THE DURBAN DECLARATION A Confession of Faith

By Simon Wain-Hobson et al.

Dear Colleagues,

You have probably heard about the reappearance of an old myth surrounding the cause of AIDS. Peter Duesberg is back in the columns of Nature and Science. His thesis is that HIV doesn't cause AIDS, that there is no need to screen blood, or treat patients. The situation has taken a serious turn in that President Mbeki of South Africa is consulting him. The consequences are being felt in Africa and Asia. An international group of scientists and doctors has come up with something called the Durban Declaration to be published in Nature on July 6. You will find it at the bottom of this message. As a scientific statement in plain language, it attempts to set the record straight by stating the facts. The organizing committee of scientists and front-line physicians has 181 members spread over 43 different countries. The list of committee members follows the declaration. Among them you will find David Baltimore, Sir Aaron Klug, President of the Royal Society, Luc Montagnier, Rolf Zinkernagel and many more.

The object is to get as many names of scientists and doctors to sign on. Names of signatories will appear on the Nature website. If you would like to sign on we would be delighted. Send me an e-mail confirming this. To economise space on the website we have to name people in a single line:

Name, Major degree, One title if necessary, Hospital/University/Institute, City, Country. The form of the ideal response would be: Durban Declaration: Agreed Robin WEISS, PhD, Professor, University College, London, UK Please note in CAPITALS your name as found in the index of an English language scientific paper. This is important as we will be listing everyone in alphabetical order.

Many of you will say that HIV/AIDS is not your area. However over the years you have heard enough of the arguments to understand the association.

Furthermore many of you know well infectious diseases and understand Koch's postulates. If you have colleagues in the laboratory or in the clinic who you feel would like to sign on please ask them. The more the better. However, please note that in order to be authoritative we feel it necessary to restrict the list to those with major university qualifications. Hence please do not ask students. Apologies for this. We would need email replies as soon as possible and before June 27.

Finally please do not talk to reporters about the Durban Declaration until Nature publishes it. If you are asked by a member of the press, just say "I'd be pleased to talk to you about this, but I'm afraid I am not at liberty to do so at the moment." Please could you point this out to others who wish to sign on.

Many thanks,
Simon Wain-Hobson on behalf of the organizing committee

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THE DURBAN DECLARATION

Seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of people from around the world have gathered in Durban, South Africa to attend the XIII International AIDS Conference. At the turn of the millennium, an estimated 34 million people worldwide are living with HIV or AIDS, 24 million of them in sub-Saharan Africa (1). Last year alone, 2.6 million people died of AIDS, the highest rate since the start of the epidemic. If current trends continue, Southern and South-East Asia, South America and regions of the former Soviet Union will also bear a heavy burden in the next two decades.

Like many other diseases, such as tuberculosis and malaria that cause illness and death in underprivileged and impoverished communities, AIDS spreads by infection. HIV-1, the retrovirus that is responsible for the AIDS pandemic, is closely related to a simian immunodeficiency virus (SIV), which infects chimpanzees. HIV-2, which is prevalent in West Africa and has spread to Europe and India, is almost indistinguishable from an SIV that infects sooty mangabey monkeys. Although HIV-1 and HIV-2 first arose as infections transmitted from animals to humans, or zoonoses (2), both are now spread among humans through sexual contact, from mother to infant and via contaminated blood.

An animal source for a new infection is not unique to HIV. The plague came from rodents. Influenza and the new Nipah virus in South-East Asia reached humans via pigs. Variant Creutzfeldt-Jakob disease in the United Kingdom came from 'mad cows'. Once HIV became established in humans, it soon followed human habits and movements. Like other viruses, HIV recognizes no social, political or geographic boundaries.

The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous. This evidence meets the highest standards of science (3-7). The data fulfil exactly the same criteria as for other viral diseases, such as poliomyelitis, measles and smallpox:

• Patients with acquired immune deficiency syndrome, regardless of where they live, are infected with HIV (3-7).
• If not treated, most people with HIV infection show signs of AIDS within 5-10 years (6, 7). HIV infection is identified in blood by detecting antibodies, gene sequences or viral isolation. These tests are as reliable as any used for detecting other virus infections.
• Persons who received HIV-contaminated blood or blood products develop AIDS, whereas those who received untainted or screened blood do not (6).
• Most children who develop AIDS are born to HIV infected mothers. The higher the viral load in the mother the greater the risk of the child becoming infected (8).
• In the laboratory HIV infects the exact type of white blood cell (CD4 lymphocytes) that becomes depleted in persons with AIDS (3-5).
• Drugs that block HIV replication in the test tube also reduce viral load and delay progression to AIDS. Where available, treatment has reduced AIDS mortality by more than 80% (9). Monkeys inoculated with cloned SIV DNA become infected and develop AIDS (10).

Further compelling data are available (4). HIV causes AIDS (5). It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives. In different regions of the world HIV/AIDS shows altered patterns of spread and symptoms. In Africa, for example, HIV-infected persons are 11 times more likely to die within 5 years (7), and over 100 times more likely than uninfected persons to develop Kaposi's sarcoma, a cancer linked to yet another virus (11).

As with any other chronic infection, various co-factors play a role in determining the risk of disease. Persons who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weaken the scientific evidence that HIV is the sole cause of AIDS. In this global emergency, prevention of HIV infection must be our greatest worldwide public health priority. The knowledge and tools to prevent infection exist. The sexual spread of HIV can be prevented by monogamy, abstinence or by using condoms. Blood transmission can be stopped by screening blood products and by not re-using needles. Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs (12, 13).

Limited resources and the crushing burden of poverty in many parts of the world constitute formidable challenges to the control of HIV infection. People already infected can be helped by treatment with life-saving drugs, but high cost puts these treatments out of reach for most. It is crucial to develop new antiviral drugs that are easier to take, have fewer side effects and are much less expensive, so that millions more can benefit from them.

There are many ways to communicate the vital information about HIV/AIDS. What works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments, and hopefully a vaccine. But for now, emphasis must be placed on preventing sexual transmission.

There is no end in sight to the AIDS pandemic. By working together, we have the power to reverse the tide of this epidemic. Science will one day triumph over AIDS, just as it did over smallpox. Curbing the spread of HIV will be the first step. Until then, reason, solidarity, political will and courage must be our partners.

References

1. UNAIDS. AIDS epidemic update. December 1999. www.unaids.org/hivaidsinfo/documents.html

2. Hahn, B. H., Shaw, G. M., De Cock, K. M., Sharp, P. M. (2000). AIDS as a zoonosis: scientific and public health implications. Science, 287, 607-614.

3. Weiss R.A and Jaffe, H.W. (1990). Duesberg, HIV and AIDS. Nature, 345, 659-660.

4. NIAID (1996). HIV as the cause of AIDS. www.niaid.nih.gov/spotlight/hiv00/default.html

5. O'Brien, S.J. and Goedert, J.J. (1996). HIV causes AIDS: Koch's postulates fulfilled. Current Opinion in Immunology, 8, 613-618.

6. Darby, S.C. et al., (1995). Mortality before and after HIV infection in the complete UK population of haemophiliacs. Nature, 377, 79-82.

7. Nunn, A.J. et al., (1997). Mortality associated with HIV-1 infection over five years in a rural Ugandan population: cohort study. BMJ, 315, 767-771.

8. Sperling, R. S. et al., (1996). Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N. Engl. J. Med. 335, 1678-80.

9. Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report 1999; 11, 1-44.

10. Liska, V. et al., (1999). Viremia and AIDS in rhesus macaques after intramuscular inoculation of plasmid DNA encoding full-length SIVmac239.AIDS Research & Human Retroviruses, 15, 445-450.

11. Sitas, F. et al., (1999). Antibodies against human herpesvirus 8 in black South African patients with cancer. N. Engl. J. Med., 340, 1863-1871.

12. Shaffer, N. et al., (1999). Short course zidovudine for perinatal HIV-1 transmission in Bangkok Thailand: a randomised controlled trial. Lancet, 353, 773-780.

13. Guay, L. A. et al., (1999). Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet, 354, 795-802.

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ORGANIZING COMMITTEE

Updated 15 June 2000

Committee Members: The following scientists have expressed their support for the initiative and have agreed to serve on the organizing committee:

Laura Astarloa, Argentina
Pedro Cahn, Argentina
Oscar Fay, Argentina
Gaston Picchio, Argentina
Horacio Salomón, Argentina
David Cooper, Australia
Suzanne Crowe, Australia
John Mills, Australia
Arsene Burny, Belgium
Erik De Clercq, Belgium
Roberto Badaró, Brazil
Carlos Brites, Brazil
Euclides Castilho, Brazil
Artur Kalichman, Brazil
David Lewi, Brazil
André Villela Lomar, Brazil
Susie Noguiera, Brazil
Amilcar Tanuri, Brazil
Marco Antônio de Ávila Vitória, Brazil
Nicolas Meda, Burkina Faso
Philippe Van de Perre, Burkina Faso
Seng Sut Wantha, Cambodia
Leopold Zekeng, Cameroon
Catherine Hankins, Canada
Julio Montaner, Canada
Mark Wainberg, Canada
Marcelo Wolff, Chile
Yunzhen Cao, China
Zunyou Wu, China
Weimin Xu, China
Fujie Zhang, China
Xiwen Zheng, China
Juan Diego Vélez, Colombia
Brigitte Autran, France
Françoise Barré-Sinoussi, France
Stéphane Blanche, France
Françoise Brun-Vézinet, France
François Dabis, France
Patrice Debré, France
Marc Gentilini, France
Marc Girard, France
Christine Katlama, France
Philippe Kourilsky, France
Jean-Paul Levy, France
Luc Montagnier, France
Christine Rouzioux, France
Maxime Seligmann, France
Simon Wain-Hobson, France
Patrick Yeni, France
Tumani Corrah, The Gambia
Reinhard Kurth, Germany
Veronica Miller, Germany
Mun Hon Ng, Hong Kong
Wing Hong Seto, Hong Kong
Kanai Banerjee, India
Sekhar Chakrabarti, India
Alaka Deshpande, India
Raman Gangakhedkar, India
I.S. Gilada, India
N. Kumarasamy, India
N.M. Samuel, India
Pradeep Seth, India
Didi Sumarsidi, Indonesia
Dewa Wirawan, Indonesia
Luigi Chieco-Bianchi, Italy
Mario Clerici, Italy
Barbara Ensoli, Italy
Carlo Giaquinto, Italy
Franco Lori, Italy
Gabriella Scarlatti, Italy
Pier-Angelo Tovo, Italy
Stefano Vella, Italy
Georgette Adjorlolo-Johnson, Ivory Coast
John Nkengasong, Ivory Coast
Satoshi Kimura, Japan
Dorothy Mbori-Ngacha, Kenya
Ruth Nduati, Kenya
John Chiphangwi, Malawi
Christopher Lee, Malaysia
Stefano Bertozzi, Mexico
Roel Coutinho, Netherlands
Joep Lange, Netherlands
Frank Miedema, Netherlands
Alash'le Abimiku, Nigeria
Simon Agwale, Nigeria
John Idoko, Nigeria
Zulfiqar Bhutta, Pakistan
Ernesto Scerpella, Peru
Birgitta Åsjö, Norway
Souleymane M'Boup, Senegal
Quarraisha Abdool-Karim, South Africa
Salim Abdool-Karim, South Africa
Mark Colvin, South Africa
Hoosen Coovadia, South Africa
Ashraf Grimwood, South Africa
Greg Hussey, South Africa
James McIntyre, South Africa
William Makgoba, South Africa
Des Martin, South Africa
Lynn Morris, South Africa
Freddy Sitas, South Africa
Carolyn Williamson, South Africa
Robin Wood, South Africa
Jose Gatell, Spain
Rafael Nájera, Spain
Vicente Soriano, Spain
Eva Maria Fenyö, Sweden
Lars Kallings, Sweden
Hans Wigzell, Sweden
Bernard Hirschel, Switzerland
Giuseppe Pantaleo, Switzerland
Rolf Zinkernagel, Switzerland
Fred Mhalu, Tanzania
Natth Bhamarapravati, Thailand
Francis Miiro, Uganda
Philippa Musoke, Uganda
Nelson Sewankambo, Uganda
Michael Adler, UK
Janet Darbyshire, UK
Diana Gibb, UK
Charles Gilks, UK
Andrew McMichael, UK
Andrew Nunn, UK
Sarah Rowland-Jones, UK
Peter Smith, UK
David Warrell, UK
Jonathan Weber, UK
Robin Weiss, UK
Ali Zumla, UK
Arthur Ammann, USA
David Baltimore, USA
Irvin Chen, USA
Thomas Coates, USA
John Coffin, USA
Larry Corey, USA
Gerald Friedland, USA
Helene Gayle, USA
Eric Goosby, USA
Warner Greene, USA
Geeta Rao Gupta, USA
Ashley Haase, USA
Beatrice Hahn, USA
Scott Hammer, USA
Martin Hirsch, USA
David Ho, USA
Samuel Katz, USA
Wayne Koff, USA
Bette Korber, USA
Richard Koup, USA
Jay Levy, USA
Dan Littman, USA
Mike McCune, USA
Tom Merigan, USA
Michael Merson, USA
Neal Nathanson, USA
Stephen O'Brien, USA
John Phair, USA
Bill Powderly, USA
Doug Richman, USA
Mike Saag, USA
Robert Schooley, USA
George Shaw, USA
Robert Siliciano, USA
Joseph Sodroski, USA
Mario Stevenson, USA
John Sullivan, USA
Charles van der Horst, USA
Paul Volberding, USA
Bruce Walker, USA
Catherine Wilfert, USA
Eduardo Savio, Uruguay
Gloria Echeverria de Perez, Venezuela
Raul Isturiz, Venezuela
Chewe Luo, Zambia
Alwyn Mwinga, Zambia
Mary Bassett, Zimbabwe
Inam Chitsike, Zimbabwe
Ahmed Latif, Zimbabwe
Chipo Mbanje, Zimbabwe
Lynn Zijenah, Zimbabwe

Committee Secretary
Peter Hale, UK
phale@aidsresearch.org

Simon Wain-Hobson
Unité de Rétrovirologie Moléculaire
Institut Pasteur
28 rue du Dr Roux
75724 Paris cedex 15
Tel 33 1 45 68 88 21
Fax 33 1 45 68 88 74
simon@pasteur.fr

Secretary, Michele Chahine
mchahine@pasteur.fr
Dr. M.H.V. Van Regenmortel
UPR 9021-Immunochemistry Department
IBMC, CNRS
15 rue René Descartes
67084 STRASBOURG CEDEX
FRANCE
Tel. +33 3 88 41 70 22
Fax +33 3 88 61 06 80
e-mail: M.Vanregen@ibmc.u-strasbg.fr