PRESIDENTIAL
AIDS ADVISORY PANEL REPORT



A synthesis report of the deliberations by the panel of experts
invited by the President of the Republic of South Africa,
the Honourable Mr Thabo Mbeki


March 2001

This document is also available in zipped MS Word and zipped PDF formats

 

Contents

Acknowledgements
Abbreviations

CHAPTER 1 – SETTING THE SCENE

1.1 Background
1.2 Composition of the Presidential AIDS Advisory Panel
1.3 Terms of reference for the Presidential AIDS Advisory Panel
1.4 The report

CHAPTER 2 - AETIOLOGY AND TRANSMISSION OF AIDS

2.1 Introduction
2.2 Does HIV cause AIDS?

2.2.1 Visualisation and Isolation of the Virus
2.2.2 PCR (Polymerase Chain Reaction) and ELISAs
2.2.3 Clinical and Laboratory Evidence of Causation
2.2.4 Evidence from Animal Models
2.2.5 Epidemiological Evidence

2.3 Alternative hypothesis on the cause of AIDS

2.3.1 The Chemical AIDS Hypothesis
2.3.2 The Immunotoxicological Hypothesis
2.3.3 The Oxidation Hypothesis

2.4 The involvement of cofactors (or risk factors) in AIDS

2.4.1 Involvement of cofactors in HIV-causes-AIDS Hypothesis
2.4.2 Risk factors that are the primary cause of AIDS according to alternative hypotheses/theories

2.5 Transmission of HIV and AIDS

2.5.1 HIV Transmission as Estimated from ‘AIDS Deaths’
2.5.2 Sexual Transmission
2.5.3 Mother-to-Child Transmission
2.5.4 Blood-borne transmission and Occupational Exposure
2.5.5 Epidemiology of Transmission

CHAPTER 3 – SURVEILLANCE

3.1 What are the questions and issues?
3.2 Overview on the necessity for surveillance
3.3 South African epidemic – Fact or fiction

3.3.1 AIDS mortality

3.4 Epidemiological Theory of Causal Inference
3.5 Socio-economic risk factors
3.6 Differences in the African epidemic, compared with Europe and the USA
3.7 The role of mathematical models in forecasting the epidemic
3.8 Surveillance recommendations – what should be done about the South African epidemic?

3.8.1 Deliberations of the panel

Recommendation

3.8.2 Discussion on mortality data

Recommendation

3.8.3 Recommendations from panellists who do not subscribe to the causal linkage between HIV and AIDS
3.8.4 Recommendations from panellists who subscribe to HIV as the cause of AIDS
3.8.5 General recommendation 472.5.5 Epidemiology of Transmission

CHAPTER 4 – HIV TESTS AND THEIR ACCURACY

4.1 HIV testing

4.1.1 ELISA test
4.1.2 Western Blot
4.1.3 PCR test for viral load
4.1.4 CD4 count

4.2 Virus isolation or co-culturing
4.3 Moratorium on HIV testing
4.4 Recommendations on HIV testing

4.4.1 Proposed studies and experiments
4.4.2 Recommendation on future HIV testing
4.4.3 General recommendations on testing

CHAPTER 5 – THE TREATMENT OF AIDS AND THE USE OF ANTI-RETROVIRAL DRUGS

5.1 Introduction
5.2 Evidence in support of the use of anti-retroviral drugs
5.3 Evidence against the use of anti-retroviral drugs
5.4 Recommendations on treatment with anti-retroviral drug

5.4.1 Recommendations on the use of anti-retroviral drugs from the group opposed to their use
5.4.2 Recommendations from the proponents of anti-retroviral drug use

Recommendations:

CHAPTER 6 - PREVENTIVE AND PROPHYLACTIC MEASURES AGAINST AIDS

6.1 Prevention of AIDS from the point of view of panellists who do not support the causal link between HIV and AIDS

6.1.1 Recommendations

6.2 Prevention of AIDS from the point of view of panellists who support the causal link of HIV to AIDS

6.2.1 General recommendations
6.2.2 Recommendations on prevention of HIV/AIDS through sexual transmission
6.2.3 Recommendations on prevention of blood-borne transmission of HIV/AIDS
6.2.4 Recommendations on prevention of mother-to-child transmission of HIV

6.3 Prophylaxis against opportunistic infections

6.3.1 Introduction
6.3.2 Opportunistic infections

CHAPTER 7 – Socio--economic factors in the context of HIV/AIDS

7.1 Malnutrition and sanitation
7.2 Orphans
7.3 Ethics and human rights

7.3.1 Ethics
7.3.2 Human rights

7.4 Sexual behaviour

7.4.1 Rape
7.4.2 Stigmatisation
7.4.3 Promiscuity
7.4.4 Condom use
7.4.5 Issues of economics

7.5 Vaccine development
7.6 Summary and recommendations

CHAPTER 8 - RECOMMENDATIONS

8.1 Introduction
8.2 Recommendations on surveillance – what should be done about the South African epidemic?

8.2.1 Deliberations of the panel

Recommendation

8.2.2 Discussions on mortality data

Recommendation

8.2.3 Recommendations from panellists who do not subscribe to the causal linkage between HIV and AIDS
8.2.4 Recommendations from panellists who subscribe to HIV as the cause of AIDS
8.2.5 General recommendation

8.3 Recommendations on HIV Testing

8.3.1 Proposed studies and experiments
8.3.2 Recommendation on future HIV testing
8.3.3 General recommendations on testing

8.4 Recommendations on treatment of AIDS with anti-retroviral drug

8.4.1 Recommendations on the use of anti-retroviral drugs for the treatment of AIDS from the panellists opposed the causal link between HIV and AIDS
8.4.2 Recommendations on the treatment of AIDS from the proponents of anti-retroviral drug use

8.5 Recommendations on prevention of AIDS

8.5.1 Recommendations on prevention of AIDS from the point of view of panellists who do not support the causal link between HIV and AIDS
8.5.2 Recommendations on prevention of AIDS from the point of view of panellists who support the causal link of HIV to AIDS

8.6 Recommendations on socio-economic factors that impact on AIDS

CHAPTER 9 - PROPOSED RESEARCH PROJECTS AND STUDIES

9.1 General recommendations on research
9.2 Proposal 1: Quality assessment of HIV testing: Establishing a Baseline and validating HIV ELISA testing in South Africa.

9.2.1 Rationale
9.2.2 Establishing a Baseline: Quality Assessment of HIV Testing of five independent sites in South Africa

9.3 Proposal 2: Determination of the robustness of the current HIV ELISA tests that are being used in South Africa.

9.3.1 Purpose of experiment
9.3.2 Methodology

9.4 Proposal 3: Molecular beacons
9.5 Proposal 4: Do most people with HIV infection show signs of AIDS within five (5) to ten (10) years?
9.6 Proposal 5: Preadsorption and Virus Isolation Experiments - The need for a Gold Standard in the diagnosis of HIV infection.

9.6.1 Importance of the Proposed HIV Experiments
9.6.2 Principles of the Proposed Experiments

9.7 Proposal 6: Questionable African AIDS /HIV Statistics - Epidemiology
9.8 Proposal 7: Proposed investigation of the diagnosis of HIV/AIDS

9.8.1 Current procedure
9.8.2 Investigation of reliability of serological tests for HIV
9.8.3 Extensions
9.8.4 Interpretation of findings

9.9 Proposal 8: Study to find out the real meaning of HIV Tests
9.10 Proposal 9: To test the reliability of one of the main laboratory methods currently used to quantify HIV in the blood of seropositive individuals - using the Electron Microscope.

9.10.1 Aim of the experiments.
9.10.2 Materials and Methods
9.10.3 Technical assistance needed:

9.11 Proposal 10: To determine which is more harmful - HIV or Anti HIV drugs?

CHAPTER 10 - CONCLUSION

Appendix 1

Internet discussion of the PRESIDENTIAL AIDS REVIEW PANEL

Appendix 2

Data on adult mortality presented by Dr MW Makgoba at the second meeting

Appendix 3

STATS SA response to the Medical Research Council's interpretation of deaths

Appendix 4

STATS SA rejoinder to the MRC's response

Footnotes