Time for the end of AIDS 18 March 2003
Previous Rapid Response Next Rapid Response Top
Ed Cooper,
Consultant Pediatrician
Newham General Hospital, London E13

Send response to journal:
Re: Time for the end of AIDS

Why don’t we get rid of AIDS? – the name, that is, the diagnostic designation. It has outlived its usefulness, in the same way that we no longer diagnose “consumption” but recognise an infection, tuberculosis. The analogy holds well: centuries ago individuals were recognised to be consumed, sometimes rapidly (“galloping consumption”) by something related to their environment – damp, overcrowding – or perhaps their own constitution. Now we recognise Mycobacterium tuberculosis and see that the infection has a natural history varying by the passage of time, the nutritional state of the host, etc, etc. We are also less likely to misdiagnose “consumption” as we no longer rely on a constellation of symptoms and signs but make the detection of the micro-organism, or at least its protein, essential to confirmation of the diagnosis of tuberculosis.

The history of AIDS is well known: in 1981 in New York an unusual combination of symptoms was observed and its epidemic nature was soon seen. The only link among the effects was the loss of the host’s immune control of parasites and mutant cells. Based on the resemblance to the genetically mediated congenital immunodeficiencies, the entity Acquired ImmunoDeficiency Syndrome was born. Both the definition and the risk factors of the new syndrome were revised repeatedly. A virus was later identified. The virology has been elucidated in unusual detail and with great consistency, and its nature as a retrovirus fits with advances in cellular biology on the broad front of scientific research around it. The natural history of infection with this virus has been observed thoroughly. It often culminates in that list of characteristics that meets whatever is the current definition of AIDS. But neither a bedside diagnosis of AIDS, nor a bedside diagnosis of galloping consumption, are as reliable as the laboratory diagnosis of HIV infection, or M. tuberculosis infection.

The argument about whether the characteristics of AIDS in Africa are identical to those in North America is sterile. Not every failure of immunity is mediated by HIV. All diseases, like cancer, vary in symptomatology. The model molecular disease, sickle cell disease, homozygous hemoglobin S, has an invariant genotype and a widely variable phenotype.

But Africa and North America do share an infectious disease. Could it be called immunoretrovirosis (IRV)? The agent is HIV. It is epidemic and dangerous, ultimately lethal. It occurs in Africa. President Mbeki should stop worrying about whether HIV causes AIDS, but worry about the epidemic of immunoretrovirosis around him. We all need to work on the known preventive and treatment measures to control this viral infection. We do not need the acronym AIDS.

Competing interests:   None declared