VIRUSMYTH HOMEPAGE


MOTHER TO CHILD TRANSMISSION OF HIV
AND ITS PREVENTION WITH AZT AND NEVIRAPINE

A Critical Analysis of the Evidence

ISBN 1 876763 72 8

By Eleni Papadopulos-Eleopulos, Valendar F. Turner, John M Papadimitriou, Helman Alfonso, Barry A. P. Page, David Causer, Sam Mhlongo, Christian Fiala, Todd Miller, Anthony Brink, Neville Hodgkinson

October 2001


PROLOGUE

"We absolutely must leave room for doubt or there is no progress and there is no learning. There is no learning without having to pose a question".

-- Richard P Feynman, Physicist and Nobel Laureate. Galileo Symposium Address 1964.

The impetus for this review arose as a result of the Presidential AIDS Panel meetings held in South Africa during May and July 2000 under the auspices of the South African Government and President Thabo Mbeki. Our purpose in this publication was not to discuss the HIV theory of AIDS or even the existence of HIV (Those interested in the fundamental question of proving the existence of HIV will find it discussed in Appendix XI). The question this monograph addresses, assuming that HIV does exist, is whether a unique retrovirus is transmitted from pregnant women to their children and whether compounds such as zidovudine (AZT) and nevirapine are able to prevent such transmission.

In Parts I-II we examine on the indirect methods said to prove HIV infection and transmission, as well as epidemiological data on mother-to-child transmission. Part III analyses data associated with breastfeeding practices and the possibility of infection. Part IV includes pharmacological data relevant to zidovudine and nevirapine as well as their effects on the several parameters claimed to be indicative of HIV infection and transmission. Included in Part IV is a detailed review of the Pediatric AIDS Clinical Trials Group (ACTG) 076 study which forms the basis of recommending the administration of AZT to all pregnant, HIV positive women and their newborn babies. In Part V we present data on non-retroviral factors which affect the putative mother-to-child transmission of HIV and its prevention, especially the role of nutrition including micronutrients. Part VI consists of a general discussion of the topic.

In reviewing evidence of such a voluminous nature authors face the perennial problem of space and balance. To present too much data is to overwhelm the reader. To present too little is to risk scientific scholarship. Notwithstanding, given the critical nature of this subject to continents of people, and that mother to child transmission is accepted as fact by virtually the whole scientific establishment, we decided to present and discuss at length all the data we could muster. However, with the reader in mind, many of the epidemiological studies are prefaced with a precis. We make apology for studies we may have inadvertently omitted.

Scientists who question prevailing theories are under an obligation to present alternatives or, as a minimum, explain particular observations by other means. Consequently, we have included data on the role of cellular oxidation in the genesis of “HIV” phenomenology as well as diseases constituting the clinical syndrome.

It is hoped that this critical analysis of the evidence will prompt a reappraisal of the data interpreted as proof of mother to child transmission of HIV and thereby direct resources towards appropriate efforts to ameliorate factors linked to such biological phenomena.



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


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VIRUSMYTH HOMEPAGE