iClinic - September 22, 2000
Marjolein Harvey
"A syndrome is a number of very different symptoms or conditions resulting from a common cause. In the context of HIV there is destruction of the immune system by the virus and as a result of this various conditions supervene, we call them opportunistic infections, tumours and so on," explains Martin on SABC radio.
Mbeki argues that the virus can be the initial agent causing a certain degree of collapse of the immune system, but that certain other factors - poverty, malnutrition - can also cause the collapse of the immune system. However, Martin argues that they cannot do this to the degree that HIV can.
Also, he points out that there are a number of other viruses that have been associated with syndromes, for example acute Hepatitis C infection and glandular fever.
Nevertheless, he says that the debate is undermining prevention and treatment efforts at grassroots level. Working with HIV-positive people and AIDS patients daily, Martin says that he has had instances where people have stopped therapies believing that HIV doesn't cause AIDS, and have died.
"We see youngsters that are not adhering to the messages regarding safe sex. We have people in the insurance industry causing problems for patients because they do not believe that the antibody test is indicative of an HIV infection," Martin told SABC radio.
He also says that the antibody test is a well-established practice in medicine to diagnose infections. The antibody test for HIV has been criticised as unreliable, but it is not, he says.
"I think if we would go back 17 years when the tests were first available, a number of false positives could have been expected. But today, with the new generation of antibody tests, combined with the prevalences in populations that we test, the positive-predictive value of the tests if high."
He also says that the screening test is followed by a barrage of tests before a patient is declared HIV-positive.
He says that if a person is tested HIV-positive, a number of diseases (29) can be expected to ensue and in all cases, AIDS has been associated with a positive HIV antibody test, whether in the West or in Africa.
Speaking in parliament on Wednesday, Mbeki shared his doubts whether the virus HIV can cause the syndrome AIDS.
"A virus will cause a disease and AIDS is a syndrome. When you ask the question: does HIV cause AIDS, the question is: does a virus cause a syndrome? How does a virus cause a syndrome? It can't," said Mbeki.
Also reacting to Mbeki's speech is Kobus Gous, Democratic Alliance spokesperson on AIDS, who says that Mbeki does not have to be a medical expert, but his advisers do.
With reference to Mbeki's pronouncements on a virus that cannot cause a syndrome, and a syndrome that is actually a collection of diseases, the DA says that "those who supplied the President with his information should be fired immediately".
Mbeki also said he is awaiting a report from the Presidential Advisory Committee on AIDS. But the DA says "the President will wait in vain for something new to emerge from this Committee. The perplexing composition of this committee, namely half dissidents and half conventional scientists, will cause all findings to be repeated over and over again, to everyone's great frustration."
Meanwhile, an iClinic reader from the US (Frank from North Carolina) says Mbeki's question is a very good one, and the answer is that AIDS is not a syndrome.
"The name Acquired Immune Deficiency Syndrome was given to a set of diseases [Karposi's Sarcoma, Thrush, etc] when the mechanism that allowed them to invade sufferers was unknown. Both Karposi's Sarcoma and Thrush are rare conditions, which had not been found to that degree in those populations. At this time [the early 1980s], AIDS was a properly named syndrome.
"Then HIV was found and its mechanism was analysed. Properly, Acquired Immune Deficiency Syndrome should have been renamed Acquired Immune Deficiency [AID]. AID should have been defined as a disease which creates the conditions that allow other diseases such as Karposi's Sarcoma and Thrush to invade patients.
"But re-naming is the province and concern of information professionals, rather than medical professionals.
"In other words, Mbeki's question was valid. The answer is a naming history in which a true syndrome became a primary disease, whose name didn't change."
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