Health Education AIDS Liaison, Toronto

Protease Inhibitors, Combination Therapy and HAART*

* Highly Active Anti-Retroviral Therapy (The Lancet, Apr.4,98)

"One of the major barriers to effectively treating HIV is that most people do not feel sick at the time that they are offered anti-HIV medications. In fact, it is only after starting the medications that they begin to feel sick."
   - Lori Swick, practicing Doctor of Pharmacy

     Advances in HIV treatment a mixed blessing
     The Toronto Star, September 24, 1999

"WARNING: CRIXIVAN is indicated for the treatment of HIV infection in adults when antiretroviral therapy is warranted. This indication is based on analyses of surrogate endpoints in studies of up to 24 weeks in duration. At present, there are no results from controlled clinical trials evaluating the effect of therapy with CRIXIVAN on clinical progression of HIV infection, such as survival or the incidence of opportunistic infections."
    - from Merck's Crixivan product information

All the protease inhibitors come with similar disclaimers

Is the conventional view and treatment of AIDS
the answer or part of the PROBLEM?

No scientific studies for any protease inhibitor has shown proven clinical benefits (improved health) for patients as compared to a similar group of HIV positive people who do not take the drugs (see note). Long Term Survivors typically avoid "anti-HIV" drugs. The lists of side effects for all the protease inhibitors are long. All protease inhibitors have to be very similar molecules in order to do their very specific job. If there are serious side effects with one, there are certain to be with the others. ASK YOUR DOCTOR FOR THE FULL PRODUCT INFORMATION AND READ IT. And remember, your doctor is working for you. If you think the drugs are not for you, don't be pressured. You can always shop around to find a doctor who respects your decisions (see Doctors)

Also, protease inhibitors are rarely prescribed alone; don't forget to inform yourself about the other drugs in the "cocktail" ( AZT, DDI, 3TC...).

Myth: "People with HIV are living longer and healthier lives since the new drugs became available"

Fact: AIDS Deaths and New Cases Down Since 1993/94
Both Trends Predate Protease Inhibitors

Yes, there were fewer new AIDS cases and AIDS deaths in 1996 than in 1995. This was the third year in a row for decreased AIDS diagnoses, which peaked in 1993 (in spite of the CDC fudging the statistics upward 100% with the new definition of AIDS that year). AIDS deaths peaked in 1994, held steady in 1995, then dropped in 1996. AIDS mortality was calculated for January-June, 1996, and was 13% lower than the same period in 1995.
HIV proponents have never acknowledged the decline of AIDS cases, but have attributed the decline of AIDS deaths to protease inhibitor-based therapy. However, protease inhibitors became FDA-approved in December, 1995, a year after AIDS mortality began its decline, and did not become widely used until mid-1996. See: AIDS Deaths Drop

HAART Treatment Worse Than AIDS?

..."in addition, long-term use of HAART has now been associated with significant metabolic abnormalities which could lead to unintended morbidity. In some patients, this morbidity could be worse than what one could expect from the progression of HIV-associated immune disease itself over the same period of time..."

In other words, some patients taking the AIDS drug regimens known as HAART may experience side effects that are worse than the illnesses the drugs are supposed to prevent!

From: HIVresistanceWeb / November 24, 2002


Risk of Progression to AIDS and Death in Women Infected With HIV-1 Initiating Highly Active Antiretroviral Treatment at Different Stages of Disease
Anastos et al. Arch Intern Med 162: 1973-80 (2002)
The paper is torture to read because of the confused logic and techno-babble, but it provides otherwise hard-to-come-by useful data on just how ineffective HAART really is. As usual, the authors do not provide a control of consisting of the outcomes of women who were HIV-negative or the outcomes of HIV-positive women who did not take HAART. Nevertheless, the results are highly damaging to the value of HAART. David Rasnick provides illuminating commentary.

Liver failure top killer of AIDS patients
UPMC Health System News Bureau ~ July 8, 2002
Elevations in ALT and AST enzymes signal injury to liver cells and, in some cases, to other cells in the body. The condition can result from highly active anti-retroviral therapy (HAART), viral hepatitis or alcohol abuse, all of which are toxic to liver cells. Liver failure is the most common cause of death in people with AIDS. "The fact that the findings were similar in two very different cohorts suggests that these results apply to all HIV patients," said Dr. Justice. "Furthermore, the fact that the most common current cause of death among people with HIV is liver failure suggests that liver injury may be a major limiting factor in the effectiveness of current HIV treatment."

Cause of serious illness among HAART-users not clear
CATIE TreatmentUpdate 2002 March Volume 14 Issue 3
NIH researchers analysed their data, in part, by collecting information on the number of "AIDS-related events" such as AIDS-related infections. They also collected data on serious or life-threatening [treatment-related] complications (which they called "grade IV events"). These complications included such events as bone marrow damage, inflamed pancreas glands, liver-related problems and so on. In analysing their data, here is what the researchers found that occurred over the course of their study: number of AIDS-related events – 316; number of grade IV events – 663. As a proportion of the study population, the figures can be expressed as follows: AIDS-related events – 14%; grade IV events – 28%. Thus, grade IV events were twice as common as AIDS-related illnesses. Survival: After about 30 months, about 10% of subjects died. The risk of death from AIDS or a grade IV event was about equal. This attests to the severity of such complications. Although PHAs who had more than 200 CD4+ cells had a relatively low risk of developing AIDS (6%), their risk of developing a grade IV event was about four times greater (26%).

JAMA study shows increased mortality protease inhibitor use
By Matthew Irwin, MD
In November 2001 JAMA (the Journal of the American Medical Association) published two major studies on "antiretroviral" drugs, one of which showed increased mortality for people taking protease inhibitors. The other study did not look at mortality, but rather focused on "viral load". The increased mortality in people using protease inhibitors was found in the second study to be reviewed, but the first study also found many inconsistencies with conventional beliefs about HIV and AIDS. For example, the first study to be reviewed found that 40% of people on any drug regimen had to change drugs, mostly due to toxic side effects. Following is a brief review of both studies.

Researchers Find AIDS Drugs Cause T-Cell Deaths in Healthy, HIV Negative Patients!
In the June 2, 2002 issue of the Journal of Virology, researchers report an astounding discovery: The protease inhibitor drugs Crixivan (indinavir) and Invarase (saquinavir) caused T cell death in healthy HIV negative donor blood in three separate experiments.

Three Studies Contradict Common Assumptions about HAART
New studies provide more evidence that AIDS "cocktail treatments," the three drug combinations containing Protease Inhibitors (PIs), cannot be the significant or sole cause of decreased AIDS deaths or increased survival in people diagnosed with AIDS.

Changing the AIDS Definition Increases AIDS Survival Rates
"When you suddenly label large numbers of illness-free, symptom-free people HIV positives as 'AIDS patients,' this must result in increased survival in the overall AIDS patient population. This has to do with the labeling, not with the effects of any treatment."

Might HAART Help?
Benefits from blocking opportunistic infections, not HIV
Protease inhibitors labeled "anti-HIV" directly block the opportunistic infections that make-up the "AIDS" definition. This fact has emerged quietly, without press attention, several years after the popular and scientific media in 1997 uncritically trumpeted corporate proclamations that these "HAART" drugs specifically targeted HIV while producing benefits, and thus confirmed the official HIV-causes--AIDS model. Two recent studies now flatly falsify any claims of HIV specificity, and offer a sensible explanation for beneficial effects that have nothing to do with HIV. This means that any evidence of HAART benefits cannot automatically bolster the HIV model, even among scientists who believe that HIV causes AIDS and that HIV tests indicate HIV infections. by Paul Philpott

Inflammatory Reactions in HIV-1-Infected Persons after Initiation of Highly Active Antiretroviral Therapy
Joseph A. DeSimone, MD; Roger J. Pomerantz, MD; and Timothy J. Babinchak, MD
Ann Intern Med. 2000;133:447-454.

"It is possible […] that HAART may actually promote the clinical expression and development of such infections, as well as AIDS-related malignant conditions and other noninfectious diseases" This is a review article with 95 references, where authors list several opportunistic infections and malignancies usually known as AIDS defining conditions that afflicted patients only after initiation of HAART therapy lowered viral load and increased CD4 cell counts. HIV researchers have created an ironic new name for this IATROGENIC AIDS: "Immune Restoration Syndrome".

Adverse Effects From HIV Drugs Found to Be Common
NEW YORK (Reuters Health) - As many as two-thirds of patients on HIV drug combinations may suffer a medication side effect that could affect their adherence to therapy, new study results suggest.

Mortality from liver disease increasing in HIV-positive patients
"End-stage liver disease has become the leading cause of death of HIV-seropositive patients at our institution," the authors conclude. "This trend is occurring in the background of a dramatic decline in the incidence of opportunistic infections and the rate of AIDS-related mortality in the era of HAART." The article also reports injection drug use, antiretroviral therapy (HAART), and treatment with other potentially hepatotoxic agents for most of the patients.

No more cocktails
New Scientist magazine, 16 December 2000.
Four years of "hit hard, hit early" HIV treatment may be on the way out in the US, as evidence mounts of the drugs' serious side effects. AIDS experts in the US are about to complete a humiliating U-turn when the Department of Health and Human Services launches its revised HIV treatment guidelines in January.

New US guidelines make the case for ongoing scientific inquiry
ANC Today A review of the new guidelines on the use of anti-HIV drugs that the US government issued on February 5, 2001 this year as "HIV Treatment Guidelines Updated for Adults and Adolescents".

Can AZT & other anti-HIV drugs cause AIDS?
By Matthew Irwin, MD
The truth is that AZT, ddI, ddC , protease inhibitors and other drugs termed "antiretrovirals" have not been found in any controlled studies to show proven clinical benefits for HIV/AIDS patients. Even more alarming, there is plenty of evidence that these drugs have been found to cause the very symptoms they are meant to cure. Are the effects of AZT and other "antiretrovirals" being blamed on HIV?

Concerns About HAART (Combination therapy including AZT or another Nucleoside Analog, plus a Protease Inhibitor)
compiled by David Crowe of the Alberta Reappraising AIDS Society
Two dozen reasons why you might not want to follow the doctor's orders. Quotes and citations mostly from the scientific literature.

The trouble with nevirapine*
By Anthony Brink
Advocate of the High Court of South Africa
[*also known as Viramune]
This article is divided into four parts:
Part One relates the history and licensing of nevirapine in the US and Europe, and outlines its pharmacology and its toxicities;
Part Two reveals the extraordinary circumstances in which the drug was licensed in Canada;
Part Three looks at a South African clinical drug trial involving nevirapine and other drugs, aborted by order of the Medicines Control Council in April 2001 after a spate of severe toxic reactions, several fatal;
Part Four provides a critique for non-expert readers of HIVNET 012, the Ugandan study of the effect of administering nevirapine to HIV-positive pregnant women conducted by Guay et al, on the basis of which the Treatment Action Campaign won an order from the High Court on 15 December 2001 compelling the South African government to supply the drug to such women and their newborn children.

PERTH GROUP PRESENTATION ON NEVIRAPINE
By Val Turner
View the 83 slides, and listen to the audio stream (Real audio, 65 min.), or read the transcript.
This presentation has been prepared by Eleni Papadopulos and the Perth Group and several other colleagues. The subject is an analysis of the data claimed to prove nevirapine an effective agent for the prevention of mother to child transmission of HIV. The presenter is Dr. Val Turner from the Department of Emergency Medicine, Royal Perth Hospital.

Cocktail Hangover
By Frank Green
Cleveland Free Times May 5 - May 12, 1999
HIV patients find that the current drug treatments aren’t necessarily the answer.

The BIG 'TEASE
By Mark K. Anderson
Are protease inhibitors miracle AIDS drugs, or are researchers rushing down a dead-end street?

The Mind is a Terrible Thing to Waste:
The Brainwashing of AIDS

By Stephen C. Byrnes, Ph.D., D.N.T.

side fx 2000
Pills! Chills! Spills! Thrills!
POZ September 2000
This is a prime example of the perverse rhetoric POZ magazine employs to direct market one of the most gruesome experiments in medical history. No study has ever proven that these drugs are "lengthening life spans" and many of the "side fx" listed here would amount to full blown AIDS.

If the virus doesn't get you, the drugs you take will
POZ column by Stephen Gendin.
"The drugs we have are nowhere near as powerful as we once thought... Reports of treatment failure have ranged between 20 percent and 50 percent for more than a year now... If you don't die of a heart attack from the raised cholesterol and triglyceride levels caused by protease inhibitors, and if you aren't struck down by diabetes, you'll almost certainly be disfigured by lipodystrophy syndrome: a big stomach, a huge hump on your back, scrawny, skinny legs and arms."
And this is from POZ a magazine that has totally bought in to HIV/AIDS as a vehicle for pharmaceutical company advertising!

HIV and AIDS: gap between biology and reality in AIDS
Andrew Carr, David A Cooper
Lancet, Volume 352, Supplement 5, 19 December 1998
Among other admissions about "antiretroviral" therapy, the authors state: "Despite biological plausibility, studies of protease inhibitors which evaluate survival benefit have not yet been carried out. The post-1996 AIDS conference hype that 'combination therapy including a protease inhibitor will make HIV a chronic, manageable disease just like diabetes' came back to haunt us."

"AIDS Deaths Drop"
Just about every major paper in North America ran a story, based on a U.S. government press release, attributing the dramatic decline in AIDS deaths to new protease inhibitor drug combinations (Oct 8 '98). Should we buy the hype? Here are some reasons not to. Judge for yourself.

Antiretroviral Therapy for HIV Infection: Promises and Problems
JAMA, May 6, 1998:279:1343-1344
"These observations underscore the uncertainties regarding the safety of long-term combination therapy in general and protease inhibitor therapy in particular."

Letters to the Lancet, April 4th 1998
Have a look at this if you want to have an idea of how completely confused the doctors are about the benefits(?) and dangers of HAART combination therapy.
(You may have to fill in a little box to access this page: username:had/password:enough.)

What David Rasnick learned at the Gordon Conference
I interrupted the uncomfortable silence by restating the question. Your patients should be doing better, right? Again Markowitz was speechless. He either didn’t know how his patients had done over the course of therapy (which is very unlikely) or they were not doing well-despite having HIV "viral loads" of zero. During this revealing silence the lecture was ended by the announcement of a coffee break. I left with one of my curiosities satisfied: the press accounts of miracles attributed to cocktail therapy-the fabled "Lazarus effect"-weren’t showing up in scientific studies.

HAART Chart
The scoop on how many antiretorviral takers suffer side effects
compiled by Linda Grinberg and Tim Horn
POZ May 1999

ADVERSE DRUG REACTIONS
Adverse drug reactions (ADRs) are the 4th leading cause of death in the USA, according to a recent study (JAMA 1998; 279: 1200-05). Not only that, ADRs mimic the symptoms of many diseases making them a serious concern for people taking or considering taking "anti- HIV" drugs.


NOTE: Claims of victory for protease inhibitors are based entirely on changes in surrogate markers*, laboratory measurements of unsubstantiated accuracy and value in assessing actual health. In the only published report alleging higher survival rates for patients treated with protease inhibitors, the study used no unmedicated placebo controls, did not allow reporting of any recurrent AIDS-defining events except pneumonia, included no patient data, cited outcomes for less than 10% of overall participants, and was prematurely terminated after an average follow-up of 38 weeks when emerging mortality statistics favored the protease inhibitor treated patients(1). The survival outcomes between the two groups-1.4% mortality among those on the new drugs, 3.1% for the old drugs-have no statistical significance, a fact that forces the drug advertisements to admit "because the study was ended early, there was insufficient data to determine the statistical impact of Crixivan on survival(2)."(3)

* Surrogate Marker: A laboratory test result that takes the place of or substitutes for a clinical indication or diagnosis.
(1) New England Journal of Medicine 1997, 337: 725-733.
(2) Merck ad for Crixivan A&U magazine July 1999
(3) Paragraph except from: from: What if everything you thought about AIDS was wrong? by Christine Maggiore


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