VIRUSMYTH HOMEPAGE

NEVER, NEVER LAND
Question AZT for Babies and People Get Hot Under the Collar

By Nicholas Regush

ABCNews.com 22 September 1999

Passions can run high in scientific circles when questions are raised about conventional thinking in AIDS research. The use of the anti-HIV drug AZT in children of HIV-positive mothers is just such an issue.

Consider the telephone call I made this week to Dr. Mark Wainberg, head of the International AIDS Society: I had called Wainberg, who does AIDS research at Montreal's Jewish General Hospital, to interview him on the science underlying the view that HIV-positive women should be given AZT and that their newborns should also be put on the drug.

(Last week, I began this series by writing about HIV-positive women and their supporters who are taking action in the courts to prevent government authorities from seizing their children if they don't agree to AZT treatments. Closely related is the question of whether HIV is the cause of AIDS, an issue I will deal with next week.)

Holocaust Equation

I called Wainberg because he had been quoted in the Ottawa Citizen, a major Canadian daily, saying that the dissidents were "fringe people," and that "There are people out there who deny that the Holocaust happened. Do we want to give them equal credibility?" This article quoting Wainberg had been circulated on the Web. That's how I learned about it.

Did Wainberg really make the Holocaust comment? If so, did he really believe a comparison between mothers fighting for their rights in the courts and those denying the Holocaust was valid? If he indeed felt so strongly, then maybe he could document the AZT science underlying his views.

Not only did Wainberg verify what he had said in regard to the Holocaust in the Ottawa Citizen, but he began shouting at me, saying that if I wrote anything at all on this issue, I would be a "child murderer." He threatened that if I wrote anything, he would do everything possible to get me fired from my column and my "bosses" fired. He taunted me, saying that I wouldn't have the guts to print these comments.

I asked him if he therefore believed that this AZT issue should never be reported by the media. "Never," he continued to shout. "Absolutely never." He then went on to condemn me again and again as a "murderer." He also told me that he considered any other journalist raising questions about the use of AZT in children of HIV-positive mothers to be a child killer.

Just Don't Ask

Wainberg, a well-recognized AIDS researcher who is one of the developers of the anti-HIV drug 3TC, never once asked me what science questions I wanted to explore with him, and I could barely get a word in edgewise. He had remembered me from more than a decade ago as a Canadian medical reporter who had included nonconventional features and commentaries on AIDS among my more mainstream AIDS stories. Though Wainberg had taken issue with some of my reporting in those days, I had been totally unprepared for this week's savage assault on anyone (including myself) who had questions about AZT treatment in pregnant HIV-positive women and their newborns.

Considering that there is usually room for argument on scientific studies, that there are reasonable fears about the potentially powerful side effects of AIDS drugs, and that there may be legitimate concerns about human rights involved in such a complex situation, I could only shake my head in amazement when I put the phone down. Given that other scientists have also shown strong emotion in denouncing challenges to AIDS orthodoxy, it can make you wonder what in the world is happening to scientific debate.

Final Answers?

One key study was published on Nov. 3, 1994, in the New England Journal of Medicine. It showed that HIV-infected mothers who received AZT gave birth to 13 HIV-positive infants, while mothers on placebos gave birth to 40 HIV-positive infants. This small study was stopped early because of the significant difference between the two groups and the results were immediately touted as grounds for making AZT standard therapy for HIV-positive mothers and their newborns.

But no study comes with all the facts. The authors of the NEJM article note, for example, that the risks and the benefits of initiating (AZT) treatment during the first trimester of pregnancy, after 34 weeks' gestation, or in labor, or of treating only the newborn were not assessed. In an editorial accompanying the study, the authors state: "The results, however, raise many questions about the mechanism of action of (AZT), the timing of transmission, the effectiveness of the regimen in women with clinical characteristics that differ from those women in the trial, the long-term effects of exposure to (AZT) during pregnancy, and the type of counseling that is appropriate to ensure that HIV-infected women understand the benefits, risks and uncertainties of the therapy."

No Absolutes Except One

The authors also note that in its recommendations for AZT therapy, the public health service emphasizes "the need for a thorough discussion of the benefits and risks… The final decision on therapy should be made by the woman in consultation with her health care provider." I might add, a health provider who is properly informed.

No study has since been published that should change the spirit of that recommendation. While some proponents speak of the steady decline of infant and child AIDS cases after a 1992 peak, factors such as declining births to HIV-positive women and better prenatal care may have played a role. (I'll explore other factors related to the issue of AIDS causation next week.)

Then there are the voluminous reports of adverse reactions to AZT to consider, including the drug's ability to damage bone marrow, kill growing cells (particularly immune cells) by interrupting their synthesis of DNA (life's blueprint), and to establish itself in DNA with the potential for long-term consequences, which includes the possibility of cancers.

Should there be widespread reporting and discussion about this entire issue? Absolutely!

Nicholas Regush produces medical features for ABCNEWS. In his weekly column, published Wednesdays, he looks at medical trouble spots, heralds innovative achievements and analyzes health trends that may greatly influence our lives. His latest book is The Breaking Point: Understanding Your Potential for Violence.

VIRUSMYTH HOMEPAGE