drastically wrong. It’s time for a new approach, even, if it involves natural products, harmless drugs and non-traditional therapies. Everyone can volly the ball back and forth about this theory and that study, how ever entertaining, many of us are living it out in real life, maybe our theories should count for something.

  68. john-2 Says:

    Dan,

    It is obvious, is it not, that if these people had not been on ARVs that MANY more of them WOULD have died?

    How can you possibly deny that given the rigorous, quantifiable, severely peer-reviewed inspiringly-authored and abstracted in the PubMed databases? You must be a scientific as well as a mathematical moron.

    BTW I really, really urge you to have a look at the READ THIS that is now lost forever above. Even though it was not posted so very long ago, its import seems to have been diluted considerably in the interim.

    I also might hazard (sic) a guess that the comments by Dr. Knobless and Undergrad(XX/XY) that are found in the discussion of “Logical Fallacies” will be replicated by major scientific thinkers and public opinion makers such as JP Moore and Tara Smith and their pathetic ilk.

  69. Richard Jefferys Says:

    Dan, does the fact that people can die despite TB treatment mean that TB treatment doesn’t save lives? How about CPR?

    Just look at table 4 and webtable 3 of the Lancet paper. In the most recent period, 94% of people are free of AIDS events and 98.7% are alive after one year of ART. After two years of ART, 92% of people are free of AIDS events and 97.5% are alive. I would much prefer that both percentages were 100 but I find it amazing that people like Neville Hodgkinson, David Steele and the owner of this blog would imagine that the data somehow supports their false claim that ART is ineffective. The data are the data Dan, citing a natural history study which unequivocally demonstrates the risk of immunodeficiency and death associated with HIV infection hardly strikes me as running away from the truth. Treatment decisions in any illness are about risk/benefit, pretending that there are no risks associated with HIV infection and thus that people risk drug toxicity for no reason is just fraudulent.

    As for the timing of AIDS events, the increase in TB and decline in starting CD4 counts are likely to have played a role but, thankfully, it did not translate into an increase in mortality.

    Wilhelm claims CD4 T cell counts have not been shown to correlate with anything…Wilhem, do you really believe that the risk of disseminated MAC or CMV retinitis is no different in someone with >500 CD4 T cell count versus someone with
    John, do you have any thoughts on the mutations in hepatitis B reverse transcriptase that are associated with 3TC resistance?

  70. German Guest Says:

    Hi Dan and John,

    there are lot of open questions. But one thing is for sure: The AZT patent (Glaxo) expired in September 2005. I wouldn’t be very surprised if some new studies prove quite soon that AZT is ineffective and has longterm lethal effects.

    Meanwhile the “Biodefense and Pandemic and Vaccine and Drug Development Act of 2005” will quarantee that:

    “a manufacturer, distributor, or administrator of a security countermeasure, or a qualifed pandemic and epidemic product, described subsection [b,1,A] or a health care provider shall be immune from suit or liability caused by or arising out of: the design, development, clinical testing and investigation,manufacture, labeling, distribution, sale, purchase, donation, dispensing, prescribing, administration, or use of a security countermeasure, or a qualified pandemic and epidemic product.”

  71. pat Says:

    “Dan, alot of us have this simple view and are flushing these meds down the toilet so to speak”

    I think really flushing them into the water system might be concidered an environmental crime.

  72. john-2 Says:

    German Guest:

    You do not have to wait. This ONE proved it conclusively in 1994 !

    I keep trying to get you folks to look at it, but thus far to no avail.

    Gezay gezunct!

  73. Truthseeker Says:

    And you sad sack clowns dump on Duesberg all over the net for ten years about whether 400 or 40 angels can dance on the head of a pin.

    True, and one probably shouldn’t encourage it, because neophytes get the impression that the picayune rebuttals justify the disastrous main scheme.

    But just to add one angel, if you look closely at Table 4 of this masterwork (the Lancet HAART study showing the situation as deteriorated under HAART) you see some evidence that introducing HAART had a rather unpleasant effect.

    AIDS events risk went from 1.07 to 1.30 from 1995/6 to 1997, a statistically significant jump of about 22 per cent = people got a lot sicker in the first year they were treated.

    Also, the risk of death (adjusted hazard ratio) went from 0.87 to 1.12, a 29 % jump, which is not actually statistically significant, as it happens, but makes one wonder. Certainly things more likely went in the wrong direction, rather than improve significantly.

    And why should they? There is no good evidence they were directed at the right thing. Any beneficial effect was surely a fluke.

    The whole HAART study shows that things have not improved, in fact they have gone South, under HAART, and as far as one can tell, its introduction didn’t do anyone any good.

    But of course, one cannot say for sure because there are no HAART clinical trials with a placebo group. You simply cannot tell for sure.

    Is this what they might call “non-study by design”?

    What are they afraid of? It is all too clear.

  74. Dan Says:

    Richard,

    I certainly don’t hear the words “life-saving TB drugs”. I DO hear the propaganda-ish phrase “life-saving AIDS drugs”. If people are still dying while taking these drugs, then they AREN’T life-saving now, are they? It’s oh so simple, Richard, but you’ll have to break out that Dar Es Salaam study now.

  75. john-2 Says:

    Mr. TS,

    It appears that you as well have gone off into the weeds, as professional bloggers like to call it, and are more concerned with arguing scholastic finery with Mr. Dickhead than paying any attention to the DEVASTATING post that is, for your easy of durfing, once more LINKED HERE.

    But perhaps it is indeed on your NAR staff’s agenda, and you felt it necessary to make one last effort to demonstrate something scientific to the Dick.

    “We” hope so. 🙂

  76. McKiernan Says:

    john-2,

    It doesn’t count since they only had twice as many deaths in the group on AZT and only 4 times as many AIDS events. It could be a printing error.

    Do you have any more trump cards ?

  77. john-2 Says:

    Hey McK,

    That ain’t one I have ever heard before. So how should the erratum read?

    ERRATUM: The paper by Goedert et al. contains an unfortunate error that was introduced in the PRODUCTION process, post editorial review, by some sloppy or worse a denialist worker who you can be sure has been summarily dismissed. The error is a simple one to correct, and to miss, and that is the reason we did not print this minor erratum earlier.

    All that needs to be done to TOTALLY ameliorate this, we repeat VERY minor error is to MOVE the decimal point one place to the left in the AZT line.

  78. McKiernan Says:

    john-2,

    That would help a lot . They could have included it here:

    Erratum in:

    * Lancet 1994 Oct 29;344(8931):1238.

  79. john-2 Says:

    Yes they could have. But did they?

    Perhaps you would like to quote the erratum they did publish?

  80. Richard Jefferys Says:

    Dan, to follow your logic, if people are still dying despite CPR then CPR isn’t life-saving now, is it? It’s oh so simple, Dan.

    And being facetious about the Dar Es Salaam study isn’t funny to me at all. Those were/are real people, and the people that avoided HIV infection had a ~1 in 100 risk of dying during follow up compared to a ~1 in 6 risk for people that became HIV infected during the study and a ~1 in 5 risk for people that were seropositive at study entry. Is that really a joke to you?

    As for TS revisiting hazard ratios, I will spare you my clumsy attempts at explaining how wrong-headed this is by asking an actual statistician. But to be arguing that a decrease from 2.2% to 1.3% is actually a 29% increase…doesn’t make any sense to me, sorry. Note also that TS has avoided applying his hazard ratio logic to webtable 3 which contains the analysis two years after starting ART.

  81. German Guest Says:

    john-2, McKiernan:

    I thought of a printing error as well. I pray – at least for Robert Gallo and Glaxo – those numbers are wrong.

    Of course, we know this table reflects reality. Of course Gallo, Glaxo and CDC know this is reality. Therefore, I predict a smooth renunciation from AZT during the next 1-2 years or so. This will happen silently in order to avoid public debate about the adverse health effects of AZT in 1986-1995 when daily dose was 1.500 mg.

  82. Richard Jefferys Says:

    The Goedert paper doesn’t contain an error, you’re just muddying correlation and causation in this instance because it serves your purposes to do so. The FDA reduced the recommended dose of AZT at the beginning of 1990 (might have been the end of 89 actually). The oft-repeated claim that 300,000 people took high-dose AZT is farcical, if you want to make an accurate claim, get the sales data from IMS.

  83. Dan Says:

    Richard,
    you can attempt to twist and turn this all you like, but if people are dying on HAART, then HAART isn’t saving lives. End of story.

  84. john-2 Says:

    Dick,

    You did not really type this did you?

    you’re just muddying correlation and causation in this instance because it serves your purposes to do so

    I am sure it is some denialst saboteur who posted this under your name. Please confirm asap or there will not be a dry eye in the blogsphere.

  85. john-2 Says:

    Dick,

    BTW, on the off chance that that was you. Your are right. The paper contains NO ERROR. The only error was the author’s in not having the cleverness to see and remove that AZT data prior to submission. When first one practices to deceive, etc. as Pope David and Cardinal Gallo and a few others have discovered with the loss of their reputation among their former real peers, if not among the public thanks to the ever obedient, lap-dog media that serves AIDS, Inc.’s every desire.

  86. john-2 Says:

    A distinguished, by his writing, commenter at Hank’s, “George”, has just posted this:

    There may be some who are wondering if the “Errata” to this paper that is inthe upper left of the PubMed entry perhaps relates in some way to this post.

    For your benefit, and theirs, here is the errata:

    Risks of immunodeficiency, AIDS, and death related to purity of factor VIII c…
    Goedert, James J; Cohen, Alan R; Kessler, Craig M; Eichinger, Sabine; et al
    The Lancet; Sep 17, 1994; 344, 8925; Academic Research Library
    pg. 791

    Corrections
    The Lancet; Oct 29, 1994; 344, 8931; Academic Research Library
    pg. 1238

    My they were careful when they read the article in pages. How did they miss the AZT line? Angels perhaps at play in the atemporal hypercontinuum, otherwise known as when the chickens come home to roost.

  87. john Says:

    Richard says

    John, do you have any thoughts on the mutations in hepatitis B reverse transcriptase that are associated with 3TC resistance?

    The M512V “mutation in hepB virus polymerase (and not Reverse transcriptase, HBV is not a retrovirus)? (ATG gives GTA ?)
    Yes, but it is strange to notice that finally it is the same alteration as for the RT of the “HIV”. What means that we can also consider it as a marker. But apparently, placed in position 512 of the polymerase, this modification returns maybe this one less oxidizible, (there is not sulfur anymore) and thus, in return, the lamivudine has no more its antioxidant effect

  88. Truthseeker Says:

    As for TS revisiting hazard ratios, I will spare you my clumsy attempts at explaining how wrong-headed this is by asking an actual statistician. But to be arguing that a decrease from 2.2% to 1.3% is actually a 29% increase…doesn’t make any sense to me, sorry. Note also that TS has avoided applying his hazard ratio logic to webtable 3 which contains the analysis two years after starting ART.

    Richard, perhaps you are the wrongheaded one. You cannot argue from the crude figures. What is there about “adjusted” and “crude” you cannot understand without asking a statistician? And if you have to ask a statistician, surely you should refrain from making statements until you have done so. The two years table yields similar results, you will find.

    Defending the HAART study as somehow not showing an abysmal scene of medication which immediately had some bad effects and is now having ever less effect on rescuing patients from sickness and death even after the reduction of AZT as a dark angel is just whistling in the wind, since even the authors of the study (done with especial separation at every stage from the funders of the study, they note in a special note, which they feel is a point to be made, Richard, what do you think of that impulse?) feel very much like cats on a hot stove when they contemplate the results of their work. HAART hasn’t helped the influx of the new kind of AIDS patients, who are sicker earlier.

    Let’s be honest, the study suggests that HAART performs increasingly poorly in returning people to health, but at least it is better than AZT, which is still included but in much lower doses. Lower AZT results in people living longer, common sense and natural history indicates.

    And by the way, when you say The oft-repeated claim that 300,000 people took high-dose AZT is farcical , how many AZT deaths do you count? And is the lower total something that comforts you in some way?

    However, here’s an argument you might like to use. The TB patients from Africa are similar to those that Max Essex a number of years ago found in Uganda who cross reacted on the HIV test to yield positive readings eight to ten times more often than the population without TB. So maybe a large proportion of these new AIDS patients are not really HIV positive at all. If you get them out of the picture, perhaps HAART is doing better than this study suggests.

    Feel free to use that one if you want.

    It appears that you as well have gone off into the weeds, as professional bloggers like to call it, and are more concerned with arguing scholastic finery with Mr. Dickhead than paying any attention to the DEVASTATING post that is, for your easy of surfing, once more LINKED HERE.

    Please state what links refer to if posting them here. If you want to comment, on it, comment. Certainly we look forward to Richard’s response. Richard?

    In the light of that finding, AZT Lethal for Hemophiliacs, and your comment above, Richard,

    The oft-repeated claim that 300,000 people took high-dose AZT is farcical, if you want to make an accurate claim, get the sales data from IMS.

    We wonder if you now accept the lethality of AZT, the culpability of all involved. and the fact that whether it was 300,000 or 300,000 – x deaths makes no difference?

    Quote from Hank:

    the risk of hemophiliacs on AZT developing AIDS was 4.5-fold elevated, and they were more than twice as likely to die. How ya like them poisoned apples!

    If AZT is a killer, what about HAART?

  89. Pharma Bawd Says:

    “Let’s be honest, the study suggests that HAART performs increasingly poorly in returning people to health,…”

    I’m curious TS. What was the adjusted hazard ratio for death in the year 2001?

    Does that influence your conclusions at all?

    Should it?

  90. Richard Jefferys Says:

    TS wrote:

    “Let’s be honest, the study suggests that HAART performs increasingly poorly in returning people to health.”

    No, you’re being completely dishonest because it suggests nothing of the sort. 92% free of AIDS events at two years, 97.5% of people alive. Those are the numbers after two years of follow up of the cohort of 2,783 people that started ART in 2001. The adjusted hazard ratios only come into play for the comparison with the reference year that the researchers picked (1998), those comparisons do not alter the number of people that experienced AIDS events or died in 2001 (am I anywhere close to getting this point across?).

    Despite your attempts to suggest otherwise, statistically there are no significant differences between the periods (although there is a trend for AIDS events that is associated with the increased numbers of people with TB). And because few people died or progress during the first two years of therapy, it will require additional follow up to find out if newer drugs have improved long term prognosis.

    And are you really arguing that it’s wrong to say that fewer people died after two years of ART in 2001 versus 95/96 when the % is 2.5 versus 4.3 and the adjusted hazard ratio is 0.95 versus 1? It would be wrong to say significantly less people died, but also grotesquely inaccurate to try and claim that more people died.

  91. Richard Jefferys Says:

    In this study digoxin use significantly predicted greater mortality following cardiac arrest (hazard ratio 4.5). Does anyone think that means digoxin is dangerous killer that should not be used?

  92. McKiernan Says:

    YES

  93. Truthseeker Says:

    Well, the adjusted hazard ratio for 2001 mortality is 0.87 (95% CI 0.61-1.24) which is pretty close to the original 1995/96 measure of 0.87 (0.56-1.36) but of course the confidence spread is so wide there is no evidence that anything has happened at all at any stage in the mortality rates, it could all be rather flat as indeed the Web table for 2 years shows.

    There is nothing statistically significant shown in the mortality rates and we wouldn’t claim otherwise, but the figures for AIDS certainly suggest things are getting out of control, and they include AIDS deaths, which include TB. This is not a clinical trial, sadly enough, because one with a proper placebo group would tell us exactly what we need to know: does HAART help or hinder?

    Let’s just say that the visible trend may not be correct, and the fact it is a jump as calculated for the first year doesn’t allow one to be sure of it but it is highly suggestive of a bad first year and no improvement since. With HAART things are not much better than 1996, for sure, and we have had ten years to see what has happened.

    No, you’re being completely dishonest because it suggests nothing of the sort. 92% free of AIDS events at two years, 97.5% of people alive. Those are the numbers after two years of follow up of the cohort of 2,783 people that started ART in 2001. The adjusted hazard ratios only come into play for the comparison with the reference year that the researchers picked (1998), those comparisons do not alter the number of people that experienced AIDS events or died in 2001 (am I anywhere close to getting this point across?).

    No argument here. The issue is the trend to more AIDS earlier that worried the authors and the rest of the world when this study appeared. To this we added our suspicions of more deaths, indicated but fogged in by lack of statistical significance. Does the number of AIDS events and deaths make HAART a winner? Not to us. We would expect them have zero of either if properly medicated and not attacked by HAART on a spurious basis. Let’s compare them to a group free of ARV drugs, Richard. Oh, but that isn’t allowed, is it? Why not? Why no placebo group in ten years? Ethics? Or convenience?

    Despite your attempts to suggest otherwise, statistically there are no significant differences between the periods (although there is a trend for AIDS events that is associated with the increased numbers of people with TB). And because few people died or progress during the first two years of therapy, it will require additional follow up to find out if newer drugs have improved long term prognosis.

    No argument there.

    And are you really arguing that it’s wrong to say that fewer people died after two years of ART in 2001 versus 95/96 when the % is 2.5 versus 4.3 and the adjusted hazard ratio is 0.95 versus 1? It would be wrong to say significantly less people died, but also grotesquely inaccurate to try and claim that more people died.

    We are going by the authors of the study who calculate hazard ratios to suggest that things are worsening but without it emerging from statistical questionability. But we can say they have not shown any improvement. Can we say more people are dying? Not with any certainty, but that is the trend to 2002/3 which could well be wrong but that is the calculation.

    At the moment we agree that it is probably the TB factor which is causing the deterioration in sickness and the possible deterioration in mortality (which you don’t accept as a given, which position is valid). We two of us disagree with the general impression created by the study in counting the number of deaths and the sickness, however. You think it is a tribute to the success of HAART in preventing further sickness and death. We think it is an indication of the fact that HAART helps everyone into their bed and grave.

    Give us a placeboed study and we would know who was right.

  94. Richard Jefferys Says:

    “Give us a placeboed study and we would know who was right.”

    So am I right in thinking that your hypothesis, based on the literature to date, is that two year survival on placebo for people starting with 200 CD4 T cells would be equal to or greater than 97.5%?

    You are of course correct that any ethical review board in the world would look at the literature (particularly the natural history data) and say no to that study. I’m afraid that as much as you’re comfortable maligning their integrity from your position as a journalist, the review boards would be right. To pretend that there isn’t information on what happens in untreated HIV infection is not just denying AIDS, it’s denying the existence of PubMed and denying what happened to the people that contributed data to studies like those cited above. Still, despite its shortcomings in terms of potential bias, perhaps someone will find a way to do the study that’s been suggested by people that genuinely want to volunteer for the no treatment arm. If so, I hope they manage to do it in a way that involves a DSMB.

    “There is nothing statistically significant shown in the mortality rates and we wouldn’t claim otherwise, but the figures for AIDS certainly suggest things are getting out of control, and they include AIDS deaths, which include TB”

    Out of control? In the most recent period analyzed, 199/2421 people starting out with an average CD4 count of 200 experienced AIDS events by two years of follow up. The increased contribution of TB did not translate into an increase in mortality, which is consistent with the dramatic three year difference in survival in the Thai study comparing ART vs no ART in people with TB &HIV (87.7% versus 9.3%).

  95. Truthseeker Says:

    So am I right in thinking that your hypothesis, based on the literature to date, is that two year survival on placebo for people starting with 200 CD4 T cells would be equal to or greater than 97.5%?

    That would depend entirely on their symptoms whatever they were, and whatever they signified outside the HIV∫AIDS belief system, but for those with HIV+ and no symptoms that would be the expectation, yes, 100% survival, 100% health, minus whatever the non-AIDS problems might be for their group and locale.

    You are of course correct that any ethical review board in the world would look at the literature (particularly the natural history data) and say no to that study.

    That would be unethical, and evidence a serious inattention to the literature, which both in critical review of HIV claims and in mainstream studies assuming HIV∫AIDS ideology has revealed such a thundering horde of problems that anyone who gives medication of any kind posited on the paradigm is either medically illiterate or shamefully ruthless in dealing with patients, and totally self indulgent in examining his/her own beliefs. No offense to present company, we hope, whose distinguished qualities as a defender of the idol with clay feet are fully recognized and respected here.

    Still, despite its shortcomings in terms of potential bias, perhaps someone will find a way to do the study that’s been suggested by people that genuinely want to volunteer for the no treatment arm. If so, I hope they manage to do it in a way that involves a DSMB.

    A proposal precisely indicative of your outstanding qualities as thorough PubMed researcher and patient discussant that we ascribed to your distinguished self.

    Out of control? In the most recent period analyzed, 199/2421 people starting out with an average CD4 count of 200 experienced AIDS events by two years of follow up. The increased contribution of TB did not translate into an increase in mortality, which is consistent with the dramatic three year difference in survival in the Thai study comparing ART vs no ART in people with TB &HIV (87.7% versus 9.3%).

    Ten per cent were accelerated into AIDS sickness, when otherwise they might have been OK, if their TB had been treated without sickening them with ARVs which their liver and kidney had to deal with. Haven’t read the Thai study, sorry. Certainly sounds impressive, as these things always do until you take the lid off. Nearly four out of five saved from dying with ARVs, over three years? Zowie! Maybe this stuff is the magic elixir after all.

    So your answer to my question is that Yes you think ARVs are entirely appropriate to beat back TB? This is exciting! Do you think they would work for colds and flu? Anti…viral, after all. Are you willing to experiment together? We could see which belief system proved out!

    We hope they controlled for other factors.

  96. German Guest Says:

    Dear Mr. Jefferys:

    for now and forever, reduced mortality in AIDS-patients occures independently from HAART!

    “In our institution, mortality from severe PCP requiring admission to the ICU fell, from 71% before mid-1996 to 34% subsequently, despite the fact that no patient received HAART prior to or during admission to the ICU. These survival figures are similar to those reported by Morris et al [28]. In our study the observed improved

    survival cannot be ascribed to HAART.”

    Thorax. 2006 Aug;61(8):716-21. Epub 2006 Apr 6.

  97. German Guest Says:

    direct link to Thorax-online:

    Thorax 2006;61:716-721

  98. noreen martin Says:

    Unofficially, this is being done with Dr. Bihari’s patients and by other progressive physicians. As I have suggested before, put LOW DOSE NALTREXONE up against HAART. This should make both sides happy because the patient is on a drug. The down side is that if LDN fares better, the drugs companies will have egg on their faces because it costs about $25.00 per month and it doesn’t have the side effects of HAART. 7 months and counting!

  99. Michael Says:

    German Guest,

    The Thorax study and conclusions were fascinating:

    Results: Fifty nine patients were admitted to the ICU on 60 occasions. Thirty four patients (57%) required mechanical ventilation. Overall mortality was 53%. No patient received HAART before or during ICU admission. Multivariate analysis showed that the factors associated with mortality were the year of diagnosis (before mid 1996 (mortality 71%) compared with later (mortality 34%; p = 0.008)), age (p = 0.016), and the need for mechanical ventilation and/or development of pneumothorax (p = 0.031). Mortality was not associated with sex, ethnicity, prior receipt of sulpha prophylaxis, haemoglobin, serum albumin, CD4 count, PaO2, A-aO2 gradient, co-pathology in bronchoscopic lavage fluid, medical co-morbidity, APACHE II score, or duration of mechanical ventilation.

    Conclusions: Observed improved outcomes from severe PCP for patients admitted to the ICU occurred in the absence of intervention with HAART and probably reflect general improvements in ICU management of respiratory failure and ARDS rather than improvements in the management of PCP.

    I can’t help but wonder if the 71% mortality of PCP cases before pre mid 1996 were also in large part due to high dosage AZT.

  100. Wilhelm Godschalk Says:

    So Wilhelm, your conclusion is that Lancet got it wrong and so does NAR And Richard for bringing us all up to date on how convoluted the statistical wizardry can spin it to suit ones pet theories. Right ?

    Yes, that is my conclusion. There is a lot of hanky-panky going on with statistics. You can always recognize it by the way they jump back and forth from absolute numbers to percentages.

    How does the following statement strike you?
    “In the early seventies, the UVa. Medical School tripled its enrollment of black students.”
    Completely true. But what it meant was: Instead of one token black, there were now 3 admitted.

    And this one:
    “Dr. Wen-Dom Wok has been able to predict 100% of all turns in the stock market.”

    Maybe he did. But what he simply predicted a turn in the market every single day! That way he never missed a single one. He remained silent about the days when the market just continued in the original direction.

    Schmatistics? Bah. If you use it, do it right.
    Bad statistics make good (?) journalism.

  101. Wilhelm Godschalk Says:

    John wrote:

    I forgot to say that, in this study, lamivudine well seems to thwart the long-term lethal effects of AZT

    There is a purely chemical explanation for that, pointed out to me by a French chemist. AZT is, apart from a DNA chain terminator, a strong oxidant because of the azido group. Lamivudine has anti-oxidant qualities, because it has a sulfur-containing ring, which can be opened up under physiological conditions, producing a thiol (-SH) group.

  102. McKiernan Says:

    Wilhelm,

    Thank you, yes, statistics are misused, that’s for sure.

    And the reference in ‘Oncogenes’ on page 209 under prediction number nine wherein it is announced (Duesberg) that 275,000 random sexual contacts are necessary for transmission of the hiv virus including its reference to Padian can be placed in the error file.

  103. Wilhelm Godschalk Says:

    Richard Jefferys wrote:

    Wilhem, do you really believe that the risk of disseminated MAC or CMV retinitis is no different in someone with >500 CD4 T cell count versus someone with
    No, I don’t really believe that. But my thoughts on the subject run a little deeper. I’m getting the impression that CD4 T-cell counts in healthy subjects run all over the map, both individually and on a time basis. This would be easy to check, by doing counts on a large cohort of healthy subjects.
    But I’m afraid that won’t be done for two reasons: 1. Nobody is making a buck off that kind of study. 2. The old lawyer’s credo: “If you think you won’t like the answer, don’t ask the question.”
    If CD4 counts vary in a natural way, a low count could mean nothing in terms of susceptibility to infectious disease. But if the immune system is already in bad shape, there is, of course, a structural reason for low T-cell counts.
    Anyhow, I see no reason why, if a subject’s CD4 count comes out low, we should destroy his immune system further by administering toxic drugs. Doesn’t it make more sense to build up immunity again? (For example, with lemons, garlic, and olive oil, as Tine van der Maas does in South Africa).
    Practicing physicians still assume (correctly) that a high count of white blood cells means there’s an infection going on. Why does HIV/AIDS science put everything on its ear by saying that a high count of a certain sub-class of these cells is suddenly a sign of good health, while a low (resting) count is bad news that requires drastic measures?

    John, do you have any thoughts on the mutations in hepatitis B reverse transcriptase that are associated with 3TC resistance?

    Well, I’m not John, but I would be very interested too in his views on this subject.
    My question: What has a vague virus such as Hepatitis B (Hey! I’m NOT saying it doesn’t exist, OK? Hep-C is the nonexisting one) to do with reverse transcriptase? Is Hep-B now a retrovirus, all of a sudden? What if all these reverse transcriptases were endogenous after all?

  104. john Says:

    Hey, Wilhelm,
    I have already answered it.

    Link

    I also discovered that électrophiles as NO+ was capable of accelerating the opening of the acetalic ring of lamivudine, to release glycolic aldehyde , probably used by the aldehyde réductase to reduce nitroantibiotics, isoxazoles ( bactrim )… (Carey and Sundberg).

    Finally, it is possible that lamivudine exerts its antioxidizing action only in an already very “oxidized” cell, where from its weak pharmacological toxicity. The haserd makes sometimes well things.

  105. Truthseeker Says:

    The adjusted hazard ratios only come into play for the comparison with the reference year that the researchers picked (1998), those comparisons do not alter the number of people that experienced AIDS events or died in 2001 (am I anywhere close to getting this point across?). – Jefferys

    Oh oh, reading this over, Richard, this is all wrong, so we hope that our response “No argument here” can be rescinded. Let’s repeat. Essentially what you have said and continue to say based on the raw percentages is misplaced, because it is the adjusted hazard ratios you have to go by, since you don’t know how each of these groups year by year were made up by other smaller groups with differing characteristics. Maybe one group was 900, and were followed for two months, and no one died. Maybe another group of 100 was followed for the year, and ten died. For the total of 1000, one would not say Aha! 1 per cent died. Nor that 11 out of 1000 was the number to use for comparison. That is what ‘adjusted’ means and represents: the effort we have to make to straighten out the raw data.

    Regrettably, you seem to continue to labor under what Walter Kerr called a “delusion of adequacy” in regard to your primitive analysis. Ask a statistician. Ask your colleague in HIV apologia, Chris Noble. Where is Chris Noble, by the way? Have you noticed that he has kept out of it? Why would that be, do you wonder? Because even he cannot rescue you from your error, we would say.

    Bottom line, HAART stinks by all indications, and its atrocious effects are reflected by the Lancet study in three respects – 1) a statistically insignificant but visible indication of a sharp rise of 29% in overall mortality when it was introduced, when one would have expected it to go down if HAART did any immediate good, 2) a good indication that that deterioration was maintained, and 3) a statistically significant rise in AIDS symptoms and mortality. The stuff ain’t good for you, Richard, face it. In fact we are told that you have already published your own skepticism in the form of support for immunologically helpful solutions.

    And by the way, with such brilliant results in curbing HIV load, and no improvement whatsoever shown in one or even two years in the condition of patients, doesn’t that tell you something about the relevance of HIV to the disease. Or should we spell that i-r-r-e-l-e-v-a-n-c-e?

  106. Robert Houston Says:

    Truthseeker’s interpretation of the superiority of adjusted hazard ratios versus crude percentages for the morbidity and mortality results in the Lancet study, which involved data from multiple disparate cohorts, is correct and would be in accordance with the views of sophisticated data analysts. These include the statisticians, epidemiologists and medical experts who co-authored the study and chose to use adjusted hazard ratios – not crude percentages – in reporting morbidity and mortality results in their text and abstract.

    Richard Jefferys understandably assumed that simple percentages based on raw numbers would be a guide to the direction and limits of the results. While this may be the case for a properly controlled clinical trial, the Lancet study was not a clinical trial. It was an analysis of data from multiple cohort studies in 12 different centers. For such data to be meaningful, sophisticated techniques and adjustments are needed for comparability. Otherwise, the results would be swamped and distorted by arbitrary differences in the size of particular cohorts and the particular biases in their data.

    “The adjusted hazard ratios only come into play for the comparison with the reference year that the researchers picked (1998)…”

    The above statement by Mr. Jefferys is also in error. Since the adjusted hazard ratios for different years were expressed in terms of the results for 1998 (which equalled “1”), they can be compared proportionally with each other, as is true of any values divided by the same constant ie coding by division (see the early section on coding in any basic textbook on statistics).

    Elsewhere, it’s been asserted by Mr. Jeffreys that none of the reported changes over the years of the study were significant. This is also incorrect. The increase in the risk of AIDS events (“including AIDS-related deaths”) from 1998 compared with 2002-2003 went from 1.00 to 1.35 (95% confidence interval: 1.06-1.71). Because the confidence interval starts higher than the 1.00 of 1998, the increase is statistically significant (p

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