Re: HIV Tunnel Vision 20 July 2004
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Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY

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Re: Re: HIV Tunnel Vision

James Whitehead makes some cogent points and remarks about vitamin deficiencies and their role in HIV and AIDS. To my knowledge, it does appear to me as if such cofactors have only recently been seriously investigated by the mainstream researchers.

I would say that, sadly, those proposing the role of oxidative stress as an entire replacement for that of HIV in causing AIDS have done their cause a disservice. It now seems clear that reductions in antioxidants do occur (although the oxidative stress may not itself seem to cause HIV expression, it's more likely the other way around in vivo) and replacement seem to have real clinical (and virological) benefits. I wonder perhaps that this might have been investigated sooner had a more balanced proposal been put forward. Certainly I have been aware of strong advocates for proper nutritional replacement among those who follow the orthodox HIV/AIDS science for as long as I have been involved in the field.

Other cofactors have also been ignored: very early on it was found that psychological health played a significant part in the risk of progression to AIDS, a finding mirrored in cancer patients. I don't recall seeing a trial to date where this was directly addressed and remedied, although physician approaches to HIV-infected patients are currently very good indeed, in my experience.

I can only imagine that when faced with a viral cause for an illness, efforts were (probably rightly) focussed on trying to treat/vaccinate/prevent transmission of the original cause. After all, it seems silly to mop up the blood if the artery is still bleeding: why not go straight for the source?

However, with antiviral therapies at best an expensive stop-gap (and at worst, a cause of significant side effects themselves) and an effective vaccine still not yet out of clinical trials, it does seem rather important to address other factors directly related to the risk of AIDS progression other than viral load.

Having other factors implicated in progression to AIDS, or the causes of AIDS-related diseases (e.g. CMV in slim disease, HHV8 in kaposi's sarcoma) doesn't detract from the underlying cause of the peculiar immunodeficiency seen with HIV infection, but to ignore them seems to me to be doing those infected with HIV a great disservice. We would, after all, give someone bleeding with low platelets a transfusion, would we not...?

Competing interests: None declared