Re: Re: Re: Re: Re: Neonatal HIV 1 November 2004
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Christopher Tyler,

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Re: Re: Re: Re: Re: Re: Neonatal HIV

I must apologize to Dr. Flegg for the long time interval between his last response to me and to this one. In Dr. Flegg's previous post to me regarding the de Souza et al. paper on AZT usage in mothers and infants, he chastised me for not understanding the implications of the research. The gist of his critique is that AZT is clearly beneficial because fewer mothers in the 'treated' group 'transmitted the virus to their infants', even though a higher percentage of those infants progressed to illness.

The authors stated, "Among treated mothers 12.2% (17 of 139) transmitted the virus to their infants, whereas 22.4% (34 of 152) of the untreated mothers transmitted the virus to their infants"

Dr. Flegg attributes benefit to AZT on this basis, that only 17 of 139 'treated' infants were 'infected', whereas 34 of 152 'untreated' infants were 'infected'.

Unfortunately, those 17 of 139 'treated' infants faired worse than the 34 of 152 infants. 12 of 17 'treated' infants developed RPD, whereas only 10 of 34 'untreated' infants developed RPD. This is the crux of my argument, that AZT increases an infant's likelyhood of becoming ill. That more absolute numbers of infants in the AZT group became ill demonstrates this. Dr. Flegg would congratulate the mothers of the infants spared 'infection' but at the end of the day would have to give more 'treated' mothers bad news. In addition, in order to influence a laboratory marker, 139 infants were exposed to a drug that destroys mitochondria and causes rather nasty neurological problems that may not manifest for some time. The authors of the study say:

"risk of RPD was clearly related to maternal treatment: the proportion of infants with RPD was 29.4% (10 of 34) in the no ZDV group compared with 70.6% (12 of 17) in the ZDV group"

The ultimate goal of any drug is not simply to influence a parameter or laboratory marker, but to improve the clinical outcome of a patient. In other words, to improve actual health and quality of life. The question then becomes, how does Dr. Flegg actually know that 'HIV' was or was not transmitted to the infants? Because the antibody tests are not allowed to 'diagnose' infants (because of maternal antibodies), PCR technologies are used. Since PCR technologies are not allowed for diagnostic purposes in adults, and are said to be inferior to serology, it's difficult to understand how then they suddenly become accurate in infants. Put another way, if the PCR tests are so specific to 'HIV' genetic material, why not use them in adults also for this purpose?

In fact, an infant may or may not 'have HIV' based on the type of genetic technology used. In table 1.2, 'Viral Load vs PCR Techniques' of paper by Coste et al.,(2) we see that by one technology the culture was negative but positive by others. In fact, looking at the table it's a rather difficult task to make any kind of sense of the numbers.

This brings up another point. If I as a gay man were to walk into your office and request an 'HIV' test, I have no doubt I would be given one. However, if I asked Dr. Flegg for the references which prove that in the vast majority of positive tests the reactions were a result of one thing and one thing alone (this thing being 'HIV'), which references would you be able to readily hand me? Since most doctors believe the 'HIV' tests are highly specific (usually the number 99.9% comes up), there must be some pretty strong and inarguable evidence to support this. If my test were to come back positive (assuming I'm not in the UK), and I was told I had a positive based on 3 'strong' bands (we'll assume the lab errs on the side of caution and accepts only dark thus strong, and not light or weak, bands as proof of infection), would Dr. Flegg's course of treatment include emigration to Australia which requires 4 bands to 'prove' infection? If I had a high 'viral load' could I request a retest with a different PCR technology until I get a reduced viral load?

In addition, because of the weight of this diagnosis (and wanting to provide myself with all assurances), since these tests are so remarkably sensitive and specific, if I were to provide you with a document which said something like the following, would you be able to sign it?:

As the doctor/clinician recommending or administering the test described above, I hereby verify with a reasonable degree of certainty that this test:

___ has been approved by the US Food and Drug Administration for the express purpose of diagnosing HIV infection;

___ has been validated for accuracy by the direct finding of whole, infectious HIV in the fresh, uncultured plasma ofpersons with HIV antibody positive results;

___ will indicate current, active infection with HIV in the patient being tested;

___ will not cross-react with antibodies produced in response to any of the following conditions thereby giving a false positive result: Alcoholic hepatitis or alcoholic liver disease; alpha interferon therapy; antigenic stress from any non-HIV source; autoimmune disease; blood transfusion, candidiasis; cholera; cytomegalo virus; Epstein-Barr virus; exposure to nitrites; flu or flu vaccination; foreign semen; hemodialysis or renal failure; hemophilia; hepatitis A or hepatitis Avaccination; hepatitis B or hepatitis B vaccination; herpes simplex 1 or 2; high levels of circulating immune complexes; malaria; malignant neoplasms; mycobacterium avium; normal cellular proteins such as actin or myosin; normal humanribonucleoproteins; parasitic infections; pregnancy or prior pregnancy; retroviruses other than HIV; rheumatoid arthritis; tetanus vaccination; tuberculosis; upper respiratory tract infection; use of recreational or pharmaceutical drugs;

___ can be regularly reproduced with the same results by other qualified labs;

___ will not be influenced or interpreted based on any information in the patient's medical records including current or past recreational drug use; sexual history; current or past sexual orientation; ethnicity.

Because I simply want to be a well-informed and an educated patient, involved in my own welfare and diligent to make sure I get the best most accurate diagnostics possible, I would have no problem presenting any clinician with such a document.

Remember, these tests are regularly associated with numbers like 99%.

1. de Souza RS, Gomez-Marin O, Scott GB, et al. (2000). Effect of prenatal zidovudine on diseaseprogression in perinatally HIV- 1-infected infants. Journal of the Acquired Immune Deficiency Syndrome 24:154-61.

2. Coste J, Montes B, Reynes J, et al. (1997). Effect of HIV-1 genetic diversity on HIV-1 RNA quantificationin plasma: comparative evaluation of three commercial assays. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 15:174.

Competing interests: None declared