Biomed & Pharmacother
Vol.46, pp. 3-15, 1992
The role of drugs in the origin of AIDS
PETER H. DUESBERG
Department of Molecular and Cell Biology, 229 Stanley
Hall, University of California, Berkeley, CA 94720, USA
(Received 28 November 1991; accepted 10 December 1991)
Summary -- It is proposed that the new American and European AIDS
epidemics are caused by recreational and anti-HIV drugs rather than by
human immunodeficiency virus (HIV). Chronologically, the AIDS epidemic
in the 1980s followed a massive escalation in the consumption of recreational
drugs that started in the 1960s and 70s. Epidemiologically, both epidemics
derive about 80 % of their victims from the same groups of 20-44 year-olds,
of which 90 % are males. In America 32% of these are intravenous drug users
and an unknown percentage are prescribed the cytotoxic DNA chain terminator
AZT, as inhibitor of HIV. Direct evidence indicates that these drugs are
necessary for HIV-positives and sufficient for HIV-negatives to develop
AIDS diseases. The drug-AIDS hypothesis predicts correctly that: (i) AIDS
is new in the US, because the drug epidemic is new, while the HIV epidemic
is old -- fixed at a constant 1 million Americans since 1985; (ii) despite
an increase in venereal diseases, AIDS remains restricted to long-term
drug users and small groups with clinical deficiencies; (iii) over 72 %
of AIDS occurs in 20-44 year old males, because they make up over 80% of
hard psychoactive drug use; (iv) distinct AIDS diseases correlate with
the use of distinct drugs, eg Kaposi's sarcoma with nitrite inhalants,
tuberculosis with intravenous drugs, and leukopenia, anemia, and nausea
with AZT; (v) AIDS diseases are only acquired after long-term drug consumption,
rather than after single contacts as the virus-hypothesis predicts. The
drug hypothesis can be tested epidemiologically and experimentally in animals.
It predicts that most AIDS can be prevented by stopping the consumption
of drugs, and provides a rational basis for therapy.
Was ist das Schwerste von allem?
Was Dir das Leichteste duenkt:
mit den Augen zu'sehen
was vor den Augen Dir liegt.
What is the most difficult of all?
That which seems easiest to you:
to see with your eyes,
what is in front of your eyes.
AIDS is a new syndrome of 25 previously known diseases (19,62,63), In
American 63% are microbial diseases such as pneumonia, candidiasis, tuberculosis,
cytomegalovirus, and herpes virus disease (18,19) that result from immunodeficiency
due to a severe depletion of T-cells (62, 63). The remaining 37% of AIDS
diseases are dementia, wasting disease, Kaposi's sarcoma, and lymphoma
which are not caused by, and not consistently associated with immunodeficiency
and microbes (18, 33, 36, 115) In the US 32% of AIDS patients are intravenous
drug users (18, 86), about 60% are male homosexuals , and most of the
remainder have sever clinical or congenital deficiencies, including hemophilia
[18,33 100]. Over 80% of the American AIDS patients are 20-44 year olds,
of which about 90% are males . Different AIDS risk groups have different
AIDS diseases. For example, homosexuals have 20 times more Kaposi's sarcoma
than other AIDS patients , intravenous drug users have a proclivity
for tuberculosis [12,114], crack (cocaine) smokers exhibit pneumonia ,
and users of the cytotoxic DNA chain terminator AZT, prescribed to inhibit
human immunodeficiency virus (HIV) develop anemia, leukopenia and nausea
[94, 99, 113].
Currently most medical scientists believe that AIDS is caused by HIV
[62, 63]. This hypothesis assumes: 1) that HIV is new and therefore AIDS
is new in all countries with HIV ; 2) that AIDS is acquired by sexual
and parenteral transmission of HIV [62, 63]; and 3) that AIDS occurs in
the presence of antibodies to HIV (a positive AIDS virus [6, 33, 48].
However, each of these assumptions has been invalidated:
1) HIV has long been established in the US, fixed to an extremely constant
reservoir of about 1 million carriers, ever since 1985 when it became possible
to detect antibody against it with the AIDS test [33, 122]. This indicates
that the HIV epidemic is old in America, because new microbes spread exponentially
in a susceptible population . Thus HIV is not a plausible cause for
a new epidemic.
2) HIV is naturally transmitted from mother to child at an efficiency
of about 50% . The real efficiency may be higher than serological tests
indicate because some latent proviruses only become activated with advanced
age [33, 95]. By contrast, sexual transmission of HIV is highly inefficient,
depending on an average of about 1,000 sexual contacts [33, 71] because
there is no HIV in semen from 1 out 25 anti-body-positive men . It
follows that HIV depends on perinatal transmission for its survival .
Since retroviruses  and other viruses [42, 80] that survive from perinatal
transmission cannot be fatally pathogenic, HIV is probably harmless.
3) Within weeks after horizontal infection HIV activity is "rapidly
and effecti to less than 1 in 10,000 T-cells . This immunity does not
protect against AIDS, eliminating a role for HIV in AIDS.
Indeed there are numerous inconsistencies between AIDS and infectious
1) There is not even one confirmed case of a health care worker who
contracted AIDS from a patient, although there were over 160,000 AIDS patients
in the US in the last 10 years [18,36] and there is no antiviral vaccine
or drug. Likewise not a single scientist has contracted AIDS from the AIDS
virus or from other microbes from AIDS patients, which are propagated in
hundreds of research laboratories and companies [33, 36].
2) All new infectious diseases spread exponentially in susceptible populations
. However, despite widespread alarm, AIDS has since 1987 claimed only
about 30,000 or 0.03% per year from a reservoir of over 100 million susceptible,
sexually active Americans, although conventional venereal diseases are
increasing in the US  and there is no anti-HIV vaccine and no anti-HIV
3) The distribution of all infectious venereal diseases is almost even
between the sexes . By contrast 90% of American AIDS is restricted
to males since 1981 .
4) Almost all (94%) of the Americans who develop AIDS have been subject
to abnormal health risks . These risks include either long-term consumption
of recreational, psychoactive, and aphrodisiac drugs and anti-HIV drugs
like the cyctocidal DNA chain terminator AZT (see below) or congenital
or acquired deficiencies like hemophilia [18, 33]. This indicates that
specific health risks are necessary for AIDS.
5) The observations that distinct AIDS risk groups have distinct AIDS
diseases, eg homosexuals having 20 times more Kaposi's sarcoma than HIV
carriers from other risk groups , intravenous drug users having a proclivity
for tuberculosis [12, 114], crack (cocaine) smokers for pneumonia ,
and AZT users for leukopenia, anemia, lymphoma and nausea [50, 94, 99,
113, 130] are also hard to reconcile with a common infectious cause.
6) All AIDS diseases occur in all AIDS-risk groups in the absence of
HIV . Ironically, the monthly HIV/AIDS Survellance reports of the Centers
for Disease Control (CDC) never survey HIV in AIDS patients .
In view of these inconsistencies between AIDS and infectious disease
and the total lack of a common, active microbe in AIDS, several investigators
have concluded that AIDS may not be infectious [3, 17, 33, 34, 56, 59,
61, 70, 77, 92, 96, 100]. Here the hypothesis is investigated that American
and European AIDS diseases, above their normal background, are the result
of the long-term consumption of recreational and anti-HIV drugs.
Chronological coincidences between the AIDS and the drug epidemics
The appearance of AIDS in America in 1981 [62, 63], coincided with a
massive escalation in the consumption of psychoactive drugs [16, 44, 57,
73, 87, 89, 111]. The Bureau of Justice Statistics reports that the number
of drug arrests in the US has increased from about 450,000 in 1980 to 1.4
million in 1989 [16, 111]. About 500 kg of cocaine were confiscated by
the Drug Enforcement Administration in 1980, about 9,000 kg in 1983, 80,000
kg in 1989, and 100,000 in 1990 [16, 44, 131]. The agency estimates that
at most 20% of the cocaine smuggled into the US is confiscated . Cocaine-related
hospital emergencies increased 5-fold from 1984 to 1988 . The number
of dosage units of domestic stimulants, such as amphetamines, confiscated
increased from 2 million in 1981 to 97 million in 1989 .
Further, the recreational use of psychoactive and aphrodisiac nitrite
inhalants began in the 1960s and reached epidemic proportions in the mid-1970s,
a few years before AIDS appeared . The National Institute on Drug Abuse
reports that in 1979-80 over 5 million people used nitrite inhalants in
the US at least once a week , a total of 250 million doses per year
. In 1976 the sales of nitrite inhalants in one American city alone
amounted to $50 million annually , at $5 per 12-ml dose .
Since 1987 the cytocidal DNA chain terminator AZT is prescribed as an
anti-HIV durg [67, 130]. Currently about 80,000 HIV antibody-positive Americans
and 120,000 world-wide, with and without AIDS, take this drug .
Epidemiological overlaps among drug-and AIDS-related health statistics
Drugs and AIDS appear to claim their victims from the same risk groups.
For instance the CDC reports that the annual mortality of 25-44-year-old
American males increased from 0.21% in 1983 to 0.23% in 1987, corresponding
to about 10,000 deaths among about 50 million in this group . Since
the annual AIDS deaths had also reached 10,000 by 1987, HIV was assumed
to be the cause [18, 19, 62]. However, mortality in 25-44-year-old males
from septicemia, considered an indicator of intravenous drug use, rose
almost four- fold from 0.46 per 100,000 in 1980 to 1.65 in 1987 and direct
mortailty from drug use doubled [15, 85], suggesting that drugs played
a significant role in the increased mortality of this group . Moreover,
deaths from AIDS diseases and non-AIDS pneumonia and septicemia per 1,000
intravenous drug users in New York increased at exactly the same rates,
from 3.6 in 1984 to 14.7 and 13.6 respecitvely in 1987 . In view of
this, the CDC acknowledges: "We cannot discern, however, to what extent
the upward trend in death rates for drug abuse reflects trends in illicit
drug use independent of the HIV epidemic" . Further, maternal
drug consumption was blamed by some  and HIV infection by others [18,
63] for a new epidemic of physiological and neurological deficiencies,
including mental retardation, in American children.
Another striking coincidence is that over 72% of all American AIDS patients
 and over 80% of all Americans who consume hard psychoactive drugs
[51, 87] or get arrested for possession of drugs  are 20-44-year-old
males. Thus there is substantial epidemiological overlap between the two
epidemics  reported as "The twin epidemics of substance use and
HIV" by the National Aids Commission .
Drug use in AIDS risk groups
Intravenous drug users generate a third of all AIDS patients
Currently 32% of the American AIDS patients come from groups that use
intravenous drugs such as heroin, cocaine, and others [18, 86]. This group
includes about 75% of the heterosexual AIDS cases, 71% of the females with
AIDS, and over 10% of the male homosexuals and hemophiliacs with AIDS [18,
86]. In addition, about 50% of American children with AIDS were born to
mothers who are confirmed intravenous drug users and another 20% to mothers
who had sex with intravenous drug users and are thus likely users themselves
[18, 86]. Likewise, over 30% of European AIDS patients are intravenous
drug users .
Homosexuals who use oral drugs generate about 60% of American AIDS
Approximately 60% of the American AIDS patients are 20-44-year-old male
homosexuals . The following evidence indicates that they come from
groups who use oral psychoactive and aphrodisiac drugs. A survey of 3,916
self-identified American homosexual men, the largest of its kind, reports
in 1990 that 83% had used one, and about 60% two or more drugs with sex
during the previous 6 months . These drugs include nitrite- and ethyichloride
inhalants, cocaine, amphetamines, methaqualone, lysergic acid, phenylcyclidine,
and more [2, 10, 27, 56, 70, 91, 96, 97, 100, 101, 112, 120, 126]. A study
of a group of 359 homosexual men from San Francisco reported in 1987 that
84% had used cocaine, 82% alkylnitrites, 64% amphetamines, 51% quaaludes,
41% barbiturates, 20% injected drugs and 13% shared needles . About
74% had past or current infection by gonorrhea, 73% by hepatitis B virus,
67% by HIV, 30% by amoebae and 20% by syphilis . This group had been
randomly selected from a list of homosexuals who had volunteered to be
investigated for hepatitis B virus infection and to donate antisera to
hepatitis B virus between 1978 and 1980. It is the same group for which
the 50% progression rate from HIV to AIDS was calculated to be about 10
years [72, 83] and reported to be "relevant for the population as
a whole" .
Nitrite inhalants and possibly other drugs are preferred by male homosexuals
as aphrodisiacs because they facilitate anal intercourse [81, 88, 91, 101].
For example, an early CDC study that included 420 homosexual men found
nitrite use far more frequent among homosexuals than among heterosexuals
and correlated directlly with the number of different homosexual partners
. Surveys studying the use of nitrite inhalants in San Francisco found
that among homosexual men 58% were users in 1984 and 27% in 1991 compared
to less than 1% among hetrosexuals and lesbians of the same age group .
An unknown percentage of AIDS patients comes from groups of AZT users.
About 80,000 Americans and 120,000 persons world-wide, with and without
AIDS, currently take the cytocidal DNA chain terminator AZT  and an
unknown number take other DNA chain terminators like ddI and ddC .
AZT has been prescribed since 1987 to symptomatic [43, 63, 67, 99], and
since 1990 to asymptomatic carriers of HIV including babies and hemophiliacs
[38, 123], in an effort to inhibit HIV DNA synthesis . Thus an unknown,
but possibly a high percentage of the 30,000 Americans that currently develop
AIDS per year  have used AZT prior to or after the onset of AIDS. For
instance, 249 out of 462 HIV-Positive, AIDS-free homosexual men from Los
Angeles, included in the above survey , are on AZT or ddI .
Drug use necessary in HIV-positives and sufficient in HIV-negatives
for AIDS diseases
To distinguish between HIV and drugs as causes of AIDS, it is necessary
to identify either HIV carriers that develop AIDS only when they use drugs
or to identify HIV-free drug users that develop AIDS indicator diseases.
Drug use necessary for AIDS in presumed or confirmed carriers of
1) Epidemiological correlations indicate that nitrites are necessary
for Kaposi's sarcoma: a) a 27- to 58 fold higher consumption of nitrites
[101, 102] correlates with a 20-fold higher incidence of Kaposi's sarcoma
in male homosexuals compared to all other AIDS patients of the same age
group ; b) among male homosexuals, those with Kaposi's sarcoma have
used nitrite inhalants twice as often as those with other AIDS diseases
; c) during the last 6 to 8 years the use of nitrite inhalants among
male homosexuals decreased, eg from 58% in 1984 to 27% in 1991 in San Francisco
. In parallel, the incidence of Kaposi's sarcoma among American AIDS
patients decreased from a high of 35% in 1983  to a low of 10% in 1990
. In fact, nitrites may be sufficient causes for these diseases, because
there was no evidence of HIV infection in any of these studies.
2) Specific correlations also indicate that nitrites are necessary for
AIDS. The first five cases diagnosed as AIDS in 1981, before HIV was known,
were male homosexuals who had all consumed nitrite inhalants and presented
with pneumocystis pneumonia and cytomegalovirus infection . Early CDC
data indicate that in 1981 and 1982. 75% of male homosexuals with AIDS
had used oral drugs at least once a week and 97% occasionally [17, 57],
and that every one of 20 Kaposi's sarcoma patients had used nitrites .
The National Institute on Drug Abuse reports correlations from 69% 
to virually 100% [56, 88] between nitrite inhalants and Kaposi's sarcoma
and pneumonia. Again drugs may have been sufficient to cause these diseases,
because HIV was not diagnosed.
3) The incidence of AIDS diseases among 297 HIV-positive, asymptomatic
intravenous drug users over 16 months was three times higher in those who
persisted than in those who stopped injecting drugs .
4) The T-cell count of 65 HIV-infected drug users from New York dropped
over 9 months in proportion with drug injection, on average 35%, compared
to controls who had stopped .
5) A placebo controlled study investigating AZT as AIDS prophylaxis
in HIV-positive, AIDS-free 25-45-year-old male homosexuals and intravenous
drug users indicates that AZT induces various diseases, including some
in the AIDS definition . During one year of taking 500 mg AZT per
day aroup of 453 developed 11 AIDS cases, and a group of 457 taking 1500
mg AZT per day developed 14 cases. The placebo group of 428 developed 33
However, the price for the presumed savings of 22 and 19 AIDS cases
with AZT was high, because 19 more cases of anemia, neutropenia and severe
nausea appeared in the 500 mg AZT-group and 72 more such cases appeared
in the 1500 mg AZT-group than in the placebo group. This indicates cytocidal
effects of AZT on hemopoiesis and on the intestines. Although these AZT-specific
diseases were not diagnosed as AIDS, neutropenia generates immunodeficiency
and thus AIDS. A loss of T-cells was not reported in this study. This is
surprising in view of previous reports describing T-cell- and general bone
marrow-toxicity of AZT [32, 99, 130]. Moreover, 10 of the placebo group-specific
AIDS diseases were cancers and dementia, of which only 3 and 2 were observed
in the 500- and 1500 mg-AZT groups, respectively. This suggests a selection
bias in favor of more healthy subjects for the AZT groups. The study is
further compromised by the failure to report and to consider the recreational
drug use histories and the many compensatory treatments of the subjects
6) Within 48 weeks on AZT, 172 (56%) out of 308 Australian AIDS patients
developed one or more new AIDS diseases, including pneumonia and candidiasis
. This indicates that AZT induces AIDS diseases with less than 1 year
and thus much faster than the 10 years HIV is said to need to cause AIDS
. Likewise, no therapeutic benefits were observed in a study of 365
AIDS patients from France after six months on AZT, but new AIDS diseases
and approximately 50% leukopenias and 20% deaths occurred within nine months
on AZT, Further, no therapeutic benefits were observed in four Norwegian
AIDS patients after six months on AZT .
7) The annual lymphoma incidence of AZT-treated AIDS patients was reported
to be 9% by the National Cancer Institute and was calculated to be 50%
over 3 years . The lymphoma incidence of untreated HIV-positive AIDS
risk groups is 0.3% per year and 0.9% per 3 years, derived from the putative
average progression rate of 10 years from HIV to AIDS [33, 72, 83] and
the 3% incidence of lymphoma in AIDS patients . Thus the lymphoma incidence
is 30 to 50 times higher in AZT-treated than in untreated HIV-positive
counterparts. In addition, "during the past three years [of AZT therapy]
a progressive increase in the number of [AIDS] patients dying from lymphoma...",
to a current total of 16%, was noted in 1991 in a group of 346 AIDS patients
in London, most of whom were on AZT .
It is likely that the chronic levels of the mutagenic AZT (see below),
at 10-33 pM (500-1500 mg/person per day), were responsible for the lymphomas.
The alternative proposal that HIV-induced immunodeficiency was responsible
for the lymphomas  is unlikely, since cancers do not reflect a defective
immune system [36, 115].
8) Ten out of 11 HIV-positive AZT-treated AIDS patients recovered cellular
immunity after discontinuing AZT in favor or an experimental HIV vaccine
, suggesting that AZT was a sufficient cause of immunodeficiency.
9) Four out of 5 AZT-treated patients recovered from myopathy 2 weeks
after discontinuing AZT; two redeveloped myopathy on renewed AZT treatment
, indicating that AZT was sufficient for myopathy.
10) Four patients with pneumonia developed severe pancytopenia and bone
marrow aplasia 12 weeks after the initiation of AZT therapy. Three out
of 4 recovered within 4-5 weeks after AZT was discontinued , indicating
that AZT was sufficient for pancytopenia.
Drug use sufficient for AIDS indicator diseases in the absence of
1) Among intravenous drug users in New York representing a spectrum
of HIV-related diseases, HIV was only observed in 22 out of 50 pneumonia
deaths, 7 out of 22 endocarditis deaths, and 11 out of 16 tuberculosis
2) Pneumonia was diagnosed in 6 out of 289 HIV-free and in 14 out of
144 HIV-positive intravenous drug users from New York .
3) Among 54 prisoners with tuberculosis in New York State 47 were street-drug
users but only 24 were infected with HIV .
4) In a group of 21 heroin addicts, the ratio of helper to suppressor
T-cells declined within 13 years from a normal of 2 to less than 1, which
is typical of AIDS [19, 63], but only 2 were infected by HIV .
5) Thrombocytopenia and immunodeficiency were diagnosed in 15 intravenous
drug users on average 10 years after they became addicted, but 2 were not
infected with HIV .
6) Lymphocyte reactivity and abundance was depressed by long-term injection
of drugs not only in 111 HIV-positive but also in 210 HIV-free intravenous
drug users from Holland .
7) The same lymphadenopathy, weight loss, fever, night sweats, diarrhea,
and mouth infections were observed in 49 out of 82 HIV- free, and in about
40% of 113 intravenous drug users from France, of which 69 were HIV-positive
and 44 were negative . The French group had used drugs for an average
of 5 years.
8) Among 6 HIV-free male homosexuals with Kaposi's sarcoma, 5 have reported
the use of nitrite inhalants .
9) Similar neurological deficiencies were observed among 12 HIV- infected
and 16 uninfected infants of drug-addicted mothers .
Thus, the long term use of recreational and anti-HIV drugs appears necessary
in HIV-positives and sufficient in HIV-negatives to induce AIDS indicator
and other diseases.
Toxic effects of drugs used by AIDS patients
Toxicity of recreational drugs
From as early as 1990  evidence has accumulated that addiction to
psychoactive drugs leads to immune suppression and clinical abnormalities
similar to AIDS, including lymphopenia, lymphadenopathy, fever, weight
loss, septicemia, and increased susceptibility to infections and neurological
disorders [13, 14, 30, 49, 55, 75, 78, 103, 110, 117, 120]. Intravenous
drugs can be toxic directly, or indirectly via malnutrition, both because
of their enormous expense and via septicemia, since most illcit drugs are
not sterile [15, 24, 73, 114]. Oral comsumption of cocaine and other psychoactive
drugs has been reported to cause pneumonitis, bronchitis, edema, and other
diseases . In children born to mothers addicted to cocaine and other
drugs, physiological and neurological deficiencies including mental retardation
are observed [100, 119]. According to the National Institute on Drug Abuse
"Cocaine is, from a public health perspective...the drug of the greatest
national health concern" 
Alkylnitrites are directly toxic as they are rapidly hydrolyzed in vivo
to yield nitrite ions, which react with all biological macromolecules [70,
90]. Addicts with 0.5 mM nitrite derivatives and 70% methemoglobin in the
blood have been recorded . Toxicity for the immune system, the central
nervous system, the haematologic system, and pulmonary organs has been
observed after short exposure to nitrites in humans and in animals [88,
128]. Further, alkylnitrites were shown to be both mutagenic and carcinogenic
in animals [60, 64, 82]. Several investigators have proposed that nitrite
inhalants cause pulmonary  and skin Kaposi's sarcoma and possibly pneumonia
by direct toxicity on the skin and oral mucosa [17, 59, 77]. In view of
this, a causal link between nitrite inhalants and Kaposi's sarcoma and
pneumonia in homosexuals was first suggested in 1982 by the CDC  and
other investigators [59, 77]. As a consequence the sale of nitrite inhalants
was banned by the US Congress in 1988 (Public Law 100-690) .
Toxicity of AZT
Although AZT is an inhibitor of HIV DNA synthesis, it is not a rational
medication for persons with antibodies to HIV for the following reasons:
1) there is no proof that HIV causes AIDS [33, 36]; 2) since no detectable
RNA-dependent viral DNA synthesis occurs, and since the number of infected
cells remains stable once the virus is neutralized by antibodies [33, 36],
only cell DNA, with or without proviruses of HIV, is terminated by AZT
treatment. Further, since AZT cannot distinguish infected from uninfected
cells and only 1 in 500 T-cells is infected in AIDS patients and asymptomatic
carriers [33, 36, 105], it kills 500 uninfected cells for every infected
cell. Thus AZT is inevitably toxic, killing 500 times more uninfected than
infected cells; 3) particularly in view of the hypothesis that HIV causes
AIDS by killing T-cells [62-63, it is irrational to overkill infected cells
As expected from an inhibitor of DNA synthesis, many studies report
AZT-mediated cytotoxicity. Anemia, neutropenia, and leukopenia occur in
20-50% with about 30-50% requiring transfusions within several weeks [32,
50, 99, 113, 116]. Severe nausea from intestinal intoxication is observed
in up to 45% [99, 113, 123] and severe muscle atrophy in 6-8% [8, 52, 99,
118]. Acute hepatitis, insomnia, headaches, dementia seizures, and vomiting
are also reported effects of AZT . Lymphomas appear in about 9% within
one year on AZT . AZT is also mutagenic and carcinogenic in animals
[23, 129] and transforms cells in vitro as effectively as methylcholanthrene
. AZT toxicity varies a great deal with the subject treated, due to
differences in kinases involved in its uptake and in AZT metabolism [21,
39, 113, 130].
Nevertheless, AZT is thought to have serendipitous therapeutic benefits
based on the only placebo-controlled study of its effects on AIDS patients
[43, 99]. The study was sponsored by Burroughs- Wellcome, the manufacturer
of AZT [43, 99]. In this study T-cell counts were observed to increase
from 4-8 weeks and then to decline to pretreatment levels. Further AZT
was claimed to decrease mortality because only 1 out of 143 in the AZT-treated
group died compared to 19 out of 135 in the placebo group.
However, 30 out of the 143 in the AZT-group depended on multiple transfusions
to survive anemia, compared to only 5 out of the 135 in the placebo group.
Since the number of subjects in the AZT- group who would have died from
anemia if untreated was 30, and thus larger than the AIDS deaths and anemias
of the control group combined 19 + 5, the claim of decreased mortality
is not realistic [43, 99]. Moreover, 66 in the AZT group suffered from
severe nausea and 11 from muscle atrophy compared to only 25 and 3 in the
control group. The lymphocyte count decreased over 50% in 34% of the subjects
in the AZT group and in only 6% of those in the control group. The study
is further comprimised by concomitant medication , the failure to consider
the effects of recreational drug use and of patient-initiated randomization
of blinded AZT and placebo treatments . The brief AZT-induced gain
of T-cells may reflect compensatory hemopoiesis and random killing of pathogenic
parasites  and the influence of concomitant medication .
Surprisingly, long-term studies of AZT in animals compatible with human
applications have not been published [113, 130]. In view of the inevitable
toxicity of AZT, its popularity as an anti-HIV drug can only be explained
by the widespread acceptance of the virus- AIDS hypothesis and the failure
to consider the enormous difference between the viral and cellular DNA
It is concluded that all American AIDS exceeding the normal low incidence
of indicator diseases in the general population is the result of recreational
and anti-HIV drugs. Thus the American AIDS epidemic is a subset of the
drug epidemic. For example, only the pneumonias, tuberculoses, and dementias
of the 50% of American intravenous drug users with HIV  are recorded
as AIDS, while those of their counterparts are diagnosed by their old names.
Indeed, the drug-AIDS hypothesis is epidemiologically and pathologically
better grounded than the virus-AIDS hypothesis: about 32% American AIDS
patients are confirmed intravenous drug users, possibly 60% use recreational
drugs orally and an unknown but large percentage of both behavioral and
clinical AIDS risk groups use AZT. Moreover, the consumption of recreational
drugs by AIDS patients is probably underreported because the drugs are
illicit, and because medical scientists and support for research are currently
heavilly biased in favor of viral AIDS [35, 41, 73]. The toxicity of these
drugs is empirically known for all drugs, and mechanistically for some,
notably for AZT and nitrites.
Nonetheless, evidence for the role of drugs in AIDS is rejected by proponents
of the virus-AIDS hypothesis [6, 11, 91, 125]. This may be the reason that
despite the current drug use epidemic there are no studies that investigate
the long-term effects of psychoactive drugs and AZT in animals compatible
with the time periods and dosages used by AIDS patients . Yet, it is
a complete mystery how HIV act as a pathogen, despite enormous research
efforts [6, 9, 33, 74, 125], and even antibodies against are confirmed
in only about 50% of AIDS patients [33, 63, 108].
The drug-AIDS hypothesis resolves all scientific paradoxes posed by
the prevailing virus-AIDS hypothesis.
1) In America HIV is a long-established, endmic virus, but AIDS is new
-- because the drug epidemic is new.
2) AIDS is restricted for over 10 years to 10,000  or 0.01% of the
over 100 million sexually active heterosexual Americans per year, and to
20,000  or 0.25% of the 8 million homosexuals, estimated at 10% of
the adult male population [101, 120]. But conventional venereal diseases
are on the rise in the US , and there is no vaccine or drug against
HIV. This is because AIDS is due to drug consumption rather than sexual
3) Over 72% of American AIDS cases are 20-44-year-old males  although
no AIDS disease is male-specific [18, 19, 63] -- because males of this
age group consume over 80% of all hard psychoactive drugs [51, 87].
4) Distinct AIDS diseases occur in distinct risk groups -- because they
use distinct drugs, eg users of nitrites get Kaposi's sarcoma, users of
intravenous drugs get tuberculosis and users of AZT get leukopenia or anemia.
5) Viral AIDS occurs on average 10 years after HIV infection [33, 36,
63], although infectious agents, as self-replicating toxins, typically
strike within weeks or months after infection [46, 80]. Indeed HIV is immunogenic
and may be mildly pathogenic in humans within weeks after infection and
is then effectively and rapily limited by antiviral immunity [22, 25].
This is because HIV infection and AIDS are unrelated events. The duration
and toxicity of drug consumption and individual thresholds for disease
determine when AIDS occrrespecitve of when and whether HIV infec. On average,
five to ten years elapse between the first use of drugs and the need for
treatment [31, 40, 54]
6) HIV, as well as many other parenterally and venereally transmitted
microbes and viruses, are mere markers for AIDS and AIDS risks [27, 33,
45] -- because the higher the consumption of un- sterile, injected drugs
[28, 40] and sexual contacts mediated by aphrodisiac drugs, the more microbes
7) Some old diseases of hemophiliacs, other recipients of transfusions,
and of the general population are called AIDS - because they follow perinatal
or parenteral HIV infection .
8) Old African diseases like slim disease, fever, diarrhea and tuberculosis
are called AIDS now, although they are clinically and epidemiologically
very different from American and European AIDS. They occur in adolescents
and adults of both sexes that are subject to protein malnutrition, parasitic
infections, and poor sanitary conditions . Since HIV is endemic in
over 10% of Central Africans, over 10% of their AIDS defining diseases
will be called AIDS [33, 36, 63].
The drug-AIDS hypothesis predicts that the AIDS diseases of the behavioral
AIDS risk groups in the US and Europe can be prevented by stopping the
consumption of recreational and anti-HIV drugs, but not by safe sex 
and clean injection equipment  for unsterile street drugs. According
to the drug-AIDS hypothesis, AZT is AIDS by prescription. Screening of
blood for antibodies to HIV is superfluous, if not harmful, in view of
the anxiety that a positive test generates among the many believers in
the virus-AIDS hypothesis and the toxic AZT prophylaxis, prescribed to
many who test positive. Eliminating the test would also reduce the cost
of the approximately 12 million annual blood donations in the US 
by 11 dollars each (personal communication 1990, Irwin Memorial Blood Bank
San Francisco) and would lift travel restrictions for antibody-positives
to many countries including the US and China. The drug-AIDS hypothesis
is testable epidemiologically and experimentally by studying AIDS drugs
Note added in proof
In Europe 33% of AIDS patients are intravenous drug users
and 47% are male homosexuals and 86% of all patients are male .
I thank B Ellison (Berkeley), J Lauritsen (New York),
C Pierach (Minneapolis), P Rabinow (Berkeley), H Rubin (Berkeley, F Rothschild
(Berkeley), J Shenton (London), C Thomas Jr (San Diego), and M Verny-Elliott
(London) for critical information and T Gardner (Santa Barbara) for a generous
donation and encouragment. I am supported by Outstanding Investigator Grant
no 5-R35-CA39915-07 from the National Cancer Institute.
1 Achard C, Bernard H, Gagneux C (1909) Action de la morphine
sur les proprietes leucocytaires; leuco-diagnostic du morphinisme. Bull
Mem Soc Med Hop Paris 28 (3rd Series) 958
2 Adams J (1989) AIDS: the HIV Myth. St. Martin's Press,
3 Albonico H (1991) Liehtblicke zum zweiten Jahrzehnt
in der AIDS- Forschung. Schweiz Arzt 72, 379
4 Anderson W (1987) Drug Smuggling. US General Accounting
Office, Washington, DC
5 Aral SO, Holmes KK (1991) Sexuallly transmitted diseases
in the AIDS era. Sci Am 264, 62
6 Baltimore D, Feinberg MB (1990) Quantification of human
immunodeficiency virus in the blood. N Engl J Med 321, 1673
7 Beral V, Peterman TA, Berkelman RL, Jaffe HW (1990)
Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection?
Lancet 335, 123 8 Benssen LJ, Greene JB, Seitzman LE, Weinberg H (1988)
Severe polymyositis-like syndrome associated with zidovudine therapy of
AIDS and ARC. New Engl J Med 318, 708
9 Blattner W, Gallo RC, Temin HM (1988) HIV causes AIDS.
Science 241, 514
10 Blattner WA, Bigger RJ, Weiss SH, Clark JW, Goedert
JJ (1985) Epidemiology of human lymphotropic retroviruses: an overview.
Cancer Res 45 supplement, 4598
11 Booth W (1988) A rebel without a cause for AIDS. Science
12 Braun MM, Truman BI, Maguire B, Di Ferdinando GT Jr.
Wormser G, Broaddus R, Morse DL (1989) Increasing incidence of tuberculosis
in a prison inmate population, associated with HIV-infection. J Am Med
Assoc 261, 393
13 Briggs JH, McKerron CG, Souhami RL, Taylor DJE, Andrews
H (1967) Severe systemic infections complicating "mainline" heroin
addiction. Lancet ii, 1227
14 Brown SM, Stimmel B, Taub RN, Kochwa S, Rosenfield
RE (1974) Immunologic dysfunction in heroin addicts. Arch Intern Med 134,
15 Buehler JW, Devine OJ, Berkelman RL, Chevarley FM (1990)
Impact of the human immunodeficiency virus epidemic on mortality trends
in young men, United States. Am J Pub Health 80, 1080
16 Bureau of Justice Statistics (1988) Special report
-- Drug Law Violators 1980-1986. US Department of Justice, Washington DC.
17 Centers for Disease control (1982) Epidemiologic aspects
of the current outbreak of Kaposi's sarcoma and opportunistic infections.
N Engl J Med 306, 248
18 Centers for Disease Control (1991) HIV/AIDS Surveillance.
(January) US Department of Health and Human Services, Atlanta, GA
19 Centers for Disease Control (1987) Leads from the MMWR.
Revision of the CDC survelliance case definition for acquired immunodeficiency
syndrome. J Am Med Assoc 258, 1143
20 Centers for Disease Control (1985) Update: acquired
immunodeficiency syndrome -- United States. Morb & Mort Weekly Rpts
21 Chernov HI (1986) Document on new drug application
19-665. Food and Drug Administration, Washington DC
22 Clark SJ, Saag MS, Decker WD, Campbell-Hill S, Roberson
JL, Veldkamp PJ, Kappes JC, Hahn BH, Shaw GM (1991) High titers of cytopathic
virus in plasma of patients with symptomatic primary HIV-infection. N Engl
J Med 324, 954
23 Cohen SS (1987) Antiretroviral therapy for AIDS. N
Engl J Med 317, 629.
24 Cox TC, Jacobs MR, Leblanc AE, Marshaman JA (1983)
Drugs and Drug Abuse. Addiction Research Foundation, Toronto, Canada
25 Daar ES, Moudgil T, Meyer RD, Ho DD (1991) Transient
high levels of viremia in patients with primary human immunodeficiency
virus type 1 infection. N Engl J Med 324, 961
26 Darke S, Hall W, Heather N, Ward J, Wodak A (1991)
The reliability and validity of a scale to measure HIV risk-taking behaviour
among intravenous drug users. AIDS 5, 181.
27 Darrow WW, Echenberg DF, Jaffee HW, O'Malley PM, Byers
RH, Getchell JP, Curran JW (1987) Risk factors for human immunodeficiency
virus (HIV) infections in homosexual men. Am J Publ Health 77, 479
28 Des Jarlais D, Friedman S, Marmor M, Co H, Mildvan
D, Yancovitz S, Mathur U, El-Sadr W, Spira TJ, Garber J (1987) Development
of AIDS HIV seroconversion, and potential cofactors for T4 cell loss in
a cohort of intravenous drug users. AIDS 1, 105.
29 Des Jarlais DC, Friedman SR, Hopkins W (1988) Risk
reduction of the acquired immunodeficiency syndrome among intravenous drug
users. In: AIDS and IV Drug Abusers Current Perspectives (Galea RP, Lewis
BF, and Baker L, eds) National Health Publishing, Owings Mills, MD, p97
30 Dismukes WE, Karchmer AW, Johnson RF, Dougherty WJ
(1968) Viral hepatitis associated with illicit parenteral use of drugs.
J Am Med Assoc 206, 1048
31 Donahoe RM, Bueso-Ramos C, Donahoe F, Madden JJ, Falek
A, Nicholson JKA, Bokos P (1987) Mechanistic implications of the findings
that opiates and other drugs of abuse moderate T-cell surface receptors
and antigenic markers. Ann NY Acad Sci 496, 711
32 Dournon E, The Claude Bernard Hospital AZT Study Group
(1988) Effects of zidovudine in 365 consecutive patients with AIDS or AIDS-related
complex. Lancet ii, 1297
33 Duesberg PH (1991) AIDS epidemiology: inconsistencies
with human immunodeficiency virus and with infectious disease. PNAS 88,
34 Duesberg PH (1990) AIDS: non-infectious deficiencies
acquired by drug consumption and other risk factors. Res Immunol 141, 5
35 Duesberg PH (1991) Can alternative hypotheses survive
in this era of megaprojects? The Scientist July 8, Philadelphia, PA 12
36 Duesberg PH (1989) Human immunodeficiency virus and
acquired immunodeficiency syndrome: Correlation but not causation. PNAS
37 Duesberg PH (1987) Retroviruses as carcinogens and
pathogens: expectations and reality. Cancer Res 47, 1199
38 Editorial (1990 Zidovudine for symptomless HIV infection.
Lancet 335, 821.
39 Elwell LP, Ferone R, Freeman GA, Fyfe JA, Hill JA,
Ray PH, Richards CA, Singer SC, Knick CB, Rideout JL, Zimmerman TP (1987)
Antibacterial activity and mechanism of action of 3'-azido-3'deoxythymidine
(BW A509U). Antimicrob Agents Chemother 31, 274
40 Espinoza P, Bouchard I, Buffet C, Thiers V, Pillot
J, Etienne JP (1987) High prevalence of infection by hepatitis B virus
and HIV in incarcerated French drug addicts. Gastroenterol Clin Biol 11,
41 Ettinger NA, Albin RJ (1989) A review of the respiratory
effects of smoking cocaine. Am J Med 87, 664
42 Evans AS (1989) Viral Infections of Humans, Epidemiology
and Control. Plenum Publishing Corporation, New York
43 Fischl MA, Richman DD, Grieco MH, Gottlieb MS, Volberding
PA, The AZT Collaborative Working Group (1987) The efficacy of azidothymidine
(AZT) in the treatment of patients with AIDS and AIDS-related complex.
N Engl J Med 317, 185
44 Flanagan TJ, Maguire K (1989) Sourcebook of Criminal
Justice Statistics (1989) -- Bureau of Justice Statistics NCJ-124224. US
Department of Justice, US Government Printing Office, Washington, DC.
45 Francis DP (1983) The search for the cause. In The
AIDS Epidemic (Cahill KM, ed) St Martin's Press, New York, p 137.
46 Freeman BA (1979) Burrows Textbook of Microbiology.
WB Saunders Co, Philadelphia.
47 Friedman-Kien AE, Saltzman BR, Cao Y, Nesto, MS, Mirabile
M, Li JJ, Peterman TA (1990) Kaposi's sarcoma in HIV-negative homosexual
men. Lancet 335, 168
48 Gallo RC (1991) Virus Hunting-AIDS, Cancer & the
Human Retrovirus: A Story of Scientific Discovery. Basic Books, New York
49 Geller SA, Stimmel B (1973) Diagnostic confusion from
lymphatic lesions in heroin addicts. Ann In Med 78, 703
50 Gill PS, Rarick M, Byrnes RK, Causey D, Lourein C,
Levine AM (1987) Azydothymidine associate with bone marrow failure in the
acquired immunodeficiency syndrome (AIDS), Ann Int Med 107, 502 51 Ginzburg
HM (1988) Acquired immune deficiency syndrome (AIDS) and drug abuse. In:
AIDS and IV Drug Abusers Current Perspectives (Galea RP, Lewis BF and Baker
L, eds) National Health Publishing, Owings Mills, MD, p61
52 Gorard DA, Guilodd RJ (1988) Necrotising myopathy and
zidovudine. Lancet i, 1050 53 Gottlieb MS, Schanker HM, Fan PT, Saxon A,
Weisman JD, Pozalski J (1981) Pneumocystis pneumonia -- Los Angeles. Morb
& Mort Weekly Rpts 30, 250
54 Schuster CR (1984) Foreword. In: Cocaine: pharmacology,
effects and treatment of abuse (Grabowski J, ed) NIDA Res Monogr 50, National
Institute on Drug Abuse, Washington DC, p VII
55 Harris PD, Garret R (1972) Susceptibility of addicts
to infection and neoplasia. N Engl J Med 287, 310
56 Haverkos HW (1988) Epidemiologic studies -- Kaposi's
sarcoma vs opportunistic infections among homosexual men with AIDS. In:
Health Hazards of Nitrite Inhalants (Harverkos HW and Dougherty JA, eds)
NIDA Res Monogr 83 National Institute on Drug Abuse, Washington DC, p96
57 Haverkos HW (1988) Kaposi's sarcoma and nitrite inhalants.
In: Psychological, Neuropsychiatric and Substance Abuse Aspects of AIDS
(Bridge TP et al, eds) Raven Press, New York, p 165
58 Haverkos HW (1990) Nitrite inhalant abuse and AIDS-related
Kaposi's sarcoma. J. Acquired immune Defic Syndr 3 supplement, S47
59 Haverkos HW, Pinskky PF, Drotman DP, Bregman DJ (1985)
Disease manifestation among homosexual men with acquired immunodeficiency
syndrome: a possible role of nitrites in Kaposi's sarcoma. J Sexually Transmitted
Diseases 12, 203
60 Hersh EM, Reuben JM, Bogerd H. Rosenblum M, Bielski
M, Mansell PWA, Rios A, Newell GR, Sonnenfeld G (1983) Effect of the recreational
agent isobutyl nitrite on human peripheral blood leukocyte and on in vitro
interferon production. Cancer Res 43, 1365
61 Holub WR (1988) AIDS: a new disease? Am Clin Prod Rev
62 Institute of medicine (1986) Confronting AIDS. National
Academy Press, Washington DC
63 Institute of medicine (1988) Confronting AIDS-up-date
1988. National Academy Press, Washington DC
64 Jorgensen KA, Lawesson SO (1982) Amyl nitrite and Kaposi's
sarcoma in homosexual men. N Engl J Med 307, 893
65 Judson FN, Penley KA, Robinson ME, Smith JK (1980)
Comparative prevalence rates of sexually transmitted diseases in hetrosexual
and homosexual men. Am J. Epidemiol 112, 836
66 Koch T (1990) Uninfected children of HIV-infected mothers
may still suffer nervous problems. CDC AIDS Weeklly July 30
67 Kolata G (1987) Marrow supression hampers AZT use in
AIDS victims. Science 235, 1463
68 Lange WR, Dax EM, Haertzen CA, Snyder FR, Jaffee JH
(1988) Nitrite inhalants: contemporary patterns of abuse. In: Health Hazards
of Nitrite Inhalants (Harverkos HW, Dougherty JA, eds) NIDA Res Monogr
83, National Institute on Drug Abuse. Washington DC, p86
69 Lauritsen J (1990) Poison by Prescription -- The AZT
Story. Askleplos Press, New York
70 Lauritsen J and Wilson H (1986) Death Rush, Poppers
and AIDS. Pagan Press, New York
71 Lawrence DN, Jason JM, Holman RC, Murphy JJ (1990)
HIV transmission from hemophilic men to their heterosexual partners. In:
Heterosexual Transmission of AIDS (Alexander NJ, Gabelnick HL, Spieler
JM, eds) Wiley-Liss, New York, p35
72 Lemp GF, Payne SF, Rutherford GW, Hessol NA, Winkelstein
W Jr, Wiley JA, Moss AR, Chaisson RE, Chen RT, Feigal DW, Thomas PA, Werdegar
D (1990) Projections of AIDS morbidity and mortality in San Francisco.
J Am Med Assoc 263, 1497
73 Lerner WD (1989) Cocaine abuse and acquired immunodeficiency
syndrome: tale of two epidemics. Am J Med 87, 661
74 Levy J (1988) Mysteries of HIV: challenges for therapy
and prevention. Nature 333, 519
75 Louria DB (1974) Infectious complications of non-alcoholic
drug abuse. Annu Rev Med 25: 219
76 Maikel RP (1988) The fate and toxicity of butyl nitrites.
In: Health Hazards of Nitrite Inhalants (Haverkos HW, Dougherty JA, eds)
NIDA Res Monogr 83, National Institute on Drug Abuse, Washington, DC p15
77 Marmor M, Friedman-Kien AE, Laubenstein L, Byrum RD,
William DC, D'Onofrio S, Dubin N (1982) Risk factors for Kaposi's sarcoma
in homosexual men. Lancet i, 1083
78 McDonough RJ, Madden JJ, Falek A, Shafer DA, Pline
M, Gordon D, Bokof P, Kuehnle JC, Mandelson J (1980) Alteration of T and
null lylmphocyte frequencies in the peripheral blood of human opiate addicts:
in vivo evidence of opiate receptor sites on T lymphocytes. J Immunol 125,
2539 79 Mientjes GH, Miedema F, van Ameijden EJ, van den Hoek AA, Schellekens
PTA, Roos MT, Coutinho RA (1991) Frequent injecting impairs lymphocyte
reactivity in HIV-positive and HIV-negative drug users. AIDS 5, 35
80 Mims C and White DO (1984) Viral Pathogenesis and immunology.
Blackwell Scientific Publications, Oxford
81 Mirvish SS, Haverkos HW (1987) Butylnitrite in the
induction of Kaposi's sarcoma in AIDS. N Engl J Med 317, 1603
82 Mirvish SS, Ramm MD, Bobcock DM (1988) Indications
from animal and chemical experiments of a carcinogenic role for isobutyl
nitrite. In: Health Hazards of Nitrite Inhalants (Haverkos HW Dougherty
JA, eds) NIDA Res Monogr 83, National Institute on Drug Abuse, Washington
DC, P 39
83 Moss AR, Osmond D and Bacchetti P (1988) The cause
of AIDS. Science 242, 997
84 Multicenter AIDS Cohort Study of the National Institute
of Health (1991) LA Men's Study (LAMS) Newsletter, (March) Los Angeles
85 National Center for Health Statistics (1989) Monthly
Vital Statistics Report. Department of Health and Human Services, Public
Health Service, Publication No (PMS) 89-1120, Hyattsville, MD
86 National Commission on AIDS (1991) The Twin Epidemics
of Substance Use and HIV. (July) National Commission on AIDS
87 National Institute on Drug Abuse (1987) Trends in Episodes
and Medical Examiner Cases for Selected Drugs: DAWN 1976-1985. Natl Inst
Drug Abuse, Bethesda, MD.
88 Newell GR, Spitz MR, Wilson MB (1988) Nitrite inhalants:
historical perspective. In: Health Hazards of Nitrite Inhalants (Haverkos
HW, Dougherty JA, eds) NIDA Rees Monogr 83, National Institute on Drug
Abuse, Washington DC, p. 1
89 Office of National Drug Control Policy (1988) The National
Narcotics Intelligence Consumers Committee Reports. Executive Office of
the President, Washington DC.
90 Osterloh J, Olson K (1986) Toxicities of alkyl nitrites.
Ann Int Med 104, 727
91 Ostrow DG, Van Raden MJ, Fox R, Kingsley LA, Dudley
J, Kaslow RA, The Multicenter AIDS Cohort Study (MACS) (1990) Recreational
drug use and sexual behavior change in a cohort of homosexual men. AIDS
92 Papadopulos-Eleopulos E (1988) Reappraisal of AIDS
-- Is the oxidation induced by the risk factors the primary cause? Med
Hypotheses 25, 151. 93 Peters BS, Beck EJ, Coleman DG, Wadsworth MJH, McGuiness
O, Harris JRW, Pinching AJ (1991) Changing disease patterns in patients
with AIDS in a referral centre in the United Kingdom: the changing face
of AIDS. Br Med J 302, 203
94 Pluda JM, Yarchoan R, Jaffee ES, Feuerstein IM, Solomon
D, Steinberg S, Wyvill KM, Raubitschek A, Katz D, Broder S (1990) Development
of non-Hodgkin's lymphoma in a cohort of patients with immunodeficiency
virus (HIV) infection on long-term antiretroviral therapy. Ann Int Med
95 Quinn TC, Mann JM, Curran JW, Piot P (1986) AIDS in
Africa: an epidemiological paradigm. Science 234, 955
96 Rappoport J (1988) AIDS INC. Human Energy Press, San
97 Raymond CA (1988) Combating a deadly combination: intravenous
drug abuse, acquired immunodeficiency syndrome. J Am Med Assoc 259, 329
98 Reinvang I, Froland SS, Karlsen NR, Lundervoid AJ (1991)
Only temporary improvement in imparied neuropsychological function in AIDS
patients treated with zidovudine. AIDS 5, 228
99 Richman DD, Fischll MA, Grieco MH, Gottlieb MS, Volberding
PA, Laskin OL, Leedom JM, Groopman JE, Mildvan D. Hirsh MS, The AZT Collaborative
Working Group (1987) The toxicity of azidothymidine (AZT) in the treatment
of patients with AIDS and AIDS-related complex. N Engl J Med 317, 192
100 Root-Bernstein R (1990): Do we know the cause(s):
of AIDS? Persp Biol Med 33, 480
101 San Francisco Department of Health (1991) Gay Men,
Lesbians and their Alcohol and other Drug Use: a Review of the Literature.
(September) San Francisco, CA
102 San Francisco Department of Public Health (1991) San
Francisco Lesbian, Gay and Bisexual Substance Abuse Needs Assessment. (August)
San Francisco, CA
103 Sapira JD (1968) The narcotic addict as a medical
patient. Am J Med 45, 555
104 Savona S, Nardi MA, Lenette ET, Karpatkin S (1985)
Thrombocytopenic purpura in narcotics addicts. Ann Int Med 102, 737
105 Schnittman SM, Psallidopoulos MC, Lane HC, Thompson
L, Baseler M, Massari F, Fox CH, Salzman NP, Fauci A (1989) The reservoir
for HIV-1 in human peripheral blood is a T cell that maintains expression
of CD4. Science 245, 305
106 Schwartz RH (1988) Deliberate Inhalation of isobutyl
nitrite during adolescence: a descriptive study. In: Health Hazards of
Nitrite Inhalants (Haverkos HW, Dougherty JA, eds) NIDA Res Monogr 83,
National Institute on Drug Abuse, Washington DC, p81
107 Scolaro M, Durham R, Pieczenik G (1991) Potential
molecular competitor for HIV. Lancet 337, 731
108 Selik RM, Buehler JW, Karon JM, Chamberland ME, Berkelman
RL (1990) Impact of the 1987 revision of the case definition of acquired
immune deficiency syndrome in the United States. J Acquired Immune Defic
Syndr 3, 73
109 Selwyn PA, Feingold AR, Hartel D, Schoenbaum EE, Adderman
MH, Klein RS, Freidland SH (1988) Increased risk of bacterial pneumonia
in HIV-infected intravenous drug users without AIDS. AIDS 2, 267
110 Selwyn PA, Hartel D. Wasserman W, Drucker E (1989)
Impact of the AIDS epidemic on morbidity and mortality among intravenous
drug users in a New York City methadone maintenance program. Am J Public
Health 79, 1358
111 Shannon E. Booth C, Fowler D, McBride M (1990) A loosing
battle. Time 136(24), December 3 p44
112 Shilts R (1985) And the Band Played On. St Martin's
Press, New York
113 Smothers K (1991) Pharmacology and toxicology of AIDS
therapies. The AIDS Reader 1, 29
114 Stoneburner RL, Des Jarlais DC, Benezra D, Gorelkin
L, Sotheran JL, Friedman SR, Schultz S, Marmor M, Mildvan D, Maslansky
R (1988) A larger specturm of severe HIV-1 related disease in intravenous
drug users in New York City. Science 242, 916
115 Stutman O (1975) Immunodepression and malignancy.
Adv Cancer Res 22, 261
116 Swanson CE, Cooper DA, The Australian Zidovudine Study
Group (1990) Factors influencing outcome of treatment with zidovudine of
patients with AIDS in Australia. AIDS 4, 749.
117 Terry CE and Pellens M (1928) The Opium Problem. Bureau
of Social Hygiene of New York
118 Till M, MacDonnell KB (1990) Myopathy with human immunodeficiency
virus type 1 (HIV-1) infection: HIV-1 or zidovudine? Ann Int Med 113, 492.
119 Toufexis A (1991) Innocent victims. Time 137(19),
p 56, May 13
120 Turner CD, Miller HG, Moses LE (1989) AIDS, Sexual
Behavior and Intravenous Drug Use. National Academy Press, Washington DC
121 Van Voorhis BJ, Martinez A, Mayer K, Anderson DJ (1991)
Detection of human immunodeficiency virus type 1 in semen from seropositive
men using culture and polymerase chain reaction deoxyribonuleic acid amplification
techniques. Fertil Steril 55, 588
122 Vermund S (1991) Changing estimates of HIV-1 seroprevalence
in the United States. J. NIH RES 3, 77
123 Volberding PA, The AIDS Clinical Trial Group (1990)
Zidovudine in asymptomatic human immunodeficiency virus infection: A controlled
trial in persons with fewer than 500 CD4-positive cells per cubic millimeter,
N Engl J Med 322, 941
124 Weber R, Ledergerber W, Opravil M, Siegenthaler W,
Luthy R (1990) Progression of HIV infection in misusers of injected drugs
who stop injecting or follow programme of maintenance treatment with methadone.
Br Med J 301, 1361
125 Wiess R, Jaffe H (1990) Duesberg, HIV and AIDS. Nature
126 Weiss SH (1989) Links between cocaine and retroviral
infection. J Am Med Assoc 261, 607
127 Williams AE, Fang CT, Sandler G (1990) HTLV- I/II
and blood transfusion in the United States. In: Human Retrovirology: HTLV
(Blattner WA, ed) Raven Press, New York, p. 349
128 Wood RW (1988) The acute toxicity of butyl nitrites.
In: Health Hazards of Nitrite Inhalants (Haverkos HW, Dougherty JA, ed)
NIDA Res Monogr 83, National Institute on Drug Abuse, Washington DC, p28
129 Yarchoan R, Broder S (1987) Development of antiretroviral
therapy for the acquired immunodeficiency syndrome and related disorders.
N. Engl J Med 316, 557
131 Bureau of Justice Statistics (1991) US Department
of Justice, Washington, DC
132 World Health Organization (1990) WHO-report 26: AIDS
surveillance in Europe. June 30, WHO, Geneva.