[Letter to Colleagues from Peter Duesberg]

PNAS - Review -MS T 1867
In this paper, Duesberg presents a hypothesis that AIDS is due to
drug use and not to any sexual behavior or infection with HIV
virus. The argument is not tightly reasoned and in this
reviewer's opinion not sustainable. The following criticisms are
noted:
1. Page 4, that HIV is not sufficient for AIDS does not mean
that it is not.etiologic. For example, Mycobacterium
tuberculosis and Histoplasma capsulatum are the etiologic
agents of disseminated tuberculosis and histoplasmosis. Yet
many individuals can be infected with, and harbor these
organisms without clinical disease. This does not mean,
however, that the organism is not etiologic when disease is
produced, merely that other factors are involved. Thus, the
author's entire argument could be made with respect to
tuberculosis and histoplasmosis and would be equally
fallacious.
2. The author dismisses the consideration of hemophilia patients
as important in considering the etiology of AIDS. In this
reviewer's opinion, however, these patients provide decisive
information to indicate that HIV infection is both necessary
and sufficient for the development of AIDS. The contention
by Duesberg (point number 7 on page 16) that the
immunodeficiency disease seen in hemophiliacs merely reflects
maladies that occurred in hemophiliacs previously but prior
to HIV were not recognized as AIDS is simply unsustainable by
clinical experience. Thus in the hemophilia experience,.
physicians who have cared for patients over the era 1950 to
1978 essentially never found patients.dying of opportunistic
infections or syndromes of immunodeficiency. These patients
often had somewhat reduced lymphocyte counts, but had no
clinical disease such as AIDS. Since that time, as HIV
infection became rampant in the hemophiliac population, the
mortality from AIDS and AIDS-like illnesses is.now the
leading.causeof death in patients with hemophilia. It is
ridiculous to claim that clinicians caring for these patients
misread this phenomenon. Further evidence from the
hemophilia population comes from the wives of hemophiliac
subjects, 100 of whom have developed AIDS and 59 have died
from clinical AIDS despite the absence of any other risk
behaviors. No use of drugs, no promiscuity, merely infection
with HIV from their partner. Some infants born to such
mothers have also developed AIDS. These considerations and
cases of transfused patients with no other risk factors
essentially eliminate drug use as an etiologic possibility in
AIDS.
3. Page 10, that AZT is toxic and relatively ineffective is

irrelevant to the question of the etiology of AIDS. The fact
that patients receiving AZT do not have a highly increased
incidence -of AIDS when HIV infected would argue-against the