SUSPEND ALL HIV TESTING MBEKI EXPERT PANEL RECOMMENDS

By Huw Christie

New African September 2000

Eminent world scientists from both sides of the AIDS debate have been mandated by the Mbeki AIDS panel to undertake historic experiments to attempt to purify, or isolate, the HIV virus; and also examine the current HIV testing methodologies. In the meantime, the panel wants all HIV testing to be suspended. "It's a worthless distraction," says one panel member. Huw Christie reports from Johannesburg.

Amidst scientific debate and political revelations, senior members of the South African Presidential Panel of Inquiry into HIV/AIDS have called for the suspension of all HIV testing. The full panel of some 33 scientists convened for the second and final time in Johannesburg on 3-4 July, at the large Crowne Court Hotel in upmarket Sandton, in the attentive presence of South African minister of health Manto Tshabalala-Msimang (a medical doctor herself).

During sometimes turbulent proceedings, Dr. Valendar Turner on behalf of the Perth Group of scientists in Western Australia, Prof. Sam Mhlongo, head of Family Medicine and Primary Care at the Medical University of South Africa, and Dr. David Rasnick of UCLA, California, amongst others, appealed for the cessation of HIV testing.

The Perth Group and Prof. Mhlongo stressed that the accuracy of all HIV tests is so questionable, there is no cause for continuing to use them unless their specificity can be determined.

They say there are too many common African illnesses which create "false positive" results on HIV tests, and that no HIV test has ever been validated against the one necessary scientific "gold standard" -- virus isolation. This reality is recognised by the manufacturers of such tests who typically warn: "At present there is no recognised standard for establishing the presence or absence of antibodies to HIV-1 and HIV-2 in human blood." (Axsym System, Abbott Laboratories.)

New tests

Dr. Rasnick stressed that since there was no proof of an HIV causing AIDS, testing for it was, in his view, a worthless distraction. He also disputed the use of the term AIDS at all, in a continent where the presenting illnesses of people diagnosed with AIDS are all long-known conditions, usually associated with malnutrition and other consequences of poverty. By the end of the two-day session, a smaller working group of HIV testing had been structured which will now continue through at least Christmas to report, in President Mbeki's words, on "the reliability of, and the information communicated by, our current HIV tests and the improvement of our disease surveillance system."

The working party -- led by Prof. Mhlongo, and including Australian biophysicist Eleni Eleopulos and her colleague Dr. Valendar Turner, Dr. Harvey Bialy, with Dr. Helene Gayle of the U.S. Centers for Disease Control, and Prof. William Makgoba of the South African Medical Research Council and other panelists willing to continue working -- has accepted responsibility for historic experiments to attempt to purify, or isolate, HIV, and to examine the consequential issue of the accuracy of all so-called HIV testing methodologies.

Virus isolation is the thorn in the foot of the HIV/AIDS marching machine -- it has never been achieved by conventional standards. Until the mid-1970s, virus isolation used to mean separating virus particles from everything in the cell culture that is not virus, and producing an electromicrograph of the resulting purified particles. It is then not very difficult for virologists to analyse the particles' proteins and genetic material, and to test for infectivity.

It is a careful process, however, because all experts agree that there are abundant particles in nature and in cell cultures that in many respects resemble viruses but are not. Only once these steps are successfully completed can any other tests be evaluated for accuracy.

Government confidential website

The two-day meeting had begun on a sharp note. The South African health minister, Manto Tshabalala-Msimang, in her opening address noted that the six weeks since the first meeting in Pretoria had seen little exchange between the panelists of differing scientific and medical views via the confidential South African government website established for the purpose.

Noting that some scientists had nonetheless made extensive contributions, which had mostly gone unanswered, Tshabalala-Msimang commented that those who had worked tirelessly "will not be betrayed." The scientific website contributions of Eleni Eleopulos' Perth Group, of Dr. Roberto Giraldo, of Prof. Etiennne de Harven and Prof. Gordon Stewart, and various other "AIDS dissidents" were implied. Plans were announced to make the contents of the web discourses public in due course.

The Panel Secretariat of four civil servants, thrust into the uncharted job of coordinating the workings of the Panel and preparing the report for President Mbeki, was therefore faced with the necessity to stimulate debate in a way which had not occurred so far.

The structure favoured by the Secretariat and implemented by the Canadian, Prof. Owen (again the moderator), allowed for representatives of opposing views to speak for half an hour about their views and data, including on-screen visual material around the issues set down by the Secretariat: (1) aetiology, (2) prevention, (3) treatment, and (4) HIV testing and surveillance.

Who sayeth what

Following each presentation, there would be approximately half an hour allowed for two-minute comments on the presentation from other panelists. To begin, a young South African virologist, Dr. Carolyn Williamson, replaced the South African professor, Hoosen Coovadia, chairman of the Durban AIDS Conference. Williamson opened the proceedings with a standard explanation of the HIV-causes-AIDS theory, without proofs, and distinguished mostly by the puzzling claim that in AIDS "the cause is neither necessary nor sufficient" for the illness.

She appeared at a loss to defend this statement against the question, "How then, is it the cause?", except to say she had been instructed to include the statement. Such are the unfathomable pressures on ambitious young South African scientists, though surely she must have misunderstood the statement. Prof. Peter Duesberg next reiterated his condemnation of pharmaceutical "anti-HIV" drugs, asserting that in many cases these drugs themselves were responsible for illnesses diagnosed as AIDS.

Dr. Roberto Giraldo, the specialist in infectious diseases from New York, covered several aspects in his presentation, including the invalidity of HIV tests, and the range of stresses that can undermine a person's immune system, such as malnutrition and toxins amongst others. He included in his suggestions for treatment the use of anti-oxidants, a point well noted by the South African health minister, and touched on the role of traditional medicine in African cultures.

Next, Prof. Salim Abdool-Karim, principal AIDS researcher of South Africa's Medical Research Council, stressed his belief that the clinical picture of illness in South Africa had indeed changed in recent years. Dr. Joseph Sonnabend, an AIDS clinician from New York, appeared satisfied with conventional AIDS drugs and clinical practice, though he was heard earlier privately resisting pressure from some senior orthodox scientists to begin his presentation with a sound endorsement of the Highly Active Anti-Retroviral Therapy (HAART) drug combinations.

Dr. David Rasnick, an expert in protease inhibitor design, presented a panorama of the scientific literature from major journals discrediting these "anti-HIV" drugs. It seemed many of the conventional scientists in the room had not seen these data before. Later in the day, Dr. Valendar Turner of the Perth Group, whose Eleni Eleopulos has done so much over the years to keep the questions in HIV/AIDS focused on scientific matters, discussed perhaps the key question, which will now be carried forward: When even Prof. Luc Montagnier, accredited as discoverer of HIV, acknowledges his team was never able to isolate "the virus", why has the presence of such a virus been so universally accepted?

Turner showed a slide of a Western Blot antibody test gel -- the type of test believed throughout most of the world to be the best for HIV -- which by the strictest criteria anywhere would be positive for HIV, before revealing it was in fact positive for leprosy.

Dr. Helene Gayle of the U.S. Centers for Disease Control, who supervises the disbursement of billions of AIDS dollars, appeared to have little new to bring to the Panel, but managed to fill her time with slides of black text and statistics on a navy blue background, which this observer was not alone in finding difficult to decipher.

The second day

On the second day, Prof. William Makgoba, currently head of the South African Medical Research Council, took the floor to present epidemiological data on HIV in South Africa. He was unable, when repeatedly questioned, to give figures for actual AIDS deaths in South Africa, instead showing graphs of projected percentages of national annual mortality that could be attributed to AIDS.

He also insisted that the ELISA antibody testing methodology used in South Africa was in line with British standards, resulting in a "false positivity" rate of 0.1%. He made no attempt to address the absence of any gold standard for "true positivity." Next the Panel heard from Dr. Harvey Bialy on the progress made towards designing the experiments that had been hastily foreshadowed at the press conference at the conclusion of the first meeting six weeks before, which it was hoped would settle some of the areas of scientific disagreement.

Shortly into his improvised presentation, a loud disagreement flared up from opposite sides of the room between Prof. Peter Duesberg and Dr. Helene Gayle, ostensibly over some comments about AZT, which saw Duesberg leave the conference hall, pursued by Tshabalala-Msimang who spent tense minutes persuading him to return in the interest of the many people whose lives would be influenced by the successful working of the Panel.

However, thereafter Duesberg absented himself from the working group on experiments, at much the same time that Eleni Eleopulos, who had not been at the Pretoria meeting, became one of its most active members. Indications are that Duesberg continues to be willing to participate as the process moves forward. The Panel split into working groups next, to try to deliver recommendations to the anxious Secretariat that they could use in preparation of their report. The group on experiments confirmed it intention to "test the tests"; there was also a set of conventional recommendations produced from the working group around treatment, and that around "co-factors."

Mbeki, the whipping boy President Thabo Mbeki has become the liberal media's whipping boy for seeking advice about how applicable to South Africa the received Western wisdoms about HIV/AIDS are.

Scientific journals were asserting in the mid-1980s that HIV was not epidemic in South Africa. Now it is said to be everywhere you look. Mbeki has publicly asked how this can be so. What will the answers mean for policy? And why are these statistics showing AIDS in men and women almost equally? If this is heterosexually spread, why did it not happen in the West, where frankly most people do not use condoms? Why are there no figures for AIDS mortality in South Africa? Real data, not projected estimated. When can these figures be available? Why are the figures for HIV positivity in South Africa extrapolated from testing in ante-natal clinics with an ELISA test about which its manufacturer warns the principal cause of false-positivity is pregnancy? When none of the 29 illnesses grouped as AIDS is new, what evidence is there that a "new" microbe is involved in the apparent increase of some of these illnesses? From the answers to these questions, the Mbeki government seeks to understand whether there are untried approaches to the problems in the country -- principally TB, which is said to account for 60% of the AIDS-projection figures -- which would be affordable and effective. By Christmas, one of the biggest questions in AIDS science should have it answer, supervised by top international bodies, at the behest of a president not afraid to test convention and go the extra distance to find the truth: is there such a thing as HIV?

Huw Christie is the editor of Continuum magazine at www.continuummagazine.org