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The Reality of AIDS

A Strange Virus of Unknown Origin

by Dr. Jacques Liebowitch, translated from French by Richard Howard, with an introduction by Dr. Robert Gallo
Ballantine, 172 pp., $4.95 (paper)

Medical, Social, and Political Aspects of the AIDS Crisis: A Bibliography

compiled by D.W. McLeod, by Alan V. Miller
Canadian Gay Archives, Publication Number 10

Review of the Public Health Service’s Response to AIDS: A Technical Memorandum, February 1985

Congress of the United States, Office of Technology Assessment
US Government Printing Office, 158 pp., $5.50

AIDS: The Emerging Ethical Dilemmas

Hastings Center Report
Vol. 15, No. 4 (Special Supplement) pp.

Understanding AIDS: A Comprehensive Guide

edited by Victor Gong, foreword by F. Mervyn Silverman
Rutgers University Press, 240 pp., $9.95 (paper)

1.

AIDS has become one of the most discussed subjects in the US, yet some of its most important characteristics are not understood. From the beginning it was thought of as a homosexual’s disease, created by “promiscuity.” When a virus, HTLV-3, was found in the blood of most persons with AIDS, it was held that the virus was “the cause of AIDS.” It was also held to be the cause of the milder form of the illness known as AIDS-related complex (ARC)—a group of symptoms including swollen lymph glands in several parts of the body, night sweating, substantial weight loss, and recurrent diarrhea. All along, AIDS has been thought of as a sexually transmitted or venereal disease that is generally fatal. All of these claims, which have contributed greatly to fear of the disease, are false or misleading.

The virus is a strain of “human T-lymphotropic virus” (HTLV), which has a predilection or affinity for human T-cells—a kind of white blood cell or lymphocyte that circulates in the blood and in some bodily secretions like sperm. T-cells (named for their close association with the thymus gland, which determines their specific functions) help the immune system to limit the increase of microbes that live in the body and to fight off infectious agents. They can do so because they have acquired the capacity to recognize differences between foreign cells and those native to the body, and are able, in encountering a foreign cell, to release chemical messengers that alert other parts of the immune system.1

The “AIDS virus” cannot multiply unless it inhabits T-cells. Once it does so, it can incorporate itself into the T-cell’s genetic machinery and then subvert it by instructing the cell to reproduce it rather than the T-cells. It is able to replicate itself in this way at a very quick speed—at a rate between one hundred and one thousand times the rate of uninfected cells. As more and more of the body’s T-cells are destroyed in this way, the immune system as a whole begins to collapse. The “AIDS virus” is called “HTLV-3” because it is a mutant of another human T-cell lymphotropic virus, HTLV-1, which causes leukemia by transforming T-cells and causing them to multiply excessively. HTLV-3 probably comes from central Africa and resembles a virus that is found in Old World monkeys. It is thought by some that Haitians working in Zaire in the 1960s and 1970s brought it to Haiti, where it was picked up by vacationing American homosexuals.

There is good reason to suppose that HTLV-3 is a sine qua non of AIDS. It has been found in nearly all AIDS and ARC patients but in fewer than 1 percent of those who do not have AIDS and who are not likely to contract it. Scientists at Harvard University have succeeded in infecting monkeys with an illness very similar to AIDS by injecting a close relative of the virus into them.

Infection by HTLV-3 must be distinguished from AIDS, however, and cannot be said without qualification to be “the cause” of AIDS. Surveys of the prevalence of the virus—estimated by researchers at the Centers for Disease Control (CDC) to have infected some 750,000 to 1.5 million people in the US—show that only about 1 or 2 percent of those infected by it have AIDS, by now some 15,000 people, while perhaps ten times that number have the milder symptoms of ARC.2 AIDS is not a disease itself but the most advanced and serious result of infection. It is a group of symptoms that suggests a collapse of the immune system—a collapse that is often fatal because the body no longer resists many diseases that it would otherwise fend off, such as pneumonia or cancer, including the usually rare cancer called Kaposi’s sarcoma. (By the time such diseases become fatal, the incidence of the HTLV-3 virus in the body may have declined because the vast majority of T-cells the virus has infected have been weakened or destroyed by it.)

Just as only a small percentage of those infected by hepatitis B come down with cirrhosis, so what is often miscalled AIDS—simple infection by HTLV-3—is almost never fatal, as Dr. Jacques Leibowitch says in his often useful book, A Strange Virus of Unknown Origin. He writes: “Possibly less than ten percent of those carrying the virus will ever experience any symptoms at all.” In fact, infection by the virus alone is very likely insufficient to cause AIDS; some other “cause” is probably necessary for development of AIDS or ARC. For HTLV-3 to do damage, it must replicate itself inside T-cells when they are active or stimulated; since T-cells are used to fight off infections, a plausible hypothesis is that someone whose body is already fighting off serious infections is more likely to develop a bad case of HTLV-3 infection than someone who is not.

The suggestion that AIDS develops chiefly in those whose immune systems are already weak or defective (whether through previous illness, poor environment, or congenital deficiency) seems to explain why the disease has struck: children, hemophiliacs, habitual intravenous drug users, Africans, and Haitians, who have frequent and viral infections such as hookworm, malaria, sleeping sickness, and schistosomiasis. Homosexual men, who have always represented the majority of cases in the United States of those with AIDS, were also frequently infected by sexually transmitted diseases like syphihs, gonorrhea, herpes, and by parasites like amebiasis; some of them were nearly constantly infected by one or more such diseases. In addition, many of these same men used drugs such as amphetamines and barbiturates, LSD, heroin, and cocaine, sometimes intravenously. Many of them also used amyl nitrites or “poppers,” which cause intoxication and prolong sensations of orgasm; a recent study at the National Jewish Center for Immunology and Respiratory Medicine determined that use of poppers can impair the ability of the body to fight off infections, and that when used in anal intercourse can dilate the blood vessels of the rectum and improve absorption of the virus into the body.

Many of the homosexuals with AIDS were “promiscuous”; but it was not the promiscuity per se that “caused” AIDS. It was the fact that it made possible a greater exposure to diseases that in turn helped to set the stage for AIDS. The association of AIDS with promiscuous (and, to judge from many press reports, white and middle-class) homosexuals has had to give way to a different picture: it is estimated that fully 40 percent of American cases are black and Hispanic, many of them heterosexual. And because the CDC has classified homosexuals who take intravenous drugs as homosexual rather than putting them in the category of intravenous drug user, the number of cases contracted through needles has been insufficiently recognized. In some places, especially poor sections of large cities, IV drug users account for almost as large a proportion of AIDS cases as homosexuals.

It may be inappropriate to call HTLV-3 infection a “venereal disease” like gonorrhea. It seems to be more an infection of the blood, communicated by the mixing of infected blood with other blood, or of blood with body secretions such as sperm that contain large numbers of infected lymphocytes. For infection to occur, as Dr. Leibowitch notes, it appears that there must be contact between the infected lymphocytes of the donor and the lymphocytes of the recipient.3 As such, the virus is communicated most efficiently by direct transfusion into the bloodstream of a healthy person. This is why it can occur in blood transfusions or when tiny amounts of blood with HTLV-3 infect intravenous drug users whose needles have been previously used by those carrying the virus. Although the infection is not best interpreted as a sex disease; the virus can be spread when semen mixes with blood. For example, when ejaculated sperm is deposited on rectal tissue that has been bruised or broken by anal intercourse, a kind of transfusion of the virus directly into the bloodstream of the recipient partner occurs.

If AIDS is to be passed on in vaginal intercourse, mixing of blood or contact between sperm and blood must take place, and this is unusual. Thus far almost no evidence exists of female to male transmissions.4 Since HTLV-3 has not been found in vaginal excretions, for such transmission to occur would require either that the female were menstruating or that a tear occurred both in the vaginal wall and the penis so that blood could be passed. Dr. Stephen Schultz, assistant commissioner of health in New York City, told me that there is little reason to suppose that this happens with any appreciable frequency; the fear that prostitutes are “spreading AIDS” is therefore unproven, according to him, although some prostitutes carry HTLV-3 because they have many sex partners and are sometimes IV drug abusers. And male prostitutes may be spreading the virus on a much larger scale.

On the other hand, Schultz said that male to female transmission is “established” and is largely responsible for the growing number of children with AIDS. Such infection could occur during sexual intercourse when women are menstruating or through a tear in the vaginal wall, or through a tear in the rectal mucous membrane during anal intercourse. Although most countries in central Africa have chosen not to issue reports about the number of AIDS cases in them, and some have denied that AIDS exists within their borders out of fear of losing tourists and foreign currency, it is estimated by the director of the CDC that many millions of Africans are infected by HTLV-3 and that AIDS occurs there among men and women in nearly equal proportions. More than a year ago, a report in The Lancet (July 14, 1984) claimed that the incidence of AIDS in Kinshasa, Zaire, was very high, indeed higher than that of San Francisco or New York. That much of African AIDS is contracted by male to female transmission may be partly explained by a remark in a pamphlet on AIDS published by the New York State Department of Health which claims that anal intercourse occurs more frequently in heterosexual couples in Africa than in the United States. But it is also likely that the reuse of disposable needles is responsible for some African cases of AIDS. Cultural practices such as ritual scarification and clitoridectomy may also play a part in contributing to the spread of AIDS by causing scarring and bleading.

In any event, a heterosexual pandemic has not occurred in the United States. The proportion of those who are said to have contracted the infection through vaginal intercourse here has remained extremely small, since 1981 around 1 or 2 percent (by new some two hundred to three hundred cases) of the total number of AIDS cases; since the total number of cases has doubled in nearly each of the past few years, heterosexual cases have therefore also doubled. But according to the Center for Disease Control, the mean time it takes for the illness to manifest itself after infection is variable, sometimes as short as a year (as in the case of many children) and in other cases as long as six or more years.5 For homosexual cases, however, the average is approximately three years; and it is believed that heterosexual drug users in the US were infected by HTLV-3 around 1978, as long ago as the first homosexual cases. Therefore “there has been time enough,” in the words of the New Scientist last September, “for many more people outside the recognized risk groups to have contracted the disease during heterosexual intercourse. But they have not.”

  1. 1

    For a clearly presented guide to the immunology of AIDS, as well as many other questions about the syndrome, see the collection edited by Victor Gong.

  2. 2

    See James W. Curran, et al. (members of the AIDS Branch, Division of Viral Diseases, and the Office of the Director, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia), “The Epidemiology of AIDS: Current Status and Future Prospects,” Science (September 27, 1985), p. 1354. Estimates vary because of the difficulty of making projections on the basis of relatively small samples. Dr. Mervyn Silverman, former director of health for San Francisco, told me that only about 1 percent of those infected with HTLV-3 have clinical symptoms of AIDS. Last April, Dr. Robert Gallo, a leading researcher of AIDS, said that two million Americans were infected by HTLV-3 (the London Observer, April 7, 1985, p.1).

  3. 3

    Dr. Mathilde Krim, chairperson of the AIDS Medical Foundation in New York, writes that “it appears that, in order to infect, this virus [HTLV-3] must be virtually injected into the blood stream and then encounter cells in which it can multiply” (“AIDS: The Challenge to Science and Medicine,” Hastings Center Report, Vol. 15, No. 4, August 1985, Special Supplement, p. 4).

  4. 4

    A report in the Journal of the American Medical Association (October 18, 1985) claimed that ten men recognized as having AIDS or ARC at the Walter Reed Army Medical Center acquired their condition through heterosexual intercourse, most of them from prostitutes. But the report has been criticized, most often because the military personnel whose cases were studied would not have readily admitted homosexual conduct or drug use if they had engaged in it.

  5. 5

    Thomas A. Peterman, et. al. “Transfusion-Associated Acquired Immunodeficiency Syndrome in the United States,” Journal of the American Medical Association (November 22–29, 1985), p. 2913.

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