MEDICAL SCIENCE: by Lucy SullivanNews Weekly
Deaths from AIDS omitted from inquiry
, November 12, 2011
Anyone looking at the statistics presented in the 2010 Annual Surveillance Report on HIV, Viral Hepatitis, and Sexually Transmissible Infections from the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales (recently renamed the Kirby Institute) could be forgiven for thinking that in the course of the last decade AIDS has become a conquered disease; and further, that its former association with HIV infection has been lost.
The relevant tables in that publication show Australian AIDS deaths falling from 130 in 2001, to 69 in 2005, to only nine in 2009, and AIDS diagnoses from 246 in 2001 to 90 in 2009.
By contrast, over the same period the annual incidence of new diagnoses of HIV infection rose from the 600s in the late 1990s, to 853 in 2002, to 1,050 in 2009. Further in the just-issued 2011 Report, statistics of AIDS diagnoses and deaths have, without comment, ceased to be reported at all — the usual set of tables, headed National AIDS Registry, has disappeared.
This startling change does not signal the power and success of the anti-viral drugs with which HIV infection is now treated (the falls occurred well after the introduction of these treatments), but rather the abandonment of “AIDS” as a discrete disease category.
In fact, AIDS never was this. Acquired immune deficiency syndrome (AIDS) was a term produced to cover a variety of diseases or disease clusters which appeared in high frequency in people with human immunodeficiency virus (HIV), usually leading to their deaths, at a time when mortality from these same diseases had been virtually eliminated in the general population in First World countries.
Under the revised classificatory approach, although people are still diagnosed with HIV, they are ceasing to be diagnosed with AIDS. Instead, they are diagnosed with, and recover or die from, a specific disease, albeit one of those in the former AIDS cluster (such as Kaposi’s Sarcoma, Non-Hodgkin’s Lymphoma, Tuberculosis or Hepatitis B). Formerly, if they contracted, or died from, one of these diseases and were also HIV-infected, they were reported as having, or dying of, AIDS.
It is a matter of concern, therefore, that deaths from these HIV-related diseases in HIV-infected persons are not recorded in the Report. While recording the actual disease that caused death could represent a more fine-tuned approach to the understanding of HIV morbidity and mortality, omitting this statistic means that the connection between HIV and the incidence of death from its associated diseases is being lost from the public record.
For a true picture, a comparison of death rates from these diseases in HIV-infected persons with deaths in those without HIV infection should be available.
At the beginning of the HIV/AIDS epidemic, there was considerable opposition to notification and contact-tracing of HIV infections under the traditional public health procedures that historically were so efficacious in controlling infectious diseases.
Indeed, despite the risk to medical personnel treating infected persons for other conditions, the right to privacy and anonymity was asserted. A reassertion of the rights to privacy of the HIV-infected is now preventing the reliable collection of these necessary statistics.
It is clear from the data that HIV infection is occurring at a worrying rate, and this new evasion is likely to lull concerns about its significance.
The change in classificatory policy, which suggests a radical rethinking and redefinition of the HIV/AIDS relationship, has not been given a public airing. Does it indicate an epidemiology-based de-coupling of the HIV virus/AIDS connection?
In the interests of properly targeted public health policies (for example, the policy of free-needle distribution to drug-users to reduce HIV transmission) any new understanding of the HIV/AIDS connection (or non-connection) deserves public clarification.
A corollary of this change of methodology is its apparent support for HIV/AIDS theory doubters as regards the claimed incidence of HIV infection in Third World countries, notably in Africa, where HIV infection has primarily been inferred from the prevalence of AIDS-defining diseases rather than actual testing for the virus.
The breakdown of rural communities and translocation to slums in towns and cities that are ill-prepared to deal with public health issues are just such factors as would produce high rates of these diseases independently of the HIV virus, and many of the same issues as relate to HIV transmission, such as sexual promiscuity, are also risk factors for these diseases independently of HIV.
If the connection is not valid, then estimates of HIV infection in such countries are indeed inflated.
The Report acknowledges that 25 years on from its identification, HIV in Australia continues to be transmitted by, or perhaps one should say primarily associated with, sexual contact between men.
Dr Lucy Sullivan has written widely on literature, cultural matters, family, taxation and poverty.