HIV Controversies Continue to Dog Researchers
In the 32 years that the world has been living with HIV, there have been great strides made in treatment. The progress in making HIV preventable and turning HIV from a death sentence to a manageable condition, however, has not been a smooth one.
It's hardly unusual for research into any disease to come with a few roadblocks. When the resources of some of the most advanced institutions in the world are brought to bear on one topic, it is to be expected that controversies would arise.
From the first years of the epidemic, AIDS was marked with fierce disputes within the scientific community. The nature of HIV, who should be credited with its discovery, and even whether HIV is the cause of AIDS at all each became its own cause cèlébre, with its own partisans.
The long, drawn-out fight between Dr. Robert Gallo and Dr. Luc Montagnier became a dispute not only between two prestigious research institutions but the governments of the United States and France. Eventually, the two men agreed to share in the discovery, but it remains a source of controversy to this day. A sign of how much this remains a hot-button issue is the fact that the Nobel Prize for Medicine has not been awarded to either man -- or, for that matter, to both.
As to whether HIV is the cause of AIDS, nearly all scientists now agree: It does. But nevertheless, there are plenty of outliers left, most notably Peter Duesberg, a molecular biologist at the University of California Berkeley, who continues to support a hypothesis that AIDS is caused by outside factors such as recreational drug use; that many of the drugs used to treat AIDS in fact helps bring on the disease; and that AIDS in Africa is not even AIDS at all, but the result of external factors like malnutrition.
Even though the scientific community has long rejected such theories, they exert influence on a remaining group of vocal activists. Most controversially, Duesberg's theories influenced the government of South Africa, which, critics assert, resulted in the death of hundreds of thousands, including infants. The "AIDS denialists" maintain a grand-sounding website called the Office of Medical and Scientific Justice that continues to put forward their views.
Although the vast majority of the general public and researchers have long moved past such theories, several controversies continue to dog research into HIV and AIDS. What follows is a discussion of three recurring controversies current in AIDS research.
Is a ’Super Bug’ Possible?
In 2005, then-New York City Health Commissioner Thomas Frieden made headlines when he convened a press conference to announce the appearance of a patient who had displayed what the press quickly termed a "super bug" or "Super AIDS" mutation of HIV.
According to Friedan, a middle-aged man in his mid-40s who went on an unprotected weekend sex binge while under the influence of crystal meth, contracted a strain of HIV that was resistant to current meds. "We consider this a major potential problem," he said at the time.
What was particularly worrisome was that the man had apparently contracted full-blown AIDS only a few months after exposure to HIV, a far shorter window than is typical in such cases. Frieden speculated that someone else had developed the super-strain. The scenario was reminiscent of the 1950 film "Panic in the Street," in which a public health officer tries to find everyone in New Orleans who had been in contact with a deceased man found to carry pneumonic plague.
The story of the super bug, however, turned out quite differently. The super-strain never materialized. Frieden was criticized in some quarters for unnecessarily causing panic, while others praised him for taking the lessons gleaned from the very early days of the AIDS epidemic and not waiting until the strain had become widespread.
Frieden has since gone on to become the head of the federal Centers for Disease Control. As for the super-strain, although it has never been proven, it inspired an ongoing discussion among researchers whether HIV, which has been shown to be highly mutable virus, could indeed replicate a drug-resistant strain.
Does Circumcision Help Prevent Infection?
If you really want to get a good argument going, bring up circumcision among a group of men. Chances are good that you’ll find an "intactivist;" that is, men who view male circumcision with the same contempt that Westerners harbor for female genital mutilation.
Adding fuel to the fire is a raft of studies that have been reported in highly respected peer-review journals such as the Lancet that male circumcision appears to reduce the chances of heterosexual HIV transfer in Africa.
The latest such study, conducted in Uganda among 156 men published in the journal mBio earlier this year, showed significantly higher decrease of bacteria in the circumcised group. The study was considered important because it provided a possible explanation for all of those earlier studies.
"We’re not trying to prove that everyone should be circumcised," said Lance Price, the study’s senior author. "We’re trying to understand how it works, and by understanding, possibly establish alternative strategies to reduce people’s risk for HIV."
The World Health Organization and U.N. AIDS have issued guidelines that recommend circumcision as an important tool in fighting HIV, especially in Africa. The intactivists and their allies counter that the data for all of the studies so far have been clouded by researchers’ own bias, and that circumcision is, in fact, dangerous because it allows men to believe that they don’t have to use condoms. They further argue that unsanitary circumcision in these nations increases the risk of non-HIV infections and resulted in men dying after the operation.
Here in the States, the American Academy of Pediatrics last year changed its stance on infant circumcision. As a result of the research, it concluded that the procedure would help protect against HIV. That kind of statement has the intactivists screaming.
The controversy won’t be going away anytime soon. Courts have struck down attempts to put local referenda banning circumcision to a vote in California, but the debate over whether infant male circumcision is immoral rages on in several countries, including Australia, Austria, Germany and Denmark.
Can the ’Berlin Patient’ Be Duplicated?
If a vaccine to prevent HIV remains one of the main goals for researchers, eradicating the virus entirely from those infected is their holy grail.
In 2008, reports came out of Berlin that an American named Timothy Brown appeared to have done just that. Diagnosed with HIV back in 1993, Brown came down with leukemia in 2006 while living in Berlin.
Since Brown was going to require a bone marrow transplant to treat his leukemia, an enterprising doctor figured he might as well go for broke and find a donor who also had the genetic mutation that blocks HIV from replicating itself in immune cells. The mutation occurs in approximately 1 in 100 Northern Europeans.
Thus began a search among the 2.7 million German donor registry that yielded one person who matched Brown’s tissue and also carried that "delta 32" mutation. After the first transplant didn’t take, the man (who ironically was living in the U.S. at the time) agreed to a second transplant.
After a touch-and-go battle that nearly left Brown dead, he recovered -- and, thus far, has not tested positive for HIV. Some, however, believe that the virus is still in Brown’s body, but that it is dormant -- for now; they believe it could come back. Only time, they say, will tell.
For his part, Brown, a longtime AIDS activist in his native Seattle before all of this made him headline news, has become a vocal advocate of the kind of treatment he received. But most scientists believe that duplicating Brown’s operation would not be feasible on a wide scale. Aside from the difficulty of double-matching bone marrow and that elusive gene, such an operation is itself very dangerous -- and expensive.
Still, the National Institutes of Health here in the United States and other government-funded bodies in Europe are studying Brown’s case to see if there is a way to duplicate it without undergoing a harrowing bone-marrow transplant. The World AIDS Institute has even launched a Timothy Brown Foundation dedicated to the cause.