Talk:HIV/AIDS/Archive 13

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Stuff slipped back in

I notice Sci Guy has yet again inserted the claim that medical transmission is responsible for 30% of HIV infections, which is *not* supported by the references he presents, and the opening paragraph is again less readable than it should be. --Robert Merkel 08:36, 2 August 2005 (UTC)

This was not one of my references, but the source quoted is: "Hutin told the lawmakers that WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections but warned that his research of several "relatively reliable" HIV studies has revealed that medical transmission could actually be three to fifteen times higher than the conservative WHO figure." This gives a range of 7.5% to 37.5%. For comparison the WHO figure is around 12.5% consisting of 10% transmitted through the transfusion of infected blood and blood products plus 2.5% transmitted through unsafe healthcare injections. To demonstate good faith, I will edit the 30% to 20% Sci guy 04:36, 3 August 2005 (UTC)
Nice try, but that view doesn't sit with the medical mainstream. Try this 2004 Lancet paper (I have the full PDF if anybody's interested and can't get it) by a large group of authors from the WHO and other notable places of expertise on AIDS. They give a thorough bollocking to the methodology of people claiming higher rates of medical transmision in sub-Saharan Africa. They agree that unsafe injection practices should be eliminated, but they still regard it as a relatively minor factor in the spread of AIDS in those countries, and believe that heterosexual transmission is responsible for the vast majority of infections there. Finally, they see no reason to discard the 2.5% estimate based on these new studies.
Again, I'm not claiming that the medical mainstream is always right. But to claim that the medical mainstream reckons dirty needles are a big factor in the sub-Saharan epidemic is wrong. As far as your show of good faith, how is altering the fudge factors on your back-of-the-envelope calculations anything other than a tapdance around the fact that your evidence to support your figures is shaky in the extreme?--Robert Merkel 06:17, 3 August 2005 (UTC)
Ahem. ZING!
I wonder how many times we'll have to say that until he gets it... JoeSmack (talk) 18:14, August 4, 2005 (UTC)
SciGuy states : I will edit the 30% to 20%. Now that is really scientific!!! What are we working on here, facts or fiction? --Grcampbell 18:05, 11 August 2005 (UTC)

Genetic susceptibility

I am quoting this unreferenced section in full, because it is becoming increasingly speculative and lacks any sources for an editor to verify. Sci guy 04:24, 3 August 2005 (UTC)

CDC has released findings that genes influence susceptibility to HIV infection and progression to AIDS. HIV enters cells through an interaction with both CD4 and a chemokine receptor of the 7 Tm family. They first reviewed the role of genes in encoding chemokine receptors (CCR5 and CCR2) and chemokines (SDF-1). While CCR5 has multiple variants in its coding region, the deletion of a 32-bp segment results in a nonfunctional receptor, thus preventing HIV entry; two copies of this gene provide strong protection against HIV infection, although the protection is not absolute. This gene is found in up to 20% of Europeans but is rare in Africans and Asians; researchers and scientists believe that the HIV virus had a similar viral shell as the virus which caused the black plague (1347-1350), leading to the decimation of one-third of the European population, possibly explaining why the CCR5-32 receptor gene is more prevalent in Europeans than Africans and Asians. Multiple studies of HIV-infected persons have shown that presence of one copy of this gene delays progression to the condition of AIDS by about 2 years. And it is possible that a person with the CCR5-32 receptor gene will not develop AIDS, although they will still carry the HIV virus.

Here is a quick ref pulled from a quick google'd article: [1]. It is also known as the 'delta-32' gene, or 32 base deletion. this gene, if carried in one or both parents, can have a very favorable effect for a person exposed to HIV. This gene produces a unique condition with the CCR5 on macrophages which is used by HIV to enter the cell and infect its DNA. Most people have normal CCR5 growing in the appropriate cells, and HIV takes advantage of that fact. What delta-32 does is cause the body to make abnormal CCR5 in cells that travels more slowly to the outside cell membrane where they normally are. This causes HIV to have trouble infecting particular cells as it would have no CCR5 to attach to, thus arresting the whole process.
It is important to note that this genetic resistance (32 base deletion) happens to prohibit the process best in a strain called HIV-1 B, which prefers the sexual route. Thus someone who goes around all willy-nilly without worrying about HIV could run up against another strain, say, one that is more prolific with needle-sharing, and the genes wouldn't mean didly squat. JoeSmack (talk) 16:16, August 4, 2005 (UTC)


P.S. You know, while we're on the topic of HIV resistance and thus HIV long term non-progressors, anyone want to tackle RANTES, HLA B*5701 or Hepatitis G co-infection? Really really interesting stuff.... JoeSmack (talk) 16:16, August 4, 2005 (UTC)
On the subject of host genetic variability, we could also include a section about Fractalkine receptor mutations and disease progression in children. There have been a couple of articles published in AIDS recently on this subject (Singh et al., 2005).
Well, here's one big problem with the quoted paragraph: "the virus which caused the black plague". Although some scientists have proposed that the Black Death was a viral disease rather than bubonic plague, that's very far from a consensus view. I suspect that whoever wrote that paragraph was summarizing something incompletely understood. Hob 03:39, August 13, 2005 (UTC)

Defining AIDS

We seem to be drifitng back to the idea that AIDS is defined in different ways in different countries. This may be more factually correct, but is opens a can of worms If a group of AIDS patients in Uganda would not be diagnosed with AIDS in Europe or the USA, then are we talking about the same disease? If we put then on a ship to the USA would they be cured? What does it mean to say that millions of Africans have a disease that would not be considered a disease in the USA?

My recollection is that if we count actual reported cases of AIDS then the number of reported cases in Africa is about the same as the USA (around a million people). But while all the USA reported cases were supported by HIV antibody tests, HIV testing of small groups of the reported AIDS cases in Africa revealed that about half were NOT infected with HIV. All this has been extensively discuused and referenced in the develpoment of the Wikipedia AIDS article.

The current position of the AIDS article is to follow the UNAIDS position that about 40 million people are "infected with HIV". This is NOT based on reported or diagnosed cases. UNAIDS clearly set out the basis for their estimates, HIV antibody testing of pregnant women in sentinal hospitals. This firmly places AIDS in the context of HIV infection rather than the older style Bangui definition I also note that the British Medical establishment has consistently challenged the assumption that pregnant women aquired HIV from sex. Specifically this group of women have a high exposure to both unsafe blood transfusions and unsafe medical injections.

I have no problem adopting the more scientifically rigorous approach advocated by Grcampbell. By stating what is known and the limitiaons of our current knowledge we would move toward a more NPOV approach. But my previous attempts to move in this direction were vigorously opposed by other Wikipedia editors - hence my adoption of the consesus pseudo science Sci guy 02:51, 13 August 2005 (UTC)

There is no reason explanations of the above-stated limitations of current knowledge can't be explained in the article, and that divergent definitions and diagnostic approaches can't be explained. If a number is an estimate, it is dishonest to report the estimated number as a fact. In so far as immune difficiencies are identified in Africa absent the presence of HIV, however they are classified under various disease taxonomies, the details need to be accurately explained for any article on the topic to be accurate.
There is no concensus among editors to the contrary, at least not as long as I contribute even the slightest punctuation and thereby qualify as an editor of the article. AIbaco 02:45, 16 August 2005 (UTC)

Surrogate markers

I think this article honestly presents the facts in an unbiased way:

"An ideal surrogate marker still does not exist for HIV/AIDS. In fact, after two decades of looking, only two assays, CD4+ T-lymphocyte count and HIV RNA viral load, have been widely adopted as imperfect surrogates for monitoring and predicting the course of disease in people with HIV. These markers have been fairly well correlated with the natural history of HIV infection and progression to AIDS, but each has limitations." [2]

A more recent article, July 2005, is suprisingly frank about the fact that "we honestly don't know when and how to best treat HIV infection." [3]

It is not the task of Wikipedia editors to create certanty where none exists! Sci guy 16:10, 13 August 2005 (UTC)

accuracy

I am attempting to include qualifying language in the lead to improve the presumptive verb "is." The language I introduced is in no way "POV" unless having one's eyes open to recognize that other views exist comprises a point of view. The qualification and scope of those scientists who continue to ask questions about this syndrome are widely known and are well documented in Wikipedia, regardless persistant efforts to exclude research that does not support the government-approved point of view concerning this recent science. Sandlawould 20:50, 13 August 2005 (UTC)

This article goings down the sewers

Robert Merkel left me a message on my talk page that this article was going down the sewers, and I can see he was right. All the references have been deleted. THe introduction (yet again) fails to actually introduce the topic, and (once again) it's full of AIDS denalist propaganda. →Raul654 05:32, August 14, 2005 (UTC)

on attribution

If the article is written with attribution to the sources, there can be little controversy. Wikipedia is not an authority on micribiology, but the WHO and NIH are. If the article cites those groups as the authors of the findings explained in the article, there is little room for controversy. There is little debate about whether WHO and NIH concluded certian things, and whatever debate has arisen about the content of their findings can also be reported encylopedically, without relying on loaded POV language such as "denialist" and "propaganda". I'm attempting to merge the better lead of July 28 with the meaningul edits that were contributed since then, as well as improving attribution at the top so as to avoid controversy. Albaco 06:07, 14 August 2005 (UTC)

On the contrary, HIV causes AIDS not because WHO and NIH says so, but because it is so. There's no reputable debate about that fact outside a small community of denialists with an active Internet contingent with an unlimited supply of sockpuppets who seem intent on inserting disinformation into the article. The lead of July 28 is not better: the lede, for example, sucks. You don't need to cram every synonym into the first sentence. - Nunh-huh 06:15, 14 August 2005 (UTC)

What is AIDS?

The fact is that in the USA, since 1993, most AIDS diagnosis have been based on low T cell counts, below 200. These people did NOT have an opportunistic infection and did NOT have an AIDS defining condition. They were healty people with a low T cell count. This was before the era of HAART, so some of these people may be alive and well today without HAART. They may even have T cell counts above 200.

It is NOT correct to say that AIDS was formerly known as GRIDS, because half the so call GRIDS case were not infected with HIV.Sci guy 08:45, 14 August 2005 (UTC)

Are you saying that a large number of gay men suffer(ed) a lethal immunodifficiency syndrome but were not infected by HIV?AIbaco
I reviewed some data, and though many gay men (and others) have exhibited immunodifficiencies absent a positive HIV test, it seems the relevant "half" (42% at the end of 1982?) related to renaming GRIDS was that roughly half of the so-called GRIDS patients were not gay, were not IV drug users and were not transufsion recipients. AIbaco 04:15, 15 August 2005 (UTC)

HIV is not vernacular it is the correct scientific term for the AIDS virus see HIV article Sci guy 08:45, 14 August 2005 (UTC)

It would be nice if you could source these claims, and do your edits in minor steps, because you removed a lot of information from the article here. See for instance http://biotech.law.lsu.edu/Books/lbb/x590.htm for a link that shows GRID/GRIDS was used by at least a few scientists. Because of this, I reverted your whole edit, but feel free to edit again if you can source your claims. Thanks! Sam Hocevar 10:10, 14 August 2005 (UTC)
No, HIV is not correct scientific nomenclature. HIV is an acronym that describes a group of similar RNA sequences. The correct scientific term is human immunodeficiency virus followed by a number classifying a particular strain of the retrovirus. But go ahead and dumb down the content if you so demand. AIbaco 17:00, 14 August 2005 (UTC)
The HIV article cites the soucre as Coffin, J., Haase, A., Levy, J. A., Montagnier, L., Oroszlan, S., Teich, N., Temin, H., Toyoshima, K., Varmus, H., Vogt, P. and Weiss, R. A. (1986) What to call the AIDS virus? Nature 321, 10.[4] Sci guy 15:53, 15 August 2005 (UTC)
Yes I have read the link at http://biotech.law.lsu.edu/Books/lbb/x590.htm which actually says "Terms such as GRID (gay-related immunodeficiency disease) were considered but rejected in favor of the more neutral AIDS" Sci guy 15:15, 14 August 2005 (UTC)
"The first name for the new disease was GRID" [5] [6][7][8][9][10]. The failure of writers in the links above to specify whom they identified as "officials" complicates efforts now to use their work as sources. Many Wikipedia writers seem eager to continue this generalized, non-specific, authoritarian style, but an accurate encyclopedia will discover and report who so named the "new disease". But I agree, the reference to a historical name is not lead material, and tends to muddy an already difficult-to-read paragraph. It belongs lower in the article.
I agree that references to unnamed official sources is clearly not NPOV, but I did enjoy reading that "HIV is a tiny virus with backward RNA" can we add this to an AIDS humor section? Sci guy 16:57, 17 August 2005 (UTC)
For surveillance purposes, the CDC does not define AIDS as HIV disease, but instead characterizes it by symptomology, as is expressed in the current lead, which essentially the July 28 lead Raul643 reverted to. "For the limited purposes of epidemiologic surveillance, CDC defines a case of AIDS as a reliable diagnosed disease that is at least moderately indicative of an underlying cellular immunodeficiency in a person who has had no known cause of underlying cellular immunodeficiency or any other underlying reduced resistance reported to be associated with that disease."[JAMA 1983; 250:1016]
Since tihs 1983 reference, the CDC has progressively developed the AIDS definition. For example it now requires evidence of HIV infection! But thank you for this blast from the past. We all agree that in 1983 the CDC had no idea what AIDS was, and neither did anyone else! Sci guy 15:49, 15 August 2005 (UTC)

References

Is there any particular reason why the references are archived at a Talk page? Wouldn't AIDS/references be more appropriate? - Jakew 13:09, 18 August 2005 (UTC)

Done Sci guy 15:00, 22 August 2005 (UTC)
These should be on the page, not in an archive somewhere. --Bob 23:05, 8 November 2005 (UTC)

ABC educational approach

I'm a british gay man who came out in the early 90's (at the height of the AIDS epidemic) so I've been subject to loads of HIV/AIDS education over the past decade and a bit, but I've never heard of this ABC thing. Perhaps it's mainly an American thing? Could somone in the know clarify? - Gypsum Fantastic 13:56, 22 August 2005 (UTC)

You can read how the ABC approach is credited with having brought the HIV prevalence rate in Uganda down from around 15% in the early 1990s to 5% in 2001. [11] Sci guy 14:57, 22 August 2005 (UTC)
I don't know why Sci guy didn't just answer your question, but that link does contain the answer: "ABC" (Abstinence, Be faithful, and Condoms) is a slogan invented in Botswana, and subsequently adopted by public health authorities in Uganda and elsewhere in Africa. It's gotten more public attention in the U.S. than in Britain because the Bush administration has expressed a desire to only support AIDS-prevention programs that place abstinence first, and has mentioned "ABC" several times when pointing to Uganda as an example. Hob 04:35, August 29, 2005 (UTC)

Inappropriate removal of section

An anonymous editor removed the very brief "Alternative theories" section, with the following edit summary: "there are also people who believe that Abe Lincoln was a space alien, we don't list them in his article". I restored the section, which merely indicated the existence of the AIDS reappraisal article. I don't personally believe any of the theories described in that article, but they have been the subject of highly publicized international debate (which, unless I've missed something, the alien-Lincoln theories have not) and certainly deserve to be at least mentioned. There are plenty of analogous examples elsewhere in WP; for instance, it would be very odd if the article on Haile Selassie did not mention the Rastafari movement. Hob 04:29, August 29, 2005 (UTC)

should be there, even if their theories hold water like a teabag --Bob 23:05, 8 November 2005 (UTC)

The red ribbon

It's very widely known that the late New York-based painter Ed Moore invented the red AIDS ribbon. For instance the Art In America article at the time of his retrospective exhibition at the Albright-Knox Gallery [12]. "The Red Ribbon was created by singer/songwriter Paul Jabara" says the Wikipedia article. Is this a vanity insertion. Who is Paul Jabara? This does him no credit. I'm changing the attribution. --Wetman 19:22, 17 September 2005 (UTC)

Paul Jabara is the person credited by the Red Ribbon Foundation Sci guy 03:16, 29 September 2005 (UTC)
"In early 1991 Paul Jabara in New York created the idea for a global symbol in the fight against AIDS. A symbol for solidarity and tolerance with those often discriminated by the public - the people living with HIV and AIDS. In the style of the yellow ribbons, which were popular in the USA at the time as a symbol for awareness of those soldiers fighting in the gulf war, the Red Ribbon was born."
"Following first events in the New York art scene, Paul soon was aiming at having celebrities wear the Red Ribbon at the Tony Awards. In a spontaneous campaign, volunteers sent letters and Red Ribbons to all attendees. Unfortunately, movie actor Jeremy Irons was one of the very few celebrities wearing the Red Ribbon that night."

Patient zero

81.105.168.248 removed the following: A major setback in the search for a cure is that the origin of the hiv virus (patient zero) has not yet been found, saying Deleted implication that more knowledge of "patient zero" could lead to medical breakthough (unscientific, USA-centric). I don't see at all how that is USA-centric (I'm not from the US by the way). I'm no expert on this, but I believe that knowing patient zero (and thus the origin of the disease) is very important for finding a cure. And I added the line because I heard that said specifically about this in a tv documentary. Anticipating a possible confusion, by 'patient zero' I don't mean 'patient O'. See the first two lines of Patient_zero#The_patient_zero_of_AIDS. DirkvdM 07:50, 23 September 2005 (UTC)

Sorry to be harsh, but: if you hear something on TV, but you don't understand it well enough to explain it beyond "I believe it's true", then don't add it to the article. After nearly three decades of AIDS research, increasingly focused on molecular biology, why would anyone think that epidemiological history is anywhere near the most important thing to look at? There's probably more agreement on the modes of transmission, and the ways AIDS has spread through different populations, than on anything else; long before anyone knew anything about HIV, it was clear that it was a blood-borne disease that would spread more or less the same as hepatitis B, which is why the delay in screening blood transfusions was so inexcusable. And the prevailing theory of the disease's travels has it coming out of Africa not once, but many times - so any reference to "patient zero" is meaningless unless you choose to focus on the U.S., Europe, Asia, or wherever. Not to mention that when you say "patient zero" in the context of AIDS with no further explanation, absolutely everyone will think of Gaetan Dugas. Hob 16:20, 23 September 2005 (UTC)
Have to agree with Hob here, for the reasons stated. --Bob 17:06, 23 September 2005 (UTC)
I think the current view is that patient zero was a chimpanzee [13] - but the major setback in the search for a cure is that the HIV virus has proved difficult to obtain in pure form. Sci guy 14:12, 17 October 2005 (UTC)
Reference for that last statement, please? I follow AIDS research fairly closely and I can't think what you mean by "pure form". Hob 23:06, 19 October 2005 (UTC)

References

I've added these back to the article, it is important to keep references as clear and visible as possible. Having AIDS/references also runs counter to Wikipedia:Do not use subpages. I do doubt that all of the current references are actually used by this article. Someone should go through the list and move some of the sources to spin off pages. - SimonP 02:14, 29 September 2005 (UTC)

Adding 10k of references to an already too lonng article is not helpful - especially as you doubt that all of the current references are actually used by this article Sci guy 03:30, 29 September 2005 (UTC)

Blood transfusions as a treatment for AIDS?

I have a question - In conjuction with typical treatments that knock down the viral load, why have researchers not experimented with some kind of T-cell transplantation? (e.g., through blood or blood serum transfusions). Hemophiliacs in dire situations can go through mass-transfusions where their blood volume is relaced 2 or 3 times in the span of a few hours. Would it not be possible to do something similiar with an AIDS patient? Could this not considerably restore a low T-cell count and lower the viral load? →Raul654 06:37, 11 October 2005 (UTC)

It's kind of like running water into a sink with no plug. It ain't staying around for long. :-/ ..... JoeSmack (talk) 13:43, 11 October 2005 (UTC)
HIV is present in interstitutal fluids besides blood (such as saliva and semen) so clearly replacing the body's blood volume isn't a cure, but I don't see why this wouldn't be an effective treatment. →Raul654 18:02, 11 October 2005 (UTC)
It also has it's grips on the lymphatic system and the brain (as it crosses the blood/brain barrier). Once lots of the latent infected cells have been activated, it can act/spread quite fast. It is not a viable solution at this time. Also I imagine replacing millions of pints of blood a week would drain blood banks in no time...... JoeSmack (talk) 15:35, 12 October 2005 (UTC)
Most of the HIV load in the body exists as DNA inserted into the chromosomes of resting CD4+ lymphocytes. Viral load is measured in the blood because blood is easily accessible, but it's a bit like measuring the capacity of a bathtub by measuring the spillage when you step into it. The average virion "lives" less than one day, and the average replication cycle is about three days. You're not going to do any good by an exchange transfusion, and if your goal is reducing viral load, medication already does this more effectively, throughout the body rather than simply in the blood, and with considerably less mess. - Nunh-huh 00:56, 13 October 2005 (UTC)
Also, a big problem: getting large quantities of white blood cells from another person may kill you. You can safely transfuse red blood cells mostly because they carry no genetic information; blood types are based on surface antigens produced by a small number of genes that don't otherwise affect the function of the cell, and mature red cells have no nucleus and don't do anything except carry oxygen. But the main function of white cells, particularly T cells, is to attack any tissue that's not genetically similar to themselves—which can include the transfusion recipient. So blood transfusions are normally filtered to include mostly red cells (or plasma or platelets, whatever's required), and bone-marrow transplants have T cells removed to prevent graft-versus-host disease. You would have to do something more sophisticated to produce immature T cells that could adapt to the host; we don't know how yet. Hob 00:12, 20 October 2005 (UTC)