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Durban Declaration Rebuttal

Commentary

Though HIV is the main cause of AIDS, other factors play a role

Sir ­ Although I entirely endorse the stand taken by the authors of the Durban Declaration¹, I think that HIV is the principal, rather than the sole, initiating factor of the current world pandemic of AIDS. I believe this for the following reasons.

First, from my experience of secondary or acquired immune deficiency in treated lymphoma patients who are HIV negative and in patients who have chronic graft- versus-host disease after a transplant, HIV is not the only mechanism for adults developing the clinical syndrome. Second, external influences such as immune stimuli can modify progression, as demonstrated when haemophiliacs given recombinant factor VIII have a slower loss of CD4 lymphocytes than those who receive immunogenic serum protein containing factor VIII concentrates². Third, poor nutritional status identified on the basis of low vitamin A levels is associated with increased viral shedding³. This augments HIV perinatal transmission rate in breastfeeding African women⁴ and non-breastfeeding US women⁵. Fourth, general genital hygiene⁶, underage sexual activity and circumcision⁷ all affect the risk of acquiring HIV infection.

It is appalling that, as Dorritie states in Correspondence⁸, there may be a right-wing political agenda behind the campaign claiming AIDS is not caused by HIV. Nevertheless, other social factors are involved in the African aspects of this epidemic, such as Johannesburg's high incidence of rape, the myth that raping a virgin can cure AIDS, and the high level of non-HIV sexually transmitted diseases in sub-Saharan Africa⁹.

As a consequence, there are benefits to be gained from President Mbeki's call for scientists to address the nature of AIDS and its links to HIV in an African setting. Such an investigation could well conclude that investments such as educating young men in the basics of sexual hygiene, providing nutritional supplements for pregnant women and treating mastitis¹⁰ might produce greater gains than spending money on antenatal treatment with antiretroviral drugs.

R. T. D. Oliver
Department of Medical Oncology, Saint Bartholomew's Hospital, London EC1A 7BE, UK

References
1. Nature 406, 15-16 (2000).
2. Hoot, K.& Canty, D. Haemophilia 4, 704-713 (1998).
3. Mostad, S. B. et al. Lancet 350, 922-927 (1997).
4. Semba, R. D. et al. Lancet 343, 1593-1597 (1994).
5. Greenberg, B. L. et al. AIDS 11, 325-333 (1997).
6. Beral, V. et al. Lancet 339, 632-635 (1992).
7. Halperin, D. T.& Bailey, R. C. Lancet 354, 1813-1815 (1999).
8. Dorritie, D. Nature 406, 13 (2000).
9. Gerbase, A. C. et al. Lancet 351, 2-4 (1998).
10. Semba, R. D. et al. J. Infect. Dis. 180, 93-98 (1999).

Nature © Macmillan Publishers Ltd 2000 Registered No. 785998 England.

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