| CONTENTS |
| |
PROLOGUE |
1 |
| PART I |
TESTS USED TO DETERMINE HIV INFECTION |
3 |
| 1.1 |
Introduction |
3 |
| 1.2 |
Antibody Tests |
3 |
| 1.2.1 |
Non-specificity |
6 |
| 1.3 |
“HIV Isolation” |
8 |
| 1.4 |
Polymerase Chain Reaction (PCR) and “Viral Load” Tests |
8 |
| 1.5 |
Testing and the AIDS risk groups |
10 |
| 1.6 |
Discussion |
11 |
| 1.6.1 |
PCR |
11 |
| 1.6.2 |
Antibody tests |
12 |
| 1.6.2.1 |
If not HIV what leads to a positive test? |
12 |
| 1.6.2.2 |
Why are these tests not more often reported positive in individuals who do not belong to the AIDS risk groups? |
13 |
| 1.6.2.3 |
Why there is a relationship between a positive test and the appearance of AIDS? |
14 |
| 1.6.2.4 |
If the tests are specific, that is, if the tests prove infection, how did the women acquire HIV? |
15 |
| 1.7 |
Heterosexual transmission of HIV |
15 |
| 1.8 |
Conclusion |
24 |
PART II |
EPIDEMIOLOGICAL EVIDENCE FOR MOTHER TO CHILD TRANSMISSION OF HIV |
25 |
| 2.1 |
Introduction |
25 |
| 2.2 |
Studies from the USA |
25 |
| 2.3 |
Studies from Europe, Australia and Canada |
32 |
| 2.4 |
Studies from Africa and Asia |
38 |
| 2.5 |
Discussion |
42 |
| 2.5.1 |
Epidemiology |
43 |
| 2.5.2 |
Methods used to prove MCT |
43 |
| 2.5.2.1 |
Antibody tests |
43 |
| 2.5.2.2 |
Culture |
45 |
| 2.5.2.3 |
PCR |
46 |
| 2.5.2.4 |
Clinical symptoms and signs |
47 |
| 2.5.2.4.1 |
Pneumocystis carinii pneumonia in children |
48 |
| 2.5.2.4.2 |
Kaposi’s sarcoma in children |
51 |
| 2.5.2.4.3 |
“AIDS” in children before the AIDS era |
51 |
| 2.5.2.5 |
Experimental design |
58 |
| 2.6 |
Conclusion |
59 |
PART III |
BREAST FEEDING AND TRANSMISSION OF HIV |
61 |
| 3.1 |
Introduction |
61 |
| 3.2 |
HIV in Breast Milk |
61 |
| 3.3 |
HIV Transmission Via Breast Feeding |
63 |
| 3.3.1 |
The first Durban study |
66 |
| 3.3.2 |
The second Durban study |
66 |
| 3.3.3 |
Other studies |
68 |
| 3.4 |
Discussion |
69 |
| 3.5 |
Conclusion |
70 |
PART IV |
EVIDENCE CLAIMED TO PROVE AZT AND NEVIRAPINE REDUCE MCT OF HIV |
71 |
| 4.1 |
Introduction |
71 |
| 4.2 |
The ACTG 076 study |
71 |
| 4.2.1 |
Importance of the ACTG 076 study |
71 |
| 4.2.2 |
Patients and Methods used in the ACTG 076 study |
71 |
| 4.2.3 |
Experimental design of the ACTG 076 study |
73 |
| 4.2.4 |
HIV status of the infants in the ACTG 076 study |
73 |
| 4.3 |
Other Studies on the Effect of AZT on MCT |
75 |
| 4.3.1 |
Studies from Part II |
75 |
| 4.3.2 |
Further studies |
76 |
| 4.4 |
Discussion |
80 |
| 4.4.1 |
AZT |
80 |
| 4.4.2 |
AZT and Viral Load |
80 |
| 4.5 |
Nevirapine |
82 |
| 4.6 |
Conclusion |
83 |
PART V |
ALTERNATIVE PREVENTION OF THE PUTATIVE MOTHER TO CHILD TRANSMISSION OF HIV |
85 |
| 5.1 |
Introduction |
85 |
| 5.2 |
The safety of AZT |
85 |
| 5.3 |
Parameters associated with “MCT” and their modulation by means other than antiretroviral drugs |
89 |
| 5.3.1 |
Viral load data |
89 |
| 5.3.2 |
Malarial infection of the placenta |
92 |
| 5.3.3 |
Malnutrition |
93 |
| 5.3.4 |
Vitamin A |
100 |
| 5.3.5 |
Anti-oxidants |
104 |
| 5.3.6 |
Breast feeding |
108 |
| 5.3.7 |
Other Factors Reported to Affect MCT |
111 |
| 5.3.7.1 |
Drugs |
111 |
| 5.3.7.2 |
Antenatal obstetric factors |
111 |
| 5.4 |
Discussion |
111 |
| 5.5 |
Conclusion |
112 |
PART VI |
GENERAL DISCUSSION |
113 |
| 6.1 |
HIV Tests |
113 |
| 6.2 |
Epidemiological Evidence |
114 |
| 6.2.1 |
Racial distribution |
114 |
| 6.2.2 |
Low number of Paediatric AIDS cases |
114 |
| 6.2.3 |
Causes of death in HIV infected children |
115 |
| 6.3 |
Conclusion |
118 |
| |
References |
119 |
|
APPENDICES |
|
| I |
The WHO Bangui and Ghent Definitions of AIDS |
137 |
| II |
CDC 1987 Classification System for HIV Infection in Children under 13 years of age |
141 |
| III |
CDC 1994 Revised Classification System for HIV Infection in Children under 13 years of age |
143 |
| IV |
CDC 2000 Revised AIDS Surveillance Definition |
151 |
| V |
Reported Literature Measuring AZT triphosphorylation in Humans |
155 |
| VI |
AZT versus “Viral Load” |
157 |
| VII |
AIDS Reporting form for South Africa |
159 |
| VIII |
AIDS Reporting form for Uganda |
161 |
| IX |
Calculation of the probability of HIV transmission between sexual partners |
163 |
| X |
Email Correspondence with the CDC |
165 |
| XI |
A Critical Examination of the Evidence for the Existence of HIV |
175 |