CHAPEL HILL - Hoping to bury the destructive notion that HIV, the virus that causes AIDS, is not the cause of the illness and global epidemic and to eliminate misinformation, more than 5,000 prominent AIDS experts, other doctors and scientists around the world have signed and released a statement outlining their views. They are calling the document the Durban Declaration.
"Our purpose is to state unequivocally that everyone in the world scientific community with the exception of a misguided fringe group believes that HIV causes AIDS," said Dr. Charles van der Horst, an AIDS specialist at the University of North Carolina at Chapel Hill. "Any statement to the contrary is just fiction and flies in the face of the facts.
"What's worse is that any such statement does an incredible disservice to the world community," van der Horst said. "We have a terrible epidemic going on that is laying waste to countries in the developing world that don't have the resources we have in developed nations. By promulgating the fiction that HIV is not the cause of AIDS, prevention efforts are thrown out the window, and, I believe, it is like committing genocide."
Professor of medicine at the UNC-CH School of Medicine, van der Horst and several colleagues came up with the idea of a declaration to coincide with the XIII International AIDS Conference, which begins July 9 in Durban, South Africa. The British science journal Nature will print the statement in its July 6 issue. The UNC-CH physician and a half-dozen scientists drafted the document, and more than 250 others served on the committee that spread the word and has been collecting signatures, including those of 11 Nobel Prize winners.
"Our statement is an unprecedented call to arms for the thousands of HIV scientists and clinicians from around the world who are devoting their lives to stopping the spread of HIV and treating millions of patients," van der Horst said. "By doing this, we hope to mobilize the world -- the United Nations -- and all governments to focus on this crisis, which is having devastating consequences. Every decent person should be upset about what's happening and want to do something about it."
Nineteen million people already have died from AIDS, according to the AIDS Research Alliance. The United Nations estimates that half of all 15-year-olds in African countries most affected by AIDS will die even if infection rates drop soon.
"The AIDS epidemic now raging out of control in Africa will be duplicated in India unless we can institute widespread prevention programs," said Dr. N.M. Samuel, president of the AIDS Society of India. "The most potent weapon we have in our fight against this disease is the knowledge that HIV causes AIDS. If we can prevent the transmission of HIV, we can stop the spread of AIDS.
The following is the full text of the Durban Declaration: "Seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of people from around the world have gathered in Durban, South Africa to attend the XIII International AIDS Conference. At the turn of the millennium, an estimated 34 million people worldwide are living with HIV or AIDS, 24 million of them in sub-Saharan Africa (1). Last year alone, 2.6 million people died of AIDS, the highest rate since the start of the epidemic. If current trends continue, Southern and Southeast Asia, South America and regions of the former Soviet Union will also bear a heavy burden in the next two decades.
Like many other diseases, such as tuberculosis and malaria that cause illness and death in underprivileged and impoverished communities, AIDS spreads by infection. HIV-1, the retrovirus that is responsible for the AIDS pandemic, is closely related to a simian immunodeficiency virus (SIV), which infects chimpanzees. HIV-2, which is prevalent in West Africa and has spread to Europe and India, is almost indistinguishable from an SIV that infects sooty mangabey monkeys. Although HIV-1 and HIV-2 first arose as infections transmitted from animals to humans, or zoonoses (2), both are now spread among humans through sexual contact, from mother to infant and via contaminated blood.
An animal source for a new infection is not unique to HIV. The plague came from rodents. Influenza and the new Nipah virus in Southeast Asia reached humans via pigs. Variant Creutzfeldt-Jakob disease in the United Kingdom came from 'mad cows'. Once HIV became established in humans, it soon followed human habits and movements. Like other viruses, HIV recognizes no social, political or geographic boundaries.
The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous. This evidence meets the highest standards of science (3-7). The data fulfill exactly the same criteria as for other viral diseases, such as poliomyelitis, measles and smallpox:
* Patients with acquired immune deficiency syndrome, regardless of where they live, are infected with HIV (3-7).
* If not treated, most people with HIV infection show signs of AIDS within five to 10 years (6, 7). HIV infection is identified in blood by detecting antibodies, gene sequences or viral isolation. These tests are as reliable as any used for detecting other virus infections.
* Persons who received HIV-contaminated blood or blood products develop AIDS, whereas those who received untainted or screened blood do not (6).
* Most children who develop AIDS are born to HIV-infected mothers. The higher the viral load in the mother, the greater the risk of the child becoming infected (8).
* In the laboratory, HIV infects the exact type of white blood cell (CD4 lymphocytes) that becomes depleted in persons with AIDS (3-5).
* Drugs that block HIV replication in the test tube also reduce viral load and delay progression to AIDS. Where available, treatment has reduced AIDS mortality by more than 80% (9).
* Monkeys inoculated with cloned SIV DNA become infected and develop AIDS (10).
Further compelling data are available (4). HIV causes AIDS (5). It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives.
In different regions of the world HIV/AIDS shows altered patterns of spread and symptoms. In Africa, for example, HIV-infected persons are 11 times more likely to die within five years (7), and over 100 times more likely than uninfected persons to develop Kaposi's sarcoma, a cancer linked to yet another virus (11).
As with any other chronic infection, various co-factors play a role in determining the risk of disease. Persons who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weaken the scientific evidence that HIV is the sole cause of AIDS.
In this global emergency, prevention of HIV infection must be our greatest worldwide public health priority. The knowledge and tools to prevent infection exist. The sexual spread of HIV can be prevented by monogamy, abstinence or by using condoms. Blood transmission can be stopped by screening blood products and by not re-using needles. Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs (12, 13).
Limited resources and the crushing burden of poverty in many parts of the world constitute formidable challenges to the control of HIV infection. People already infected can be helped by treatment with life-saving drugs, but high cost puts these treatments out of reach for most. It is crucial to develop new antiviral drugs that are easier to take, have fewer side effects and are much less expensive, so that millions more can benefit from them.
There are many ways to communicate the vital information about HIV/AIDS. What works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments, and hopefully a vaccine. But for now, emphasis must be placed on preventing sexual transmission.
There is no end in sight to the AIDS pandemic. By working together, we have the power to reverse the tide of this epidemic. Science will one day triumph over AIDS, just as it did over smallpox. Curbing the spread of HIV will be the first step. Until then, reason, solidarity, political will and courage must be our partners."
By DAVID WILLIAMSON UNC-CH News Services
References
1. UNAIDS. AIDS epidemic update. December 1999.
http://www.unaids.org/hivaidsinfo/documents.html
2. Hahn, B. H., Shaw, G. M., De Cock, K. M., Sharp, P. M. (2000). AIDS as a zoonosis: scientific and public health implications. Science, 287, 607-614.
3. Weiss R.A and Jaffe, H.W. (1990). Duesberg, HIV and AIDS. Nature, 345, 659-660.
4. NIAID (1996). HIV as the cause of AIDS.
http://www.niaid.nih.gov/spotlight/hiv00/default.html
5. O'Brien, S.J. and Goedert, J.J. (1996). HIV causes AIDS: Koch's postulates fulfilled. Current Opinion in Immunology, 8, 613-618.
6. Darby, S.C. et al., (1995). Mortality before and after HIV infection in the complete UK population of haemophiliacs. Nature, 377, 79-82.
7. Nunn, A.J. et al., (1997). Mortality associated with HIV-1 infection over five years in a rural Ugandan population: cohort study. BMJ, 315, 767-771.
8. Sperling, R. S. et al., (1996). Maternal viral load, zidovudine
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Surveillance Report 1999; 11, 1-44.
10. Liska, V. et al., (1999). Viremia and AIDS in rhesus macaques
after intramuscular inoculation of plasmid DNA encoding full-length
SIVmac239. AIDS Research & Human Retroviruses, 15, 445-450.
11. Sitas, F. et al., (1999). Antibodies against human herpesvirus 8
in black South African patients with cancer. N. Engl. J. Med., 340,
1863-1871.
12. Shaffer, N. et al., (1999). Short course zidovudine for
perinatal HIV-1 transmission in Bangkok Thailand: a randomised controlled trial.Lancet, 353, 773-780.
13. Guay, L. A. et al., (1999). Intrapartum and neonatal single-dose
nevirapine compared with zidovudine for prevention of
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Lancet, 354, 795-802.
Note: van der Horst can be reached at 919-966-2536 or via pager at 216-2791. A Website he paid for himself http://www.durbandeclaration.org will contain names of all signers and other information in seven languages and activate July 6.
June 30, 2000 -- No. 357
Journal
Nature