Proof Positive

How African Science Has Demonstrated That HIV Causes AIDS

On the wall of Jane's apartment, just above a gilt legend that reads, "Thinking of you," is a photograph of her youngest son. Daniel had always been a sickly child, but only when he lay in a hospital bed with both kidneys failing was he tested for HIV. That's when doctors tested Jane, but the fact that she was also infected barely registered. "All my heart was on my boy," she recalls.

But after Daniel died, Jane's medical records show that she suffered from Kaposi's sarcoma, tuberculosis of the lymph nodes, and painful fungal infections that failed to respond to treatment. One bacterial infection caused an abscess in her thigh, and another infected her blood. Jane felt so tired that she couldn't climb the three flights of stairs to her apartment without stopping to rest several times.

"I called in her brothers," says her doctor, Peter Mugyenyi, "and I told them, 'Look, your sister is going to die unless you mobilize money' " to pay for anti-HIV drugs. They did, and she began taking a cocktail of three drugs on September 3, 1999. "By two weeks," says Jane, "I was able to walk up the stairs without stopping." Now, even her KS lesions have vanished and she is worried about gaining weight, not losing it.

The AIDS dissidents claim that HIV drugs actually cause AIDS diseases—an absurd notion for Africa, where only a tiny sliver of patients can muster the money to pay for the drugs. Still, Geshekter and Rasnick wrote to Mbeki, "The only blessing of poverty is that it may protect poor Africans from the highly toxic anti-HIV drugs that have already killed thousands, perhaps tens of thousands of Americans." In line with such thinking, Mbeki has questioned whether AZT is too toxic to administer.

What's more, his spokesperson, Parks Mankahlana, declared that whether HIV causes AIDS remains an open question "because there's no doctor that injects a human being that has got HIV/AIDS and that person gets healthy in two or three days' time." That's true, but medical science has come closer to curing AIDS than any other viral disease. The drugs do not eradicate HIV from the body; they only suppress it. But once they became available, clinics all over the developed world recorded sharp reductions in disease and death among people with HIV.

If AIDS in Africa were merely misdiagnosed old diseases, then the anti-HIV drugs should have no effect or, as the deniers claim, a harmful one. But Jane's recovery is typical of African AIDS patients lucky enough to afford the expensive therapies.

Mugyenyi, Jane's doctor, runs the Joint Clinical Research Centre, the main site for a special program that offers the HIV drugs at a discount. Still, they remain so costly that most of Mugyenyi's patients wait until they are very sick before starting therapy.

By carefully tracking his patients, Mugyenyi has demonstrated that those like Jane who can afford the recommended three drugs do better than those who can pay for only two. And, says Mugyenyi, the contrast with those who cannot afford any drugs—or who exhaust their resources and must stop the medication—is sharp: Those off therapy almost always sicken and die, while those on the drugs usually get better.

But Mugyenyi is going further. He is in the process of measuring how effectively the drugs suppress the amount of HIV in a patient's blood and then "correlating that with clinical improvement." In other words, he is gathering the evidence to show that the better the drugs suppress HIV, the better the patient does. "We are demonstrating that here," he says, "in Africa."

Research interns: Carl Bialik and Elinore Longobardi

Testing the Test

Sixteen nations, all in sub-Saharan Africa, have at least a tenth of their adults infected with HIV, according to United Nations figures announced last week. But according to AIDS dissidents, those figures are "meaningless" and no cause for alarm because the HIV antibody test is unreliable.

They point out that other microbes and conditions such as pregnancy can create false positive results. And they note that in some African countries, national surveillance is conducted with just one type of test.

What they fail to mention are the quality-control measures African countries have put in place. In South Africa, for example, the testers get tested with blood sent by a central lab, and in Uganda, the national surveillance team confirms every positive result with a different type of test. Using these and other measures, both countries have found that the antibody tests are accurate more than 98 percent of the time.

These days, there are many kinds of tests, some of which look for material from the virus itself rather than antibodies. For more than 12 years, Ugandan researcher Benon Biryahwaho has helped analyze the tests to make sure they are accurate in his country. "By combining different methods and processes," he explains, "we narrow the window for error." —M.S.

Inside the South African Government's Controversial AIDS Panel

AIDS: The Agony of Africa
The Pulitzer Prize-Winning Series by Mark Schoofs

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