Wednesday, April 23, 2008

Cancer in AIDS Patients

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Mike Neri.

In this episode, I will talk about a topic that is gaining increasing interest from the AIDS community: cancer. This podcast goes over why cancer is becoming more of an issue for AIDS patients, why some cancers occur more often in HIV-positive people, the complications of treating people with AIDS for cancer, and what needs to be done in the fight against cancer and AIDS.

Most people following the evolution treatment of AIDS patients focus on the development of more effective drugs against HIV as the main battle in the war against this disease. Certainly, finding medicines that can lessen HIV’s ability to destroy the immune system and function inside the body is critical to making progress in the treatment of this pandemic. However, many people don’t realize that prolonging the lives and improving the quality of life for people with AIDS is not the end of fight. In fact, newer drugs can often complicate treatment of other diseases later on down the road and contribute to more health issues as AIDS patients get older.

Cancer is one of the best examples of the problems that people with AIDS face even after their medication has allowed them to live a somewhat normal life. It is well known that as a person ages, his or her susceptibility to cancer increases. This is no exception in AIDS patients, and as more patients survive longer due to new medicines, cancer and cancer treatment of the immunosuppressed of the AIDS community will continue to become a bigger issue.

In the public eye, cancers are not normally associated with immunodeficiency or infectious particles, but rather with carcinogens, heredity, and genetic mutations. However, cancer statistics show that viruses are responsible for as many as 15% of cancers in humans, not to mention other infectious particles like bacteria that have been linked to some cancers. This fact may help to explain the increased occurrences of some cancers in the immunosuppressed of the AIDS community.

Certain types of cancers have been associated with AIDS since the first cases of the disease. In these early days of the pandemic, a very rare cancer called Kaposi’s sarcoma was often a tell-tale sign of AIDS, and thus became known as an AIDS-defining cancer. Some other AIDS-defining cancers were non-Hodgkin’s lymphoma and cervical cancer, both of which are associated with viruses (as is Kaposi’s sarcoma) and took advantage of a host’s decreased immune defenses. In contract, non-AIDS-defining cancers are those not associated with immunodeficiency and therefore were not indicators of HIV infection. However, research has shown that some cancers that were originally considered non-AIDS-defining, such as Hodgkin’s disease and lip cancer, are in fact associated with immunosuppression and thus could be moved from the non-AIDS-defining to the AIDS-defining cancer group. This association with decreased immune function may suggest either that these cancers are also associated with viruses or that an underperforming immune system makes a person susceptible to more types of cancer than just those caused by infectious particles.

Another study from 2005 looked at how the survival of people with AIDS from cancer has changed since the first cases of AIDS compared to the general population. While this only looked at survival for 24 months after cancer diagnosis, significant improvements were seen since the 1980s in the survival of AIDS patients with certain cancers. In particular, the time period since 1996 and the introduction of HAART (or highly active antiretroviral therapies) has seen marked increases in survival rates, suggesting that if HIV is treated with more effective drugs and the immune system is better protected, then more powerful anti-cancer drugs can be used, which translates to better survival.

A recent article from the Washington Post by Mark Wainberg does a good job of looking at some of the most recent and pressing issues surrounding cancer in people with AIDS. First of all there is the troubling fact that there have been increased cases of severe and untreatable cancers in AIDS patients above the levels in the general population. He attributes this trend to the fact that while antiretroviral drugs can help fight HIV, they cannot repair the immune system to pre-infection levels, and thus may leave a person with a decreased defense against cancer.

This fact and others are cause for concern in the AIDS community. For one, there is always the issue of treating two diseases at once – doctors have to be very careful about the side-effects of mixing powerful drugs in patients while weighing them against the effect of not giving the patient that drug at all. In addition, there is cause for concern about the rising number of cancer cases in people with HIV who have been infected for 5-15 years. Researchers are unsure about what this means for other groups, such as those infected for a longer time. There is always the worry that more and more different types of cancers will start to affect AIDS patients, which makes it harder to treat cancer since almost all types require different treatment regimens and finding drug combinations for AIDS and many different cancers could be a daunting task. These are just some of the many possible challenges that physicians and researchers face in fighting both AIDS and cancer in the coming years.

Wainberg’s article ends by emphasizing the importance of finding drugs that not only help fight HIV replication and spread, but also help repair damage already done to the immune system by the virus. In addition, there is a lot more research that needs to be done in this area to determine whether all the cancers that are occurring in higher numbers in AIDS patients are related to infectious particles or if there is some other way that HIV is causing an increased occurrence of cancer in its hosts. And physicians who deal with AIDS patients need to cooperate with those who treat cancer patients to find effective and safe drug therapies that can treat both diseases at the same time.

With a large portion of the HIV-positive population reaching the age of increased cancer susceptibility, this issue will become more significant in the AIDS community in the coming years. The sooner doctors and researchers start to take on this coming problem, the better the chances that we can find ways to prevent cancer from becoming a huge obstacle in AIDS treatment. While advances in antiretroviral therapy are great steps forward for the fight against AIDS, we need to keep making strides in treatment beyond just controlling the virus and look to anticipate and deal with issues in the treatment of HIV-positive people before they become critical.

That ends this installment of The AIDS Pandemic. I’m Mike Neri, and thanks for listening.

Monday, April 14, 2008

“Rethinking” AIDS: The Dissident Movement

On October 25th, 2007, AIDS activist Ron Hudson posted an entry on his blog describing three apparently fraudulent e-mails he had received over the past month. Each of these messages appeared to come from a prominent member or group of the mainstream AIDS establishment (Dr. Robert Gallo, Dr. Luc Montagnier, and, but each also supported the unconventional view that the HIV virus does not cause AIDS. This disputed notion is the primary tenet of a controversial group of activists who seek to overturn much of what is widely accepted about HIV and AIDS. Variously called the AIDS dissident movement, the AIDS reappraisal movement, and the AIDS denialist movement, this loosely affiliated community has various beliefs and goals but is united by the shared conviction that AIDS is not caused by HIV. In this podcast, I will examine the dissident movement’s tactics and its relation to the global AIDS pandemic.

The primary strategy employed by the AIDS dissidents is discrediting the existing scientific consensus while constructing their own dissident consensus in its place. Often this dual approach can be hypocritical. For example, dissidents vehemently reject studies or even whole groups of evidence that support the mainstream view on the basis of just one flaw or educated guess, and at the same time they selectively extrapolate from findings in other studies to arrive at conclusions consistent with their own beliefs. Additionally, they rebuff research papers published by mainstream scientists, arguing that their credibility is compromised by their funding sources or lack of expertise with HIV-AIDS, while simultaneously citing lists (like the one on Reappraising AIDS’ website) of dissident scientists, many of whom have a financial interest in “alternative” AIDS treatments or work in fields not even tangentially related to virology or epidemiology. These twin strategies used by dissidents to replace the mainstream AIDS consensus with a dissident version serve to mislead the public and obscure the truth.

A related tactic used by dissidents is “moving the goalpost”. When members of the mainstream AIDS movement offer new data in support of their view, dissidents regularly call for more or “better” evidence. Christine Maggiore, founder of the dissident website Alive & Well AIDS Alternatives, declares, “Since 1984, more than 100,000 papers have been published on HIV. None of these papers, singly or collectively, has been able to reasonably demonstrate or effectively prove that HIV can cause AIDS.”

A more subtle tactic employed by the AIDS dissidents is the exploitation of the widespread disenchantment with the scientific and medical establishment. The movement finds an eager audience among those frustrated with the high-priced treatments currently available for AIDS and the apparent lack of progress toward a vaccine or cure. This dissident strategy is especially effective among developing countries, racial and sexual minority groups, and others who have been historically exploited or oppressed by the predominantly wealthy, white, and Western establishment. Some dissident groups like VIRUSMYTH portray mainstream AIDS researchers as greedy capitalists profiteering from a fraudulent conspiracy that exploits the less fortunate. Such techniques engender skepticism and distrust toward the scientific mainstream among the public and continue to attract many individuals to the AIDS dissident movement.

So ultimately, given their occasionally disingenuous strategies, how should the AIDS dissident movement be viewed in the context of the global AIDS pandemic? I asked Ron Hudson, the activist I mentioned at the beginning of this installment, for his view on this controversial group, based on his previous interactions with them. He expressed his concern over their effect on efforts by mainstream AIDS activists to reduce and prevent the spread of HIV. He worries that the speculation and inadequately tested therapies offered by some dissidents may be construed as valid guidelines for AIDS treatment and prevention and therefore increase the risk of individuals for exposure to HIV. At the same time, however, Ron also supports the respectful exchange of ideas between individuals in the dissident movement and those belonging to the AIDS mainstream. I think that Ron makes an important distinction here regarding the dissidents, that between productive dissent and dogmatic denialism. Dissent can facilitate understanding and illuminate previously unexplored facets of HIV and AIDS, but denialism fosters animosity and suppresses established scientific facts regarding the disease. In order for the dissident movement to positively affect the AIDS pandemic, the scientific community should discourage detrimental denial and promote constructive dissent. This strategy, in my opinion, will prove to be the most effective in dealing with the AIDS dissident movement in the future.

Thanks for listening. I’m Bill Stokes.

Monday, April 07, 2008

Myths and Misconceptions about HIV/AIDS

Myths and misconceptions about HIV and AIDS have been around since the very beginning of the pandemic. The first myths stemmed largely from the lack of information on this relatively new disease. One of the first myths, one that claimed that AIDS was a gay disease only, was strongly encouraged by the media. This exacerbated problems with prevention as misinformation was widely circulated. Since then, new myths have emerged. These myths have emerged despite the fact that there is now more accurate information on HIV. These new myths also create problems with prevention as people unknowingly put themselves at risk to contract the virus.

Myths and Misconceptions about Prevention and Transmission
There are many contemporary myths and misconceptions about HIV prevention and transmission and they originate from many parts of the world. Some are about the demographics of the virus and claim that HIV/AIDS is a Black Person’s Disease only or that it only affects IV drug users. There is also the misconception in parts of Africa that there are young “virgin” prostitutes or special villages free from AIDS. There is also the speculation that HIV/AIDS is worse in Africa because Africans are hypersexual. Others come from theories on the origins of the virus. Some people think that HIV was engineered by the government for the purposes of exterminating Africans, African Americans and homosexuals. Others think that HIV was sent by God as punishment for sin. Other myths and misconceptions are about prevention and transmission. Among these are the misconceptions that only promiscuous people contract HIV, that women cannot transmit HIV to men, that people with HIV look sickly or have body odor, and that HIV does not cause AIDS. One very dangerous misconception about transmission is that two HIV positive people do not need to use condoms during intercourse. This misconception is dangerous because infection with multiple strains of the virus can occur. Paranoia has led to many myths. Some of those myths claim that HIV-Positive criminals are lurking, ready to stab victims, that AIDS can be contracted from a toilet seat, and that hugging an HIV-infected person will lead to infection. People also believe that HIV can be transmitted through kissing, or eating from the plate of an infected person.
A recent article documented a very popular myth among prostitutes in Malaysia. According to Sarawak AIDS Network, or SAN, “prostitutes and their customers shake up a can of coca cola and spray their genitals before sex”. The belief is that the bubbles in the soda will kill the virus. Dr. Andrew Kiyu, a SAN member, said that this myth likely emerged because people have seen doctors use detergent to cleanse the wounds of patients. Other myths have emerged based on current information about HIV/AIDS. As a result of scientists saying that HIV can be transmitted to women via bruises within the vagina, one popular myth states that if sexual intercourse can take place without bruises through which the virus can gain entry into the blood stream, infection will not occur. Some people believe that HIV cannot be contracted from getting tattoos and body piercings based on the fact that HIV is unlikely to be transmitted via kissing. Another myth, this time based on the knowledge of false-positives and false-negatives in testing, states that you can test negative once you’ve tested HIV-positive.

Myths and Misconceptions about a Cure
Other myths and misconceptions come from ideas about possible cures for HIV. People from diverse religious backgrounds believe that there are lucky charms, magic potions, or special rituals that can be used to prevent or cure the virus. There are also many proclaimed herbal and chemical cures; some include armenicum, colloidal silver, tetrasil, and virodene. Others think that taking ‘Immune Boosters’ or vitamins can cure AIDS. Some South Africans believe that a product called Ubhejane that is sold in pharmacies is a cure for AIDS. The creator of Ubhejane, Zeblon Gwala, says that it reduces viral load and increases CD4 counts in HIV positive people. Despite the fact that scientists have tested Ubhejane in the lab and found that it demonstrates minimal benefits, Ubhejane continues to sell.

Image Courtesy of Avert. “The fake AIDS cure Ubhejane on sale in a South African pharmacy.”

Other myths stem from celebrities and their HIV/AIDS status. Because some celebrities, like Magic Johnson and Andrew Stimpson, have been diagnosed with HIV and have not yet developed AIDS after a number of years, another popular myth is that there is a cure, but only rich people know about it because they can afford it.
One very popular myth that often leads to violence against women and young children is the myth of virgin cleansing. In parts of Africa it is widely believed that having sexual intercourse with a virgin will cure HIV. The belief is so widespread that leaders have launched campaigns to dispel it. In Zambia, billboards that depict small children and state that sex with them doesn’t cure AIDS have been placed in many areas.

Image Courtesy of Avert. “A road sign in Zambia confronting the "virgin AIDS cure myth."

In addition to this myth of virgin cleansing, is the myth of animal cleansing or specifically, that having sex with animals will cure HIV. People have also ingested and injected hydrogen peroxide because some alternative health practitioners have advocated it as a cure for HIV.

Problems with Prevention
These and other myths lead many people to expose themselves to HIV despite information that proves the contrary. This creates problems in the endeavor to curtail the spread of the virus. Though many of these myths are popular and affect those in the developing world, some of them do pose problems in the United States. Sex workers in different countries who, because of poverty, cannot switch their profession in the face of the AIDS pandemic may rely on some of these myths. Addicted drug users, who frequently encounter contaminated needles, may rely on some of these myths. The naïve adolescent who may be about to engage in sexual intercourse for the first time, may rely on some of these myths. There are present efforts in place to dispel these myths and most of the initiatives take the form of websites. However, more efforts are required before all of these myths and misconceptions are finally put to rest.

I’m Shanawa Richardson. Thanks for Listening.