Thabo Mbeki seems to have finally, and dramatically, reversed his heretofore disastrous AIDS policy. South Africa is going to begin providing free anti-retrovirals.
Bill Clinton apparently helped negotiate it. Funny that he’ll have done more for Africa as an ex-President than as President, but either way, I’ll take it.
I wrote my college thesis on this subject, when it was clear what bad shape South Africa was in but before Mbeki was so actively shooting himself in the foot–back then it looked like the cost would always be prohibitive, and people were trying to convince the government to provide AZT or nevirapene to prevent mother-to-child and rapist-to-victim transmission. It was so upsetting–here was the one place that seemed to have hope of doing things differently in Africa, with a peaceful transition and a truly honorable anti-colonialist leader, about to be completely destroyed by this disease. Well, this is a hopeful sign.
Next thing we need is a form of prevention that women can use without needing a man’s permission or knowledge.
Mbeki is, on the whole, a mediocrity without any real moral vision beyond protection of self and cronies. I can only guess what inspired this turnabout. Fear of losing ANC control of the Western Cape province? A thorough PR battering on the subject? A desire to curry favor by pleasing Bill Clinton?
Not that it matters in the end — after years of neglect, he’s finally doing the right thing.
Now, if only Clinton would talk to him about his support for the regime in Harare….
This is very good news.
Tacitus, is there any politician, anywhere, you’re merely ambivalent about?! The world needs to know.
Oh thank God. I wonder what they had to do to get Mbeki to pretend to be sane.
Katherine,
Now, I know I get in a lot of trouble when I start on this subject, but, if I may, let me register a dissenting opinion on AZT. But, unlike most subjects, I know a bit about this one
1. AZT was designed as Cancer Chemotherapy in the 1960’s. (See Munro, Modern Oncology, pg 85).
2. The first published paper on AZT is 1964. (See Horwitz, Journal of Organic Chem. 29:2076.)
3. Like all cancer chemotherapies, AZT is highly toxic, deadly, causes anemia and white blood cell loss. (numerous cites)
4. AZT is a particularly nasty cancer chemotherapy, known as as “DNA-Chain Terminator”. It’s sole function is to kill cells, preferably malignant cells. Sadly, it cannot differentiate between malignant and healthy cells. If it could, we’d cure cancer. We can’t.
5. Worse, the cells that survive AZT, are cells with damaged DNA — the hallmark of future cancer cells known as “second malignancies.” Again, I quote Munro:”Second malignancies are one of the unpleasant consequences of successful treatment for cancer. One of the ironies of the non-surgical treatment of cancer is that both radiation and chemotherapy are MUTAGENIC: they have the potential to produce the very disease they are used to treat.” (Munro, pg 280.)
I’ll bet a dollar you didn’t know AZT was cancer chemo, because few people know this, and the media doesn’t report it.
The bottom line: giving AZT to a bunch of sick, ill-nourished, and immune-depressed population is going to kill many more than save, and the ones who survive, are at increased risk of getting cancer.
You need to study AZT, before you start praising it. Many long-term survivors of HIV/AIDS are the ones who stay away from AZT.
ND, I think I’ve had this discussion you before, but: I did know that AZT was devised as cancer chemo. I did some research on the AZT issue for my senior thesis and read plenty of Lancet articles. A lot of drugs turn out to have uses beyond the ones they were first marketed for–not surprising, from what I understand of the testing process at various drug companies. I know from my last job in mental health that some of the most effective treatments for bipolar disorder were originally anti-epilepsy drugs.
A short course of AZT is effective in preventing HIV transmission from rapes, from needle sticks of health workers, and from mother to child. The side effects are low and the medical consensus is that it’s worth it. I don’t have the expertise to discuss longer term use, and I don’t think that’s what the ANC is planning to distribute.
K,
I’m glad you understand that AZT is cancer chemo, but you’re not quite getting it.
The issue isn’t whether some drugs are designed for use A, then used for B (like anti-epilepsy drugs). I have no problem with that.
The issue is, What does AZT do to a person? It cannot kill a virus (small amount of DNA) without killing a whole lot of cells (large amount of DNA), and eventually the person.
This is particularly true when HIV only infects 1 out of about 1000 t-cells. (See Simmonds, Journal of Virology 64:864-872 (1990).
Killing 1 infected cell, while killing 999 healthy cells, is not a good trade-off.
I’m not trying to press you on this. But I am consistantly bewildered that people, who have no understanding of cancer, virology, genetics, or infectious diseases, are continually singing the praises of a toxic chemo cancer drug, such as AZT, as if it were a cure-all panacea for a complicated disease process. It is not.
Moreover, ignoring the potential for second malignancies borders on malpractice. The largest study of long-term AZT use, showed a dramatic increase in lymphoma, cancer of the lymph nodes (See Pluda, Annals of Intern Medicine 113:276 – 282.)
I don’t really care about politics in South Africa. But, if AZT is introduced to that population, I predict death rates are going to soar, not decrease. And, naive folks, will blame it on the disease, rather than the toxic, cancer chemotherapy. Save this post. Better yet, read about AZT, before opining on it.
ND,
The problem with your argument is that you purport that AZT is a DNA chain terminator, it is very bad one, if one at all at normal dosage. Because it is very good I imagine it didn’t work too well in the clinical trials and was never utilized to treat cancer. Unlike the many other much more effective DNA disrupting drugs being used to treat aggressive cancers at this very moment. In the doses it is given to HIV infected people it does not effectively terminate DNA.
I have studied plenty on virology, biochemistry, carcinogenesis and pharmacology. While what you say might be true and that AZT might cause an increase in lymphomas there are plenty of other more likely reasons for people infected with HIV.
Examples include:
1. Rapid and almost uncontrolled creation of new T cells in the body in response to the initial HIV infection as the T cells killed by HIV are replaced. This is the real story of an HIV infection, a battle of attrition between your body’s ability to make new T cells to fight off both HIV and other pathogens, and HIV killing the T cells. Any type of rapid and unusual cell growth can lead to cancer, the more cells divide the more likely mutations in bad places are likely to occur.
2. HIV proviral DNA inserts next to an oncogene. This oncogene, now highly active, causes the above rapid and continuos cell growth.
3. Massive battle with HIV infected cells poisons surrounding tissue with leftover ammo, i.e. cytokines (causing rapid and continuos cell growth, cytotoxins (kills cells that need to be replaced) and oxygen radicals (mutate DNA)
You cite 2 articles from respected medical journals, need I cite the thousands that proclaim AZT’s effectiveness and safety? I actively work with HIV and routinely sequence HIV RNA for clinical research, and I work with lymphoma too, yet I haven’t heard a single thing about a huge epidemic of lymphomas in HIV patients. Is it all some conspiracy?
I’m very happy to hear Mugabe has changed his mind. For so long his position on HIV/AIDS has been horrifically cynical, and for no good reason. To sound some of Tacitus’ concerns, I hope this change will lead to increased regional pressure on Zimbabwe.
Arc,
1. You cite not a single study to support anything you wrote. Most of it is scientific gibberish.
2. You fail to respond to any of my specific cites.
The bottom line is this:
Since Jonas Salk cured polio, the treatment for viral disease, has been a vaccine.
For 20 years, AIDS scientists have failed miserably to devise a vaccine.
In a purely reactive mode, they pulled a highly toxic cancer chemo, AZT, off the shelf, and claimed it as a “wonder drug,” when in fact, as a cytopathic drug, it kills many more people, than the dreaded virus.
Why on earth would you treat a disease characterized by immune deficiency, with a drug that causes immune deficiency?
ND,
Well I guess I can start by pointing out that the HIV virus doesn’t contain DNA. So your analogy is wrong from the start.
AZT doesn’t kill HIV infected cells, it prevents HIV from replicating it is not even trying to kill cells.
As to your first reference this is the title of the article you cite and the link:
Human immunodeficiency virus-infected individuals contain provirus in small numbers of peripheral mononuclear cells and at low copy numbers.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2296085&dopt=Abstract
Yep HIV only really infects CD4 positive T cells, which are about 1:000 of your white blood cells overall. So that’s true, but the article doesn’t mention anything about the pharmacology of AZT or its use to treat HIV, so it is pretty irrelevant.
The second reference the meat of the abstract is this:
CONCLUSION: Patients with symptomatic HIV infection who survive for up to 3 years on antiretroviral therapy may have a relatively high probability of developing non-Hodgkin lymphoma. Prolonged survival in the setting of profound immunosuppression with substantial T4-cell depletion is probably an important factor in the development of these lymphomas. However, a direct role of therapy itself cannot be totally discounted. As improved therapies for the treatment of HIV infection and its complications result in prolonged survival, non-Hodgkin lymphoma may become an increasingly significant problem.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1973886&dopt=Abstract
The authors do seem to indicate that the therapy has the potential to be a problem, but do not state so directly and considers the immunosuppression caused by HIV to be a more likely reason. This article was written in 1990 more than 13 years ago with data from even earlier. Could I please have a reference to any article that sees this increase in lymphoma. Also I doubt this is the largest study of long term AZT use, it only had 55 participants.
Here is a Cite that refutes your claim in it’s entirety
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11362572&dopt=Abstract
This one’s even better it is by the same author as your second cite.
Pluda, J Clin Oncol. 1993 Jun;11(6):1099-107
The meat:
CONCLUSION: HIV-infected patients with profound immunodeficiency, especially those with less than 50 CD4 cells/microL, are at substantial risk of developing NHL and particularly PCNSL. Additional studies are needed to define the role of other factors such as IL-6 in the pathogenesis of these opportunistic tumors.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8099121&dopt=Abstract
Hmm…three years later and no mention of AZT or anti-viral therapy causing the lymphomas in their conclusion. Seems like they have discounted it and are going with immunosuppression.
It was Edward Jenner who invented the vaccine by using the cowpox virus (vaccinia virus, hence the word vaccine) to prevent smallpox.
There are now several drugs designed specifically to combat HIV, influenza, herpes and other viruses.
Agreed that scientists have failed in making a vaccine for HIV. It is a tough nut to crack but I think it will happen.
Consider yourself thoroughly Fisked
Sorry about not using the link tags but I don’t know how to use all that fancy stuff. If someone could point me to web site for instruction it would be greatly appreciated.
Arc,
Thoroughly Fisked my ass!
Well I guess I can start by pointing out that the HIV virus doesn’t contain DNA.
Of course it has DNA, you fool! The quirk of a retrovirus is simply that genetic info flows RNA=>DNA=>Protein.
Out of blocks, you miss the boat.
AZT doesn’t kill HIV infected cells, it prevents HIV from replicating it is not even trying to kill cells.
Simply clueless. Where do you think HIV replicates? In the cell, where ALL viruses must replicate, because they are parasites, dependent on hosts. Jeez, you’re missing the easy ones.
Yep HIV only really infects CD4 positive T cells, which are about 1:000 of your white blood cells overall. So that’s true,…
Thank you.
The authors do seem to indicate that the therapy has the potential to be a problem,…
Jeez, ya think? It’s the exact same result (second malignancies)any scientist would expect from pumping patients up with cancer chemo.
I quote from Science:
“more than half of all AIDS patients may not benefit from the drug because it is more toxic for them than their AIDS infection. The most serious side effect of AZT is to suppress the bone marrow, leaving patients highly vulnerable to bacterial infections” (Kolata G. Imminent marketing of AZT raises problems; marrow suppression hampers AZT use in AIDS victims. Science. 1987 Mar 20;235:1462-3.)
Or, better yet, I note the CANCERS developed in the offspring of mice given AZT:
“..in adult mice, lifetime AZT administration induces vaginal tumors at a 10-20% incidence…In newborn monkeys and mice, AZT was incorporated into DNA of many fetal tissues…AZT appears to be a moderately-strong transplacental carcinogen [i.e. it crosses the placenta and may cause cancer in the fetus]” (Olivero. AZT is a Genotoxic Transplacental Carcinogen in Animal Models. J Acquir Immune Defic Syndr. 1997 Apr 1;14(4):A29.)
Do you think pregnant women would be eager or skeptical to take a drug that caused cancer in utero of pregnant mice?
In humans, though, the conclusive fact is that AZT caused much more sickness and death in HIV patients taking it, than not taking it:
“The mortality rate was significantly higher among [a group of 1372] patients who had received antiretroviral therapy [principally AZT] before enrollment in the clinic” (Chaisson. Sex, race, drug use and progression of human immunodeficiency virus disease. N Engl J Med. 1995;333(12):751-6.)
Let me reiterate this, so that lay people can understand this simple dynamic:
1. AZT is cancer chemotherapy;
2. Cancer chemo kills both malignant and healthy cells, particularly white blood cells and bone marrow cells;
3. Cancer chemo, particularly the DNA chain terminators (which AZT is), also greatly increases the risk of future cancer, because it damages and distorts the DNA of cells it doesn’t kill.
4. If HIV has an average latency of 10 years between infection and symptoms, it is absolutely foolish to use AZT early, because mere months of steady AZT will kill even the strongest patient.
Please advise if one solitary fact here is wrong.
Ball in your court.
p.s. Yes, Jenner developed the vaccine. Great discovery. Salk, though, represents the modern day triumph for the polio vaccine.
ND
Well I went to the trouble of countering your cites the least you could do is counter mine. Of course you can’t since they destroy your point.
The simple point about HIV that you miss shows that you do not understand the underlying mechanisms of how an HIV infection works. It is not RNA>DNA>protein, that’s impossible. It is of course RNA>DNA>mRNA>protein. The AZT blocks the HIV RT from converting the viral RNA into proviral DNA once it gets into a cell. AZT does not block cell division.
AZT and in fact all anti-HIV therapies do not attempt to kill WBC’s. HIV does not replicates using RNA polymerase not DNA polymerase so a DNA chain terminator would not work.
All of your cites say that this might happen, but not one of them shows that AZT causes cancer in humans. Could I please have one citation that the main thrust of the article is that AZT cause cancer, and could the cite please be after the introduction of triple therapy including AZT which is widely used today sometimes for years and years.
1. AZT is not a cancer chemotherapy. That is why it was sitting on the shelf since the 60s, because it doesn’t work. It is also not a DNA chain terminator, and you don’t have a cite to prove that it does. Your cite about the monkeys and mice disproves this. Since the AZT seems to integrate into the DNA it obviously doesn’t terminate the DNA, else there would be no DNA extension and no fetuses to examine. Why is it that when patients take a combination of AZT and other HIV drugs their CD4 cell and overall WBC count increases and stays high as long as HIV viral levels are kept low?
2. It is true that many cancer chemptherapies kill both healthy and cancer cells, but most of those cells are rapidly dividing cells.
3. True that many cancer chemotherapies can lead to secondary tumors, but many do not. In fact the FDA doesn’t approve many of the more aggressive chemotherapies for use in children for this very fact, unless of course there is no other choice. But you have yet to prove that AZT causes cancer in humans.
4. You premise I wrong. HIV is not a latent infection it is an active infection in which billions of HIV particles are created every day in an untreated patient. Mere months of AZT treatment doesn’t kill anyone and you do not have a single cite to prove it.
Please I will admit if I am wrong, but I think the fact that almost every patient with HIV is put on AZT and there is no massive die-off of these patients. In fact they are living there lives much better now on AZT and other HIV drugs than they were before.
ND,
More cites for you to refute:
AZT doesn’t cause Lymphoma
Role of zidovudine antiretroviral therapy in the pathogenesis of acquired immunodeficiency syndrome-related lymphoma.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8541552&dopt=Abstract
This one that says lymphomas are reduced after AZT therapy:
Acquired immune deficiency syndrome-related pulmonary non-Hodgkin lymphoma regressing after zidovudine therapy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8453555&dopt=Abstract
Use this site to search all the medical journals and try to find one:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Index&DB=PubMed
Try to find any article that claims AZT causes cancer of any kind. I want an article that actually states it, not suggests it “may” be a problem or that it could “potentially” be a problem or anything like that. If it were true it should be easy, but I can’t find a single one. If fact all I find are articles that show AZT is effective in treating HIV when in combination with other drugs.
Sorry to hijack your thread K., but I can’t stand it when people spout off about crap like this. I feel the same about the morons who claim AIDS isn’t caused by HIV.