Talk:AIDS/archive 3

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Contents 1 Article Focus is AIDS 2 Polio vaccine theory 3 AIDS or Aids? 4 GRID or GRIDS? 5 Third world 6 External Links 7 Smallpox vs. Black death 8 OPV theory 9 Oral Transmission 10 Condoms recommended for ALL sexual activity ?! 11 Allele HIV Immunity? 12 gross negligence causing risks for human life? 13 Link suggestions 14 Major gap in the coverage 15 Man-Made Virus? 16 Recommended piece of news 17 Oral transmission? 18 History of hiv/aids 19 Politically charged paragraph 20 Evidence-based medicine (moved from article text)= 21 POV notice 22 Treatment guidelines 23 Defining AIDS 24 Opportunistic Infections 25 "Bangui definition" 26 Explanatory note about UNAIDS/WHO estimates 27 External link (Wangari Maathai opinion) 28 rumors 29 Liver Failure as Leading US Cause of Death?

Article Focus is AIDS

As there are excellent articles in HIV and HIV testing and HAART this information does not need to be duplicated in the AIDS article.

There is no reason to retain the now discredied Ho theories, especially since the treatment guidelines now reject the "Hit hard hit early" approach - and defer HAART if viral load is below 1000,000 and CD4 is above 350.

After ten tears, it seems safe to add the chemokines research.

Sci guy 02:49, 24 Mar 2005 (UTC)

Polio vaccine theory

I found a bit of inconsistency in the article. "History" section says : "A common theory ... held that HIV came from Simian Immunodeficiency Virus (SIV), a virus virually identical to HIV, that causes AIDS-like symptoms in primates, and that this virus was transmitted to human populations in Africa during the course of controversial polio vaccine experiments on African villagers (this theory has since been disproven)"

"Current medical understanding of AIDS" says : "HIV is closely related to viruses causing AIDS-like diseases in many primates, and is generally thought to have been transferred from animals to humans at some time during the early 20th century, though some evidence suggests it may have been transferred earlier in several isolated cases."

It goes on to suggest that this theory is still valid. So which is correct ? Does the "animal to human" theory still stand ? Jay 12:29, 18 Jun 2004 (UTC)

It's the polio vaccine theory which has been disproved. Adam 14:34, 18 Jun 2004 (UTC)

...but the confusion may stem from the fact that, and I'm a bit fuzzy on this part, it was chimpanzee livers (? kidneys? just cells?) that were used to culture the vaccine. Exploding Boy 15:05, Jun 18, 2004 (UTC)

Kidneys - though chimps weren't used at all, according to the vaccine makers. The most recent proponent of the vaccine theory was Edward Hooper in The River - Hooper's comments and reviews from 1999-2000 are here and the more recent evidence against it is discussed here and here. But aside from questions about the mode of transmission, the basic animal-to-human theory is universally accepted - the genetic evidence is not in question (even, as far as I know, among people like Duesberg who attach no importance to HIV). --Hob 17:28, 18 Jun 2004 (UTC)

Thanks everyone. I've rewritten the line in the article. 11:14, 19 Jun 2004 (UTC)

AIDS or Aids?

I've not seen it written all in capitals for quite a while (at least here in Britain), but all references here are all in caps (and I just noticed Stormie changed the reference from mixed case to all caps in another page, which is what made me think of it). Do we have a standard on this; do we care? To me, it seems like a British English / American English issue, where both are acceptable and neither should be changed to the other, edit-war stylee. Opinions? — OwenBlacker 15:24, Jun 23, 2004 (UTC)

So far as I know the Aids form is only used by some of the British press (such as the Economist) who have a long-standing policy of rendering all acronyms like that. Adam 23:12, 23 Jun 2004 (UTC)

I normally use the caps one. --Ævar Arnfjörð Bjarmason 23:14, 2004 Jun 23 (UTC)

m2cw: I am certainly not a use of American English, but to me AIDS remains AIDS, not Aids. Erich 23:33, 23 Jun 2004 (UTC)

One hopes that the downcasing mania proceeds no further or we shall be reading in the "nejm" about "hiv which causes aids" (or perhaps worse, "an hiv test"). Usage rather than logic dictates the use of capitals for abbreviations other than those standing for proper names, but noun forms (like AIDS) are usually uppercase, while adverbial forms (rpm, mpg) are usually lowercase. Long acronyms (NAFTA) tend to become lowercase (Nafta) as they are used more frequently, but I don't think AIDS is likely to do so because the use of capitalization makes clear that one is using the acronym rather than the everyday verb or noun "aids". -- Nunh-huh 23:48, 23 Jun 2004 (UTC)

It's not that all acronyms get lowercased (or Nunh-huh's worries of "downcasing mania"), it's that acronyms that are read as words (Nafta, Nato, Aids, Unesco) get rendered with an initial capital; ones that cannot (HIV, UN, EU, USA, NEJM) get rendered in all-caps. There's no danger of confusion with the dictionary word aids, as there is always an initial capital. Excessive use of capitals tends to be considered A Bad Thing(tm) — not least becaus ethey're more difficult to read. I'm not suggesting that we should standardise on mixed-case use, just that we shouldn't enforce standardisation on the all-caps form. — OwenBlacker 08:52, Jun 24, 2004 (UTC)

Well that may all be very logical but the fact is that everybody in the world except some British newspapers uses the AIDS form, and so does Wikipedia, so this article should conform to that. Adam 09:03, 24 Jun 2004 (UTC)

Other than Unesco, I've never seen any of the other examples rendered in anything but all capitals. Certainly never AIDS or HIV. I don't like it at all. Exploding Boy 09:02, Jun 24, 2004 (UTC)

Definitely never HIV, but I've seen Aids (and Nato, Nafta and Unesco, for that matter) rendered mixed-case most of the time. Still, I seem to be the only person who prefers it, so I'll shut up about it now... :o) — OwenBlacker 04:20, Jun 27, 2004 (UTC)

GRID or GRIDS?

I was about 95% positive that the initial acronym for AIDS was "GRIDS", for "Gay-Related Immune Deficiency Syndrome"... am I wrong on this? Arcuras 26 June 2004

I've never seen GRID with Syndrome on the end, as it were. Google gives 12,600 matches for GRIDS and HIV; 78,600 matches for GRID and HIV, if that's of any help (HIV in the search term to try to remove false positives). Presumably some people have used the longer form, but the shorter form seems dominant. — OwenBlacker 04:20, Jun 27, 2004 (UTC)

The expression was GRID, it was only in currency for a year or so. I've never seen the GRIDS form. Adam 06:27, 27 Jun 2004 (UTC)

Yeah, turns out I was wrong on that... just goes to show what a public education gets you. =P Arcuras

Third world

I would add a third world section in the article, including the problem of therapy and prevention in these countries without farmacological resources and international pharmacology help (List_of_pharmaceutical_companies).

External Links

Do we really want four external links to the same URL (ericdigests)? Seems to be to dictionary type articles elsewhere and it is a bit unusual? --BozMo|talk 11:49, 8 Oct 2004 (UTC)

Smallpox vs. Black death

I was interested in Bletch's change from Black death to Smallpox in the article on AIDS. He claims "Smallpox was WAYYY more deadly than the Black Death". I can see this point of view, and I agree that the introduction of smallpox was probably far more influential in terms of long-term geopolitics, but I don't think the facts back up the specific claim.

1. Although the Smallpox entry doesn't specify numbers (only percentages), the pandemic entry mentions Smallpox as a "local epidemic of extraordinary virulence", and the numbers in that paragraph add up to something like 2½ to 3 million, total. According to its entry, Black death killed 25 million.
2. The sentence he modified is "These numbers have led some experts to call AIDS the deadliest pandemic in human history since (something)". Even if Smallpox was more deadly, this could still be untrue. Which experts have called it the deadliest pandemic since Smallpox?

I didn't want to just revert without justification, so there are the reasons that I think the statement should stand at Black death. - Plutor 13:03, 12 Oct 2004 (UTC)

OPV theory

Raul654 and Adam Carr claim that there is a scientific consensus against the OPV theory. I claim that there is no scientific consensus on OPV, because at least two notable scientists support (or have supported) this theory (W D Hamilton and Omar Bagasra). I know this because I have actually bothered to research the issue (and write the article about it). As usual, it seems like some people are reverting my changes out of a personal vendetta. If this bullying continues I will seek mediation or other further action. --style 07:26, 2004 Oct 17 (UTC)

The scientific basis of your statement is flat out, totally, completely, 100% wrong. Consensus is a positive - IE, theories that have failed to be disproven numerous times are said to be accepted as true and have 'scientific consensus'. In science, there is no such thing as "consensus against an idea" because by-default they are not accepted as true. Your statement is utterly ridiculous. →Raul654 08:10, Oct 17, 2004 (UTC)

Your post doesn't even make any sense. It's nonsense and hyperbole. It's quite possible for a theory to be "failed to be disproven" multiple times, like OPV, yet not be accepted as scientific consensus because it has not yet been definitely proven. Science is not black and white. --style 08:36, 2004 Oct 17 (UTC)

There's so many things wrong with that statement, I don't know where to begin. First, in science, NOTHING is ever "definitely proven". Only someone who knows nothing about science would ever make such a statement. As I already said above, scientific theories cannot be "proven", only disproven. "Correct" theories are theories that have withstood numerous and repeated attempts at falsification over a long period of time (think decades); however, no reputable scientist would ever say that they are "definitely proven" (just look at Newton's laws for a classic example).

Furthermore, saying that OPV theory has failed to be disproven is flat out wrong. 10 seconds of googling turned up the following choice quotes:

The final nail is in the coffin for the now largely refuted theory that the human immunodeficiency virus type 1 (HIV-1) crossed into humans as a result of contamination of oral polio vaccine (OPV), according to a new study. In the April 22 Nature, Michael Worobey and colleagues report that the chimpanzees claimed to be the source of simian immunodeficiency virus (SIVcpz) that crossed over actually contain a SIVcpz unrelated to HIV-1... Scientifically, this paper spells the end of the OPV theory,” said Edward Holmes, from the University of Oxford, who was not involved in the study." --http://www.biomedcentral.com/news/20040421/02

HIV is widely believed to have appeared when the closely related simian immunodeficiency virus (SIV) jumped from a chimpanzee to a human, probably in West Africa in the early twentieth century. Exactly how the first human was infected is not known, but one theory that incited particularly vigorous debate has now been laid to rest. The theory claimed that HIV was inadvertently introduced during tests of a new oral polio vaccine (OPV), which was allegedly prepared using chimpanzee kidney cells and was administered to over a million people in the Democratic Republic of Congo in 1958. -- http://www.nature.com/nature/fow/010426.html

When Nature magazine says a theory "laid to rest", it's dead. To say afterwards that such a theory is not supported by the scientific establishment is disingenius at best. It would be more accurate to say it's been proven false. →Raul654 08:56, Oct 17, 2004 (UTC)

Typical. You don't know jack about the subject at hand, so you resort to thinly-veiled personal attacks and irrelevant rants about semantics.

Well done for discovering how to copy and paste text from web sites after "10 seconds of googling". I could do the same and post the conclusive rebuttal ([1]) from Hooper's site but I don't see the point. If you want to argue about the acceptance of the theory like an educated adult, rather than just foaming at the mouth and hurling links at me, then post your reasons and evidence why you think the theory is disproven and/or unsupported and I will eagerly listen. But if your conception of science is that theories are disproven if a particular journal says so, you are beyond help. --style 12:13, 2004 Oct 17 (UTC)

We can do without silly personal abuse and hyperbole in discussing this article. The article notes that the OPV theory exists, and that is all it needs to do. The Nature article is ample evidence that the theory is not widely accepted but we don't need to go into that in the article. Adam 13:45, 17 Oct 2004 (UTC)

I think a citation and/or quote would probably be in order. →Raul654 17:33, Oct 17, 2004 (UTC)

Oral Transmission

The paragraph on oral transmission began with

"There have been claims that a small number of people have been infected with HIV from performing oral sex on an infected on an infected partner, but these claims are disputed in the scientific community and have yet to be proven conclusively."

That seems biased to me. There are many researchers who are convinced that HIV has been transmitted throgh oral sex. My understanding is that the documented cases of oral transmission are controversial only because they haven't been able to completely rule out the influence of mouth sores and unhealthy gums. (Personally, I think that's splitting hairs--oral transmission is oral transmission isn't it?) Uranographer 07:36, 18 Oct 2004 (UTC)

I haven't kept up with the literature on this in recent years, but the last time I looked there was no undisputed case of oral transmission of HIV, and only a handful of even possible cases. Against that must be set the fact that it would be almost impossible to prove that oral transmission was the sole and undisputable cause of any case of HIV infection, because there are very few people who have oral sex as their only possible source of infection. I don't think there are "many" researchers who are "convinced" about oral transmission. I think most specialists accept that it is possible, but few believe it is at all common. The statement quoted is true as far as it goes, but it probably needs amplification. Adam 08:04, 18 Oct 2004 (UTC)

Well, last time I did a literature search there was evidence for oral transmission that was compelling enough to get the cases published. I'm not saying they are entirely undisputed (although, if we want to split hairs I'm not sure there is much of anything in all of medical science that is universally undisputed) nor am I claiming I've done any kind of survey of AIDS researchers. But all the sources I've looked into (save for that Spanish study) seem to think there is enough of a risk that they suggest using protection for oral sex. For more info, check out the references at the end of the CDD's oral sex fact sheet (http://www.cdc.gov/hiv/pubs/facts/oralsexqa.htm). Uranographer 04:19, 19 Oct 2004 (UTC)

Concidering the fact that it is possible to contract HIV through the eyes (boyfriend's seminal fluid gets into the individual's eyes through bad timing etc and is absorbed through the blood vessels in the eyeball and passed into the blood stream), it should be possible to contract HIV through oral sex, whether through gum sores, small wounds, or any other form of entering the blood stream.. The argument isn't whether it's probable, the argument is whether it's possible, and thus it deserves it's place in the article.

Besides which, there will never be a consensus on anything in regards to HIV, especially when some 'scientists' still claim it's some sort of "gay plague". Arcuras 14:49, Oct 19, 2004 (UTC)

That's interesting, I had never even thought about the eye thing. Do you know of any documented cases? I don't think there is much doubt about the possibility of oral transmission; it's a matter of how realistic the risk is, e.g., is it more like the chance of being hit by a meteor, or by a car.

Sadly, only an episode of CSI. Negative guy slashed throat of Pos girl, got the blood in his eyes, and the hiv infected blood got in through the blood vessels. That was their explanation, at least. I asked a biology prof about it later and she said that, theoretically, it would be possible... but the chances are (of course) rather slim of it actually happening. Still, something to give one pause before being on the recieving end of a 'facial'. Arcuras 16:03, Oct 21, 2004 (UTC)

Condoms recommended for ALL sexual activity ?!

"The use of latex condoms is recommended for all penetrative sexual activity."

If this would be true, humankind would die out rather quickly... I think this sentence should be either taken out (the following sentences state clearly enough that using condoms is advisable to avoid infection) or reformulated to a less absolute statement. Marcika 00:49, 11 Nov 2004 (UTC)

No, it's certainly an accurate statement, though it could better be qualified to "The use of latex condoms is recommended for all penetrative sexual activity, where the risk of HIV transmission is a concern.", perhaps. — OwenBlacker 10:30, Nov 11, 2004 (UTC)

Perhaps " . . . for all penetrative sexual activity which might pose the risk of STD transmission"? Exploding Boy 17:03, Nov 12, 2004 (UTC)

Exactly: sexual AIDS risk is exclusive for all sexual activity outside a stable and mutually loyal relationship. As soon as a couple has tested against HIV-risks from relations from before they became a couple and remains loyal, Imedical literature shows zero risk (drug related risks, blood transfussions in countries with unsafe stock etc. being another area; i was speaking here about sexual transmission). --Rudi Dierick 16:39, 4 Dec 2004 (UTC)

It's not our job to make recommandations - Wikipedia does not give medical advice. Take it out. →Raul654 18:39, Nov 12, 2004 (UTC)

This is a grossly partisan statement; moreover, it appears against the legislationin many democraries. Laws instgruct you never to engage in negligence that might cause danger to human life. As AIDS is still lethal, I really cannot understand why suddenly on this specific lethal disaise, one should apply censorship on those objective conditions that protect against this risk? --Rudi Dierick 16:39, 4 Dec 2004 (UTC)

Quite. But it's not we who are making the recommendation, but the medical community. Surely this deserves a place in an article about an STD, in particular one that already contains similar information. Exploding Boy 20:46, Nov 12, 2004 (UTC)

Well, the way that is phrased, it does sound like we are the ones making the recommendation. If you really think it belongs there, I suggest quoting and attributing it to a reputable medical source on the matter. →Raul654 21:18, Nov 12, 2004 (UTC)

Good and appropriate suggestion. --Rudi Dierick 16:39, 4 Dec 2004 (UTC)

Your revision is ok, but has removed the specific information about HIV transmission. Exploding Boy 22:40, Nov 13, 2004 (UTC)

I couldn't find a quote/cite specific to HIV. If someone has something better in mind, I'm open to it. →Raul654 22:45, Nov 13, 2004 (UTC)

In the meantime, I'm restoring the previous version which mentions HIV specifically. Exploding Boy 22:53, Nov 13, 2004 (UTC)

Much better. Exploding Boy 23:18, Nov 13, 2004 (UTC)

Condoms don't protect people from contracting Aids; their purpose is birth control. I think I heard that if you use a condom and have sex with someone whith AIDS, you still have a 1 in 6 chance of getting the virus.

You heard wrong. See this CDC fact sheet, or for more details the NIH report. Both theoretical and empirical (actually monitoring people over time) studies have shown that condom usage reduces the risk of getting AIDS by a lot; the report quotes an approximate risk reduction of 85%. That equates to a risk about 1/6th that of not using a condom, which may have been what you heard. --Robert Merkel 02:47, 22 Nov 2004 (UTC)

Allele HIV Immunity?

Recent edit by anon added: "It is known that about one per cent of the White European population carries two genetic alleles that confer total immunity to HIV. Possession of one allele causes HIV to cause a less serious form of disease in that individual. This seems to indicate that in Europe thousands of years ago there was a virus or other pathogen that mimicked the entry method of HIV into human cells. This is another example of what is known as convergent evolution as HIV and this ancient pathogen could not have been closely related."

Never heard of this before, and the anon didn't provide a citation, unfortunitly. Anyone have any information to back this up? Arcuras 02:14, Nov 11, 2004 (UTC)

Not having any responce, and being unable to find any information on the subject myself, I've removed the quoted piece until someone can provide some evidence to back it up. Arcuras 21:56, Nov 12, 2004 (UTC)

It was pretty well established (back in the 80's, I think) that about 1% of people did not get infected with HIV despite repeated exposure to the virus. All of these "immune" people had the described pair of mutated genes. However, researchers also discovered that a few HIV-infected people did have the mutated pair, so the so-called "immunity" is not complete. As for the rest of that statement, I think that old Eurpoean virus theory is entirely hypothetical. Check out [2] for an expository article. Uranographer 09:51, 27 Nov 2004 (UTC)

Ah... I just came across this article on the 'net: http://www.bbc.co.uk/worldservice/sci_tech/highlights/011025_ccr5.shtml and I was going to ask about it here, but I see the issue has already been brought up. Is this worthy of a mention in our article? func(talk) 01:14, 28 Nov 2004 (UTC)

At least one article I've read correlates the increased HIV-resistance to the areas where the bubonic plague struck the hardest. For example, it is apparently more common in Norway than Sweden, which is believed by some to be due to Norway being harder affected by the bubonic plague. Anonymous 01:30, 9 Jan 2005 (UTC)

gross negligence causing risks for human life?

The sentences "Currently the most common ways to contract HIV are via unprotected sexual activity" appears scientifically incorrect (or at least confusing). It is not unprotected sexual activity that is dangerous, but more specifically 'unprotected sexual activity outside a stable and mutually loyal relationship'.

As far as I know, teher is no single medical evidence that (leaving aside the other types of transmission as infected heroin needles, unsafe blood, etc.) sexual activity within a stable and mutually loyal relationship has ever resulted in an HIV infection. In case anybody has authoritative evidence on the contrary, please feel free to provide it. Many thanks in advance, --Rudi Dierick 16:44, 4 Dec 2004 (UTC)

The fact that the relationship is "stable and mutually loyal" (I presume you mean monogamous) provides no protection from HIV transmission now does it? Exploding Boy 18:52, Dec 4, 2004 (UTC)

Equally, condomless sex is considered "safer sex" if both partners are definitely monogamous and definitely seronegative. I think the statement in the article ("via unprotected sexual activity") is perfectly accurate and, to be honest, "unprotected sexual activity outside a stable and mutually loyal relationship" is misleading and inaccurate. — OwenBlacker 19:12, Dec 4, 2004 (UTC)

EB and Owen are both right on the money. →Raul654 20:11, Dec 4, 2004 (UTC)

Well folks, read from a different perspective then what I did, you're right. Protecting ones sexual life by having relations only within a monogamous relation with a seronegative partner is indeed also an answer to 'unprotected sex'. I justed wanted, one way or another, to add the information that condoms alone are not the best possible way to achieve safe sex. No scientist ever has pretended that just the use of condoms eliminates all risks (already because it is impossible that everybody uses condoms all the time when ncessary, and also exactly as they should be used. How should we formulate that, and the added information that a definitely monogamous relation with a seronegative partner is indeed also a very strong factor of protection? I made a try; everybody who can formulate it better, is free to irmprove it. --Rudi Dierick 14:32, 5 Dec 2004 (UTC)

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Major gap in the coverage

This article is severely lacking a historical context for AIDs. Important things it doesn't even mention: Gaetan Dugas, GRID, Robert Gallo, the CDC, 'etc. →Raul654 08:49, Dec 20, 2004 (UTC)

Man-Made Virus?

See THE STRECKER MEMORANDUM (Google/Yahoo Search)

Recommended piece of news

• DermaVir, a novel treatment for HIV/AIDS, complements and improves present drug therapies

Probably you can find more extensive sources as well. – I wonder if it would be worth including into the article.

--Adam78 01:08, 16 Jan 2005 (UTC)

Oral transmission?

The referenced "studies" in the oral transmission section should either be referenced or removed. As far as I know, there are no documented cases of oral HIV transmission, despite a theoretical risk.

Even if there are no documented cases, it is still worth talking about. OTOH, if the studies are not reputable, they should come out. →Raul654 01:16, Jan 28, 2005 (UTC)

History of hiv/aids

Is there an article on the history of hiv/aids? By this I mean the first cases that were diagnosed, what people thought was happening, naming of the virus etc. Jackliddle 01:06, 3 Feb 2005 (UTC)

Politically charged paragraph

The present wording: "Despite widely publicised fears about the possible "casual transmission" of HIV and AIDS, the risk of infection is virtually eliminated by following simple precautions, such as abstaining from sexual activity outside a definitely monogamous relation with a seronegative partner, and avoiding blood transfusions with unsafe blood." is wrong, inaccurate, bigoted and clearly holds a hidden agenda.

1. Safe sex does not only refer to sex with condoms, but has a larger meaning that includes activities like non-penetrative sex. It is about as likely to cause AIDS as accidentally sharing blood from such mundane accidents as a paper cut or a broken glass. True, those are extremely unlikely, but they are possible. The exact same thing can be said of safe sex.
2. The present wording implicitly focuses of casual sex as immoral. The discussions on this Talk page reject the addition of the term "safe sex" in this paragraph under the pretext of different interpretations of what the term means. This is not what Wikipedia is for. Protected sex is mentioned only two paragraphs later in a different context.
3. No one chooses to be transfused contaminated blood. Being injected HIV is not something someone "avoids". In that regard, the present wording is extremely offensive. Without that remark, though, the paragraph no longer makes sense; it would be saying that one can only catch AIDS by being negligent or promiscuous, thus making people who got AIDS from transfusion one of those. The contributor seems to have added helpful advice on avoiding contaminated blood transfusions to cover up for this fluke.
4. The choice of the word "abstaining" is politically charged. The words "not having", or "avoiding" seem to have been rejected on purpose.
5. Even the title of the this Talk page's discussion "Gross negligence causing risk for human life?" is a poor rhetorical device meant to implicitly and immediately label those who oppose it as begin accomplices to murder. This is not encyclopaedic language, even for the Talk pages. It is about as manipulative as referring to "having an abortion" as "killing unborn babies".

The text must at least say "as abstaining from unprotected sexual activity outside a definitely monogamous..." The people following this advice have their risk of contamination as "virtually eliminated" as those who follow the original statement's advice. And it will carry less of the huge political charge.

I did not change the text myself because I don't want to start an editing war that will cause the page to be protected, but who is in with me on this?

Eje211 22:32, 12 Feb 2005 (UTC)

Evidence-based medicine (moved from article text)=

(I cut the following anonymous text from the Treatments and vaccines section. Comments about editing the article belongs on the Talk page, not in the article. Or, better yet, instead of making a vague suggestion like this (I say vague because "evidence-based medicine" is an extremely general principle, meaning basically "relying on research")... just try writing such a section, and see what you and others think is worth saying about it. Be bold! ←Hob 19:10, 2005 Feb 27 (UTC))

The Relationship Between "Evidence-Based Medicine" and HIV and AIDS Diagnosis and Treament:

I am suggesting an additional section here to explore the relationship between the practise of "Evidence-Based Medicine" juxtaposed to the methods of screening, diagnosing, and treatment relating to the HIV and AIDS issues.

POV notice

It's disappointing to see a neutral article go downhill and get taken over like this. The new lead section is particularly bad ("AIDS is defined as beginning when..."). The lead section doesn't even bother to mention one important point: AIDS is a disease. I don't pretend that I'm an expert on this subject, but it appears that sci guy is trying to downplay the importance of HAART, spread fear, uncertainty and doubt about its side effects, and downplay the overwhelming evidence for a connection between HIV and AIDS. A huge amount of information has been removed; the rewritten paragraphs are awkwardly written ("There is good evidence that if..."). I can't think of a good explanation for the removal of the entire "prevention" section. Please explain your edits, sci guy. Rhobite 23:35, Mar 30, 2005 (UTC)

I began the article with the current definition of AIDS, and cited the reference and included an external link. Since 1993 two thirds of AIDS cases in the United States are based on CD4 cell count below 200. These people are healthy, and have no opportunistic infections. I have reported that the WHO and CDC have progreesively changed treatment recommedations to defer HAART in people without symptoms and CD4 above 200. I have cited the reference and provided external links. The reasons for this change by WHO and CDC are clear. Drug toxicity has proved to be higher than expected and progression to AIDS in untreated controls was slowed than expected. Sci guy 01:12, 31 Mar 2005 (UTC)

The prevention section wasn't removed, but it was edited down. Sci guy, please tell us why you believe that we should not tell people that abstaining from sex or using condoms can reduce the chance of contracting HIV/AIDS? Rhobite 23:38, Mar 30, 2005 (UTC)

I am happy to add "that abstaining from sex with a person infected with HIV or using condoms can reduce the chance of contracting HIV/AIDS". Should a NPOV approach include that fact that all longitudinal studies have failed to find any transmission of HIV between couples having regular unprotected sex - and that sales of condoms have not increased? Should a NPOV note the position of the Catholic Church "If people really want to prevent AIDS, they must be convinced to change their sexual behaviour, which is the principal cause of the infection's spread. Until a real effort is made in this regard, no true prevention will be achieved. " Sci guy 02:15, 31 Mar 2005 (UTC)

Given that he hasn't responded satisfactorily to further requests for information either here or on AIDS in Africa, I'm going to be bold and simply revert the article. --Robert Merkel 00:32, 31 Mar 2005 (UTC)

No reason to argue with you Sci guy. You gutted this article, rewrote the lead section but neglected to say that AIDS is a disease, and removed important prevention information. Rhobite 03:07, Mar 31, 2005 (UTC)

Treatment guidelines

First came "hit hard, hit early", then came a more conservative approach with a starting point somewhere between 350 and 500 CD4+ T cells/mm3. The latest guidelines use 200 to 350 cells/mm3 as the range to consider offering antiretroviral therapy (HAART) to asymptomatic patients. Sci guy 02:09, 31 Mar 2005 (UTC)

Defining AIDS

The CDC 1993 definition has expanded AIDS from a small group of people with rare opportunisitc infections to all people with a CD4 cell count below 200. This has trippled the number of cases in the US - but these extra cases are not progressing in the same way as pre 1993 AIDS.

Using the global figures means we need to include the Bangui definition because this is the basis for the majority of global AIDS. Sci guy 09:24, 31 Mar 2005 (UTC)

Opportunistic Infections

The idea of opportunitistic infections is probably outdated. It was originally based on the idea that PCP and KS were markers of immune deficiency (because they were previously seen mainly in patients on immuno suppressive therapy). Now that PCP and KS have been better studied, it is realised that these diseases are the result of recent infection. The organisms causing PCP and KS are 'not common in healthy people originally thought.

AIDS defining medical conditons may be more accurate. What do CDC, WHO and UNAIDS currently use?

"Bangui definition"

I've been doing some poking around on the "Bangui definition" raised by Sci Guy. It doesn't seem to be mentioned anywhere in UNAIDS's publications, or indeed any indication that AIDS cases described in their work is related to anything other than HIV infection and the consequent failure of the immune system.

Where the Bangui definition *is* raised constantly is in stuff by groups like ACT UP San Francisco. That doesn't mean it's wrong. What it does mean is it's coming from the AIDS reappraisal crowd, who are well outside the overwhelming majority of medical opinion on issues relating to AIDS.

If anybody can find a rebuttal from mainstream AIDS research on this topic, it might be handy for NPOV purposes. --Robert Merkel 11:29, 31 Mar 2005 (UTC)

The "Bangui definition" was developed by CDC and WHO in 1985, so it is part of the scientific consesus. It remains the basis for diagnosis where antibodies tests are not available - which is most of the world. The AIDS reappraisal group has consistently objected to the continued use of the "Bangui definition" because many of the people diagnoses with AIDS by this definiiton test are not infected with HIV. All this information was in the references, tha tyou deleted. Sci guy 14:38, 1 Apr 2005 (UTC)

That may be true. But what I'm trying to establish is that the Bangui definition remains the process by which the estimates of AIDS prevalence are made. Now. Not in 1985. Not in 1995. Now. If you can show me evidence (point me with some precision to one or two references, preferably in the peer-reviewed literature or from one of the big government AIDS organizations) that suggest that current AIDS statistics contain a bunch of people without HIV, then I might be convinced you have something of more than historical interest. --Robert Merkel 22:50, 1 Apr 2005 (UTC)

Explanatory note about UNAIDS/WHO estimates

The UNAIDS/WHO estimates are based on the most recent available data on the spread of HIV in countries around the world. They are provisional. UNAIDS and WHO, together with experts from national AIDS programmes and research institutions, regularly review and update the estimates as improved knowledge about the epidemic becomes available, while also drawing on advances made in the methods for deriving estimates. Because of these and future advances, the current estimates cannot be compared directly with estimates from previous years, nor with those that may be published subsequently. source Sci guy 01:12, 2 Apr 2005 (UTC)

In countries with generalized epidemics, estimates of HIV prevalence have primarily been based on blood samples left over from syphilis tests of pregnant women in antenatal clinics (or sentinel surveillance). Until very recently, these have provided the best available estimates of HIV prevalence in the population.

Surveillance systems often select clinics located in urban or peri-urban areas, both for ease of access and because those clinics serve a larger number of pregnant women and can yield sufficient sample sizes during data collection. Often this leads to few data being available from pregnant women in rural areas. This bias can be corrected, but it introduces a further layer of uncertainty (the extent of the differences between HIV prevalence levels in urban and in rural areas).

There is no gold standard for HIV surveillance. All HIV estimates need to be assessed critically source Sci guy 01:21, 2 Apr 2005 (UTC)

External link (Wangari Maathai opinion)

I've just replaced this link: [3] It had been removed by Hadal, but without explanation. The opinion expressed is held by many people around the world, and the person expressing it here – Wangari Maathai – is prominent and well respected. One can reject the theory while accepting that the link has a place here. Any other opinions? Mel Etitis (Μελ Ετητης) 16:27, 6 Apr 2005 (UTC)

It's a little disappointing that Carl Henderson has simply deleted the link without discussing it here. Mel Etitis (Μελ Ετητης) 17:36, 6 Apr 2005 (UTC)

I looked in the Discussion page before making my deletion. However, I looked in the wrong place (under the "Man-Made Disease" heading) saw no discussion, and removed it. More on my reasons for removing it below. Carl Henderson 00:17, 8 Apr 2005 (UTC)

Interesting; does no-one involved in editing this page have the simple good manners to discuss their reverts on the Talk page? Now UtherSRG has deleted it. I've put it back until someone follows Wikiquette and explains what's wrong with adding a link to a news item that reports a speech by a Nobel laureate on the topic of the article. Saying 'we don't agree with what she says' isn't good enough — it wouldn't even be good enough if we were talking about the content of the article (does NPoV ring any bells around here?), but especially not in the external links section. I don't agree with her either, but that's not the point. Mel Etitis (Μελ Ετητης) 21:01, 6 Apr 2005 (UTC)

For me, links shouldn't jusst be added willy-nilly just because the link's subject is somewhat related to the article. If we're going to supply a link like this, there should be some text in the article related to the link. The link in question taks about a controversial HIV origin theory. This theory isn't mentioned in the origins section of the article. Furthermore, just because a Nobel laureate has said something, doesn't mean that their laureate standing means anything if they are talking off the topic of their field of study. In this case, Maathai is an ecologist, not a microbial biologist or a virologist. Still further, the blog the link directs to is written by the person who initially added the link to the article (see User talk:Hadal, and Wikipedia is not a place for self-promotion. I'm removing the link again. - UtherSRG 21:56, Apr 6, 2005 (UTC)

Fair enough (though the fact that she's well-respected and influential makes her comments newsworthy, and worthy of mention here) — but that raises the question: why isn't there anything about this in the article? Again, as I said above, it's an indisputable fact that many people have claimed that AIDS is a laboratory-produced disease, and many more believe it. It would seem to be a curious gap in the article that this isn't even mentioned. Mel Etitis (Μελ Ετητης) 22:18, 6 Apr 2005 (UTC)

"Newsworthy" really shouldn't enter into it. This is an encyclopedia; not a news site. My understanding is that Wikipedia should deal in verifiable facts. Where experts are quoted, they should be experts in a field related to the subject. While Wangari Muta Maathai is Nobel Peace Prize winner, her scientific training and expertise is in biology (specifically veterinary medicine), and not fields related the origins and treatments of AIDS, such as Immunology, Virology, or Epidemiology.

It is true that many people besides Wangari Muta Maathai have made the claim that AIDS is a man-made disease. So what? That doesn't make the claim correct, or even reasonable. Many people have claimed that AIDS is a judgement from God upon sinners. Both assertions have equal scientific support--none. NPOV doesn't mean abandoning critical thinking, and highlighting all ideas on a subject. Carl Henderson 00:17, 8 Apr 2005 (UTC)

It is a verifiable fact that many people have believed AIDS to be a divine punishment; it is a verifiable fact that many people have thought AIDS to be an artificially created disease. Both beliefs are and have been widespread and influential among certain communities. I find the former nauseating and the latter unconvincing, but that's irrelevant; these facts belong in the encyclop&selig;dia. Take a look both at Wikipedia policy and at other articles to which similar considerations apply. Mel Etitis (Μελ Ετητης) 08:57, 8 Apr 2005 (UTC)

I took a look at two other Wikipedia articles where particularly persistant fringe groups make contrarian claims: Evolution and the Holocaust. In both articles, the fringe claims are briefly discussed in the body of the article, and dismissed as being without scientific or historical foundation. In the AIDS article we are discussing the same thing is done under the "Alternative Theories" section. However, in both the Evolution and Holocaust, there is no external like to a Creationist or Holocaust Denial site. Removing the Wangari Maathai link under the AIDS article brings it in line with how such issues are treated elsewhere in Wikipedia. Carl Henderson 21:23, 8 Apr 2005 (UTC)

Oh, if only those were the only two; take a look at Human and Atheism, for example. However, neither of the two 'alternative' (read 'kooky' if you like) theories are mentioned in the 'Alternative theories' section, nor in the AIDS reappraisal article to which it links — that is, the same thing isn't being done there. My point stands: as it's a verifiable fact that many people believe either that AIDS is divine punishment or that it was created by scientists, the article ought to deal with that. I'm perectly happy to see it mentioned briefly and dismissed, just not ignored completely. Mel Etitis (Μελ Ετητης) 21:32, 8 Apr 2005 (UTC)

Uther and Carl have already explained why the link was removed; one might also note that User:Wingover has done nothing but spam his conspiracy theory blog, and that the news story contained within the link in question was a verbatim copy of a News24.com article. (I'll go out on a limb and say Wingover probably doesn't have permission to duplicate the article.) As already stated, the link is only tangentially related; Wangari's comments are already documented at AIDS conspiracy theories. As for why Wangari's "theory" is not mentioned at AIDS reappraisal, one reason is that Wangari is not claiming something other than HIV causes AIDS, but rather that HIV is a synthetic bioweapon. (In other words, she's arguing the conceptual origin rather than the cause.) While these connspiracy theories (which have no scientific basis) could be summarized in the main AIDS article, care would need to be taken not to present any as being more than extreme fringe views. Linking to a random blog of tinfoil hattery is, IMO, not the best way to present these "alternative" POVs. I think the two topics are best kept separate. -- Hadal 07:03, 10 Apr 2005 (UTC)

I stopped talking about the link some time ago; none of my arguments above is concenred with it. I think that at elast a sentence each on the above-mentioned views, with a link to relvant articles, is needed. At the moment, for example, the only link to AIDS conspiracy theories is a small one in the 'related articles' box. Incidentally, Wangari's view is different from tinfoil-hattery in so far as it's believed by huge numbers of people outside the West (and a few in the West). Mel Etitis (Μελ Ετητης) 10:21, 10 Apr 2005 (UTC)

I know you're done with discussing the link itself, but because you mentioned me by name as having removed it without comment (with the later implication of lacking manners[!]), I thought I should make a statement for the record—belated as it was—rather than say nothing. I'm sorry if I've overstated these points in doing so. On the subject of tinfoil hattery, I'm not aware of any threshold of popularity beyond which a baseless and paranoid hypothesis becomes something different. To clarify, I meant the word "tinfoil hat(tery)" in its common (online) sense as a byword for paranoia (also in the popular culture sense), which is a requisite part of a conspiracy theory. Anyway, if you know the who/what/when/where/why of AIDS conspiracy theories and think these views need greater representation, by all means include them. (A less diplomatic person might boil this down to "so fix it!", but I mean no derision by it.) Personally I wouldn't feel comfortable enough with the material to make your proposed changes. Happy editing, -- Hadal 12:42, 10 Apr 2005 (UTC)

I sympathise with your feelings; the trouble is that if someone who held the theories in question were to add the material, we'd doubtless be in for horrible edit war. I'll try to think of a way of mentioning them while not giving them undue prominence, or implying any support. (By the way, it was the people who removed the link without comment after I'd posted my remarks here whom I thought guilty of poor Wikiquette, so you're in the clear...). Mel Etitis (Μελ Ετητης) 13:02, 10 Apr 2005 (UTC)

I suggest that someone write an "AIDS Conspiracy Theories" article, and link to that article from within the body of the main AIDS article. Such an article would be the appropriate place for links to sites such as the one we are debating. Carl Henderson 06:49, 11 Apr 2005 (UTC)

But there is such an article (see above); that's not the issue (as I thought that my comment made clear). Additionally, it's hard to see why the notion that AIDS is a punishment from god should be called a conspiracy (I can think of a lot of other words for it, but 'conspiracy' isn't one of them). Mel Etitis (Μελ Ετητης) 09:16, 11 Apr 2005 (UTC)

I agree that external links to blogs are to be avoided. Also there is no need to include every sensational newspaper headline about AIDS. But is the real issue here whether there is a place in this article for the voice of African women? AIDS has now been redefined from a disease of 25 affluent, promiscous, drug using, American men to a disease of 25 million Africans with limited access to western medicine, food or clean water. The estimate of 25 million is based entirely on blood tests on pregnant African women. I think we are misisng the point. Wangari Muta Maathai has questioned the idea that HIV came for monkeys. This is actually an unreferenced statement in the article - but my recollection is that this idea is based on evidence from frozen remains of one dead laboratory animal. We cannot dispute the claim by Wangari Muta Maathai that HIV is manufactured in laboraties, because this manufactured HIV is the basis for all antibody tests. Also as HIV has never been isolated from a patient (or a monkey) she is perfectly correct in stating the scientific facts, which are well within her area of expertise for which she was awarded the Nobel prize. Sci guy 15:04, 14 Apr 2005 (UTC)

rumors

i have heard rumors of a possible cure, a vacccine based on the patients DNA and the ciruses DNA, works on a one to one basis only, but i was wondering if anyone can confirm this or disproove it... whichecver.

the other riumor for a cure is based on monkey DNA. can anyone confirm or disproove this as well?

Gabrielsimon 07:56, 29 Apr 2005 (UTC)

Liver Failure as Leading US Cause of Death?

From paragraph 2, under "AIDS epidemic": "In the United States, the most common cause of death for people with AIDS is liver failure caused by antiretroviral drugs" This sounds highly suspicious to me. Does anyone know of any scientific study that backs up this claim? Carl Henderson 17:26, 17 May 2005 (UTC)

I've been unable to find any confirmation for the "liver failure as leading US cause of AIDS deaths" claim. I'm deleting it. Carl Henderson 18:40, 20 May 2005 (UTC)