Prof. Marco Ruggiero
Institute of Experimental Pathology and Oncology of the University of Florence
Jacques Fernández de Santos: There has been a controversy surrounding HIV-AIDS since the beginning of the crisis in the 1980s. Why have these issues never been resolved?
Marco Ruggiero: The controversy has existed for 26 years, but controversy is common to all aspects of science. The situation is not unique to AIDS nor to medicine or to science in general. Everybody knows, and I emphasize the word everybody, which, used in this context, is almost misleading – everybody "knows" that dinosaurs became extinct because of a meteorite. What we should more accurately say is that the majority of scientists think so, but there is a minority of scientists who believe it could have been due to massive volcanic eruptions or to other biological or climatic changes. In other words, nearly every scientific theory is controversial. There is generally a predominant position which is sometimes closer to dogma than to science per se, and sometimes a minority or dissident position. AIDS is no exception. The predominant thinking is that AIDS is caused by a virus called HIV and that HIV infection inevitably leads to AIDS unless it is slowed down by antiretroviral drugs. This is the predominant opinion and many good, honest scientists and doctors believe this, but, of course, it's more than just a matter of belief. They do have documented evidence, but in science the same evidence can be interpreted differently. If the connection between HIV infection and AIDS is not a causal one, if it is not a cause and effect relationship but rather a reverse causal relationship, then what Professor Montagnier said could be interpreted to mean that immune depression leads to chronic HIV infection and not vice versa.
JFS: Is it true that certain associations and groups have accused major "dissident" scientists and retrovirologists like Peter Duesberg and Henry Bauer of homophobia?
MR: They are friends of mine and I do not believe what certain parties have said about them in this regard. I myself have been accused of being both a deluded communist and a rabid fascist. The accusers are people who are not acquainted with the matter and they seem to enjoy making accusations of homophobia, communism, or fascism, etc. My work is respected even by scientists who disagree with my theories, and I have never been criticized for the quality of the work itself. As a demonstration of this, I was very recently awarded a significant research grant by the Italian Ministry of the University and I was nominated "national coordinator" for this project. Whatever has been said about Peter Duesberg, it's quite significant that he was recently (2011) invited to present his work at a major conference on AIDS and retroviruses. The following is an excerpt of what I wrote for rethinkingaids.com in connection with the Florence Aids conference in March:
AIDS. Florence 2011, the end of dissent.
March 27–29, 2011. Florence, Italy, hosted the Italian Conference on AIDS and Retroviruses (http://www.icar2011.it/It/Home/Home.aspx), a conference held under the auspices of, among others, the Int. Aids Society (AIS) ... It is well known fact that for more than 25 years the opinions of so-called dissident scientists such as Professors Peter Duesberg and Henry Bauer were never given a forum in mainstream conferences and any voice questioning the role of HIV in causing AIDS has been systematically shut off. Associations for the scientific reappraisal of the HIV/AIDS hypothesis such as Rethinking AIDS were never allowed to participate.... This deplorable state of affairs officially came to an end in Florence with the formal and official recognition of the contributions of scientists such as Duesberg, Bauer, Fiala, Kohenlein, Rasnick, Pacini, Nicholson, Morucci, Ruggiero, Galletti, Branca, Punzi and Mandrioli, all of whom question the role of HIV in the etiology and pathogenesis of AIDS.
... For the very first time in more than 25 years, statements such as "HIV alone is not the cause of AIDS;" "There is no gold standard for HIV tests;" and "ARVs such as AZT do not cure or prevent HIV infection or AIDS" have been recognized as scientifically sound hypotheses worthy of presentation and discussion at a conference sponsored by the International AIDS Society.
Obviously, since we, the so-called dissidents, are in a minority position, you hear more from the other side. As well, since HIV is supposedly a sexually transmitted virus, the issue garners more attention than other scientific topics because it affects the lives of many more people.
JFS: Differentiating quality information from misleading information on the Internet is sometimes difficult. Websites such as "aidstruth.com" literally insult scientists and persons from various other fields who voice ideas that differ from mainstream theories about HIV and its links to AIDS. Could you comment on that?
MR: In a free world everyone has the right to say what he or she likes. I do not read it, but as far as I know aidstruth.com is not edited by medical doctors. As a medical doctor, what I can tell you is that this state of affairs is common to a variety of illnesses. For instance, let's take a skin condition such as psoriasis. It's a very common illness that has no connection with sexual activity, and today, in 2011, if you ask a dermatologist what the cause of psoriasis is, he or she will tell you that the cause is unknown. It might be an autoimmune disease or it might be a viral disease. When it comes to treating this condition you will find physicians that do nothing to treat it, others that simply recommend certain types of soap or ointment, and still others that treat it with chemotherapy. There is proper scientific evidence to justify all of these treatments, yet there is no controversy and there is no "psoriasistruth.com." A patient can become confused because one physician will prescribe a heavy treatment, while another will tell the patients that there is no cure and that he or she simply has to live with the psoriasis. And both physicians are acting in good faith. The same applies to HIV and AIDS, or more aptly put, to HIV rather than AIDS. AIDS exists – it is an immunodeficiency syndrome and it must be cured. Once AIDS has been diagnosed, the question arises of what is the most appropriate cure. Once again, this is common to every disease as there is no single cure for any given pathology. And this is all the more true for conditions such as psoriasis and AIDS, neither of which has a clear etiology (cause). Last year (summer 2010) I attended both the mainstream and dissident AIDS conference in Vienna. At the mainstream conference, many presentations closed with the words "there are questions on HIV pathogenesis." So even mainstream scientists agree that there is still something left to discover about the cause of AIDS. Nevertheless, when Peter Duesberg says such things, he is considered a heretic since he is a dissident. When a mainstream scientist, however, says the same thing he is perceived as making a valid contribution.
JFS: What is your view of Luc Montagnier's 2009 reassertions that, since the early 1990s, he has believed that "cofactors are necessary for AIDS to develop," and how do you feel about his most recent statement that "a body with a good immune system can rid itself of the virus in a few weeks"?
MR: You should ask him personally, but in my opinion what he's saying is perfectly obvious. The point is – and this is well known – that HIV infection does not lead immediately to AIDS. It may take years and AIDS may never develop at all. There are people who never develop AIDS called LTNPs (long term nonprogressors). What we must try to understand is why some people who are HIV positive develop AIDS in a relatively short period of time while others never develop AIDS. We have known this for more than 20 years. Of course, if you have a good immune system, the probability of developing AIDS is greatly diminished. On the other hand, if you have an immune deficiency problem, for whatever reason, because of drug abuse, for example, or for any other reason – most of the time the reason is simply unknown – the probability of developing AIDS is higher. Therefore, we can take Professor Montagnier's words to mean that, no matter what the cause of AIDS, if you reinforce the immune system, the probability of developing AIDS diminishes. He goes even further and says that if you have a good immune system, you can get rid of the virus. The fact is that if you take an HIV-positive patient and you do not give him or her any antiretroviral drugs and instead you give them factors that stimulate their immune system, the virus disappears from their bodies. Experiments such as these confirm what Professor Montagnier is saying. Nevertheless, HIV eradication via antiretroviral drugs is the most common approach.
JFS: What precisely do you mean when you talk about eradicating the HIV?
MR: There is a very common technique called PCR (polymerase chain reaction) that determines viral load; in other words, the presumed amount of the virus in your body. If you take antiretroviral drugs and you respond well to those drugs, the viral load goes to 0. This is eradication of the virus from your body via antiretroviral drugs. Otherwise, if you do not take antiretroviral drugs, according to the orthodox theory, the virus will multiply and remain in the body. Instead of antiretroviral drugs, however, one can take certain immune system stimulators such as GcMAF (Gc macrophage activating factor), which have nothing to do with the virus itself. GcMAF simply stimulates macrophage cells, which are potent immune cells, and one observes that the viral load goes to 0 in this case as well. That fact confirms that it is the immune system that gets rid of the virus and not the drug itself. And it's the experiment that proves what Professor Montagnier is saying: if you have a good immune system, you get rid of the virus. It's a different therapeutic approach to AIDS. The point is that if you firmly believe that HIV alone is the cause of AIDS, you will prescribe antiretroviral drugs instead of prescribing immune therapy to stimulate the immune system. To further explain, the orthodox theory says that HIV kills the immune system and is the sole cause of AIDS. In other words, even if you reinforce the immune system but you do not kill the HIV, the HIV will keep on killing the immune system. Therefore if you strictly adhere to the orthodox theory, you only have one option, killing the virus. On the other hand, if you don't subscribe to the orthodoxy, you may think that the virus and the immune deficiency problem are merely connected in some way but are not part of a cause and effect relationship and that some sort of immune deficiency is allowing the virus to survive. In that case, you may feel free to take a different approach. You do not focus on the virus, but rather you focus on reinforcing the immune system in the hope that the immune system will take care of the virus. Various experiments have proved this to be true but, obviously, in order to feel free to take this approach you have to reject the dogma.
JFS: In Spain there have been announcements of precisely that nature, announcements of a sort of "therapeutic vaccine" based on dendritic cells. When one considers your approach and the "therapeutic vaccine" approach, one wonders if we might be in the midst of a major change, albeit little by little, in our approach to HIV-AIDS. Is that a correct perception?
MR: Yes, that's correct. The problem is that you can make announcements like this as long as you're not Peter Duesberg, since he has been ostracized from many of the official forums where this discussion is taking place. The people you refer to are smart in not calling themselves dissidents. They speak in terms of a "different approach" rather than a "dissident approach."
JFS: It definitely looks as though attitudes toward alternative approaches to understanding HIV and to treating AIDS, whatever the causes, are evolving.
MR: Absolutely. But if it weren't for Peter Duesberg, who fought the mainstream position alone for more than 25 years, maybe all of these new approaches would never have been developed or would have taken much longer. In any case, these different approaches, either via dendritic cells or GcMAF, which by the way have much in common, may soon offer an alternative cure for AIDS. This would mean that we could use not only antiretroviral drugs but also other methods designed to boost the immune system. Although many scientists will never accept or acknowledge this, such methods would prove that HIV is not the cause of AIDS. But the important thing is that, hopefully, patients may soon be freed from ARV drugs and their heavy side effects.
JFS: Coming back to Professor Montagnier. When he talks about cofactors needed to develop AIDS, how do you interpret that?
MR: Professor Montagnier obviously is an extremely smart scientist and knows that a cofactor can be weighted 0.1 % or 99.9% and still be a cofactor. But nobody knows what these cofactors really are. Let's take cancer as example, since we are here in a department of experimental oncology. If I ask you, a layperson, what the cause of lung cancer is, what would you answer?
MR: Tobacco smoking, of course. In Italy, and I think the figure is similar in Spain, approximately 26,000 people die of lung cancer every year. Of those 26,000 people there are some 4000 – which is a very high number – who never smoked, never belonged to a risk group of passive smokers, and never lived in polluted industrial areas. Nobody knows why they develop cancer. Tuscany has a population of 4 million and the mortality due to diagnosed AIDS is around 2 persons per year, which in statistical terms is basically zero. In sum, we have 2 deaths per year from AIDS in Tuscany and 4000 deaths from lung cancer in nonsmokers in Italy and the only answer is: cancer happens and immunodeficiency happens. Therefore, with our current state of knowledge, the so-called cofactors are very difficult to assess. As a theoretical scientist I am interested in the cause of cancer and of AIDS, but as a physician I am interested in curing the disease and am less concerned about the cause. If immunotherapy approaches to AIDS gains ground, more and more physicians will turn to these options for treating AIDS. The success of these treatments will, incidentally, demonstrate that HIV – let's put it in politically correct terms – is not always the only cause of AIDS. Just like smoking is not always the only cause of lung cancer.
JFS: Regarding HIV in particular, what is your personal view? Is HIV not always the only cause of AIDS or is not the cause of AIDS at all?
MR: I personally believe that there is a close connection between HIV and AIDS. But the word connection does not imply a proven cause-and-effect relationship.
JFS: Which means that, at the end of the day, one must demonstrate the cause and effect relationship between what one claims is the cause and what one claims is the effect.
MR: Let's go back to lung cancer because it's a good example and I have been studying it for many years. Say you have 1000 heavy smokers; 250 of them will die of lung cancer. Therefore, what's the logical conclusion? The majority of heavy smokers will not die of lung cancer. That is the truth. Does it contradict the statement that smoking causes lung cancer? It is up to you. In sum we have three statements and the three of them are true. First, smoking causes lung cancer. Second, 4000 people die every year in Italy of lung cancer and they were not smokers nor did they belong to any risk group. Third, of 1000 heavy smokers, a minority, 250, will die of lung cancer. All of these three statements are true and are documented. The same logic applies to HIV and AIDS. AIDS is associated most of the time, but not always, with HIV – then it also becomes a matter of how you define AIDS. If you call the disease AIDS only when it is associated with HIV, then of course you will have a 100% connection. But, the fact is that you can have AIDS in the absence of HIV. Even Italian law allows for the possibility of having AIDS in the absence of HIV. The law was enacted in 1994 and is regularly updated. For argument's sake, let's suppose that all AIDS patients do have HIV infection, keeping in mind that you can only be officially diagnosed with AIDS if you have an opportunistic disease plus HIV infection; otherwise, it is simply tuberculosis or pneumonia, etc. On the other hand, we know for a fact that the majority of HIV infected people will never develop AIDS. These two statements are as true as the statements concerning lung cancer. There is no contradiction. You can interpret those numbers or statements in both ways and both interpretations are correct. If you are an orthodox scientist, you might say that among the many people who have HIV, only a minority of them will develop AIDS, perhaps due to certain cofactors or other reasons, or simply because it takes time to develop AIDS. If you are a dissident you might say that because a majority of HIV-infected people will never develop AIDS, this fact indicates that HIV is not the cause of AIDS and that there may be other cofactors that act as a catalyst for developing AIDS. Thus, it is just a matter of weighing those cofactors. For dogmatists, the HIV cofactor is weighted at 99.9% and for the dissidents it is weighted much less. If you are a dogmatist you cannot consider other options because you are solely focused on HIV as the only cause of AIDS.
JFS: Do you mean that we are too focused on "killing the supposed killer" instead of reinforcing the system so that it can "kill the killer"?
MR: In a certain way, yes. It's as if an oncologist only focused on the cigarettes and not on the tumor itself. And this is the major limitation of being a dogmatist, since it prevents you from focusing on what the real problem is. It is an immune deficiency and the immune system is extremely complex. We can try to restore it by activating macrophages, using interleukins, using a dendritic "therapeutic vaccine," or taking still another approach.
JFS: You say that most HIV-positive people will not develop AIDS. If that's the case, what caused the deaths of so many people in the 1980s and 1990s who were diagnosed HIV-positive in Europe, North America, and Africa? Africa it is another story, but the reality is that most of deaths in Europe and North America were among homosexuals and drug users.
MR: It's difficult to document. Drug abuse is easier to understand as a cause. Drugs are potent immune depressors and street drugs even more because they are impure. With regard to homosexuals, some of the regular practices in their community are potentially quite harmful. Most homosexuals who have a healthy life style are not in a risk group. Only homosexuals who have a particular lifestyle and use multiple drugs such as nitrates (poppers) or have an extraordinarily high number of partners and use other drugs associated with sexual activity are in a risk group. The point is not homosexuality but drug use. As well, there were other substances taken by a minority of homosexuals, mostly in the 1980s, which are not classified as illegal drugs but can be very harmful, such as huge amounts of antibiotics to avoid STDs. Large amounts of antibiotics will destroy intestinal bacteria, and we all know that intestinal bacteria are key for the proper functioning of the immune system. Every day, there is new evidence to support this idea. If someone takes antibiotics for years and years, thereby destroying his intestinal bacteria, he cannot expect his immune system to work properly. Another habit practiced by some homosexuals, which is also very harmful when practiced regularly, is enemas or rectal douching, which also destroys the beneficial microbes in the intestines. There is profuse medical literature on this subject. For instance, Professor Bauer published a post on his blog in mid-2011 which basically explains that the key aspects of the intestinal dysbiosis theory have been confirmed. I will summarize it briefly:
AIDS originally manifested with three diseases: candidiasis (thrush; yeast infections), Pneumocystis carinii pneumonia (PCP), and Kaposi's sarcoma (KS). Given that many KS patients are HIV-negative, it has been acknowledged for many years now, even by the HIV-AIDS mainstream, that Kaposi's sarcoma is not caused by HIV and is linked to other factors such as the use of nitrite poppers. As well, KS is known to be extremely rare outside the gay community. As for PCP, at first it was not recognized that PCP, like candidiasis, is a fungal infection. (The disease has been renamed Pneumocystis jiroveci, but I shall continue to use "PCP" since that name is still widely used and recognized). An adequate explanation for the outbreak of AIDS in the early 1980s is the "fast-lane" lifestyle of a small proportion of gay men following the "gay liberation" movement of the '70s. These small proportions of gay men were sleeping little and partying a great deal, spreading common sexually transmitted diseases, treating those frequent infections with lots of antibiotics, even carelessly and erroneously consuming antibiotics as preventive treatments. But why specifically yeast and PCP? Why specifically fungal diseases?
In conjunction with the hypothesis on intestinal dysbiosis, some researchers like Tony Lance pointed out that certain aspects of and practices associated with the fast-lane gay lifestyle seem almost as if they were designed to damage the intestinal microflora that constitute the immune system's first line of defense, a defense that acts particularly to hold in check fungal organisms that are everywhere. The notion that HIV causes AIDS is disproved by many types of evidence. But that still leaves a conundrum: Why do gay men even nowadays so often test "HIV-positive"? Even gay men who remain in good health for decades without antiretroviral treatment? Lance suggested that the damage to gut microflora would allow translocation from the gut to the blood of a variety of substances that might cause reactions that could manifest as responding positive on "HIV" tests. That suggestion has been confirmed in recent years, as a significant number of mainstream articles have acknowledged the important role that gut microflora play in the immune system and that damage to this mucosal immune system allows translocation and "immune activation" – the latest vague term that substitutes for a specific mechanism by which "HIV" supposedly causes damage.
Therefore, the reestablishment of healthy gut microflora can lead to an apparent defeat of "HIV infection" – via an increased CD4 count. It has now been found that probiotic treatments that help healthy gut microflora reestablish itself lead to higher, and sometimes dramatically higher, increases in CD4 counts and to a decrease in immune activation. In other words, to controlling "HIV infection" without recourse to antiretroviral drugs.
JFS: As intestinal dysbiosis can be related to certain types of anal sex, to what extent is anal sex an issue?
MR: Anal sex in itself is not the problem. The problem is rectal douching to clean the rectum and the colon, which destroys bacteria that are highly beneficial. Therefore, if, via rectal douching, you regularly get rid of this bacteria for years and years, if you constantly take drugs such as nitrates (poppers) and others, and you constantly take large amounts of antibiotics, you can't expect to have an immune system that works properly whether you are HIV positive or not. Again, the issue is not homosexuality but drugs (legal; i.e., antibiotics; or illegal). On the other hand, you have a significant percentage of AIDS patients who are not male homosexuals, never took drugs, never had a "fast-lane" lifestyle and yet they still develop immune deficiency and, incidentally, are also HIV positive. How do you explain that? You might explain it in the same way I explained the deaths of the 4000 nonsmokers who die of lung cancer every year: We do not know.
JFS: What do you have to say about the news published in PubMed/Lancet 2006? "Virological response after starting HAART (antiretroviral treatment) improved over a number of years, but such improvement has not translated into a decrease in mortality."
MR: I believe that the paper you are referring to states that AIDS mortality was the same after 10 years of HAART therapy. And Lancet is not the only respected publication where such doubts are raised. If you go to the website of the US Department of Health you will see this sentence at the end of every description of every antiretroviral drug currently on the market: "This medicine does not cure or prevent HIV infection or AIDS and does not reduce the risk of passing the virus to another person."This statement qualifies all combinations of drugs as well. You could say that this is the official acceptance that Peter Duesberg is right and that HIV is not the cause of AIDS. And there's even more. The same Health Department website, a website specifically written for laypersons, also states: "AZT is a nucleoside reverse transcriptase inhibitors. It is a type of medicine called nucleoside that blocks the reverse transcriptase and protein that HIV needs to make more copies of itself." AZT (or any other antiretroviral drug) blocks HIV replication; in lay terms we might say that AZT kills the virus, which is true from a biochemical and virological point of view. The website goes on to say: "AZT does not cure or prevent HIV infection or AIDS." It is very simple: AZT kills the virus, but AZT does not cure or prevent AIDS. Therefore, we could conclude by interpreting these words to mean that HIV is not the cause of AIDS.
AZT is older drug, so let's take another, newer drug, Nevirapine. Nevirapine is a nonnucleoside that also blocks viral replication but via another mechanism: It is a nonnucleoside reverse transcriptase inhibitor that also blocks the reverse transcriptase and protein that HIV needs to make copies of itself. The result is the same as with AZT but via a different mechanism. This is important, because here we have two completely different molecules that both block HIV replication through two different mechanisms and this can apply to all antiretroviral drugs, both nucleoside and nonnucleoside. Again, the government of the US writes (regarding Nevirapine) "This medicine does not cure or prevent HIV infection or AIDS and does not reduce the risk of passing the virus to another person." So what else do you need other than an official statement from the US government saying that these antiretroviral drugs kill the virus but do not cure AIDS. Doesn't it sound, at the very least, contradictory?
JFS: But isn't the US government simply trying to protect itself from litigation with these statements about antiretroviral drugs?
MR: They probably are. But the question should be, if that's so, why are these drugs being prescribed? And the government might answer, "That's the doctors' business, not ours." By the way, the information on the US government Web page is regularly updated.
JFS: Basically, does this mean they have simply washed their hands of the matter?
MR: Things are even more alarming that that. The state of California's website regarding proposition 65 and AZT says, "AZT is known to the State of California to cause cancer and AZT is being added to the list of substances that cause cancer." Here, you have a commonly prescribed drug that does not cure HIV or AIDS and, furthermore, causes cancer.
JFS: Nevertheless, don't all current antiretroviral drugs contain AZT?
MR: AZT is still contained in many drug combinations but in lesser amounts than in the past, so it kills less rapidly. Anyone can see the ingredients on the US government website.
JFS: How accurate are the ELISA, western blot, viral load, CD4, and other lymphocyte tests?
MR: These tests are or can be as inaccurate or accurate as all the other tests used in biochemistry and medicine. They can return false positives, and they do not detect the presence of the virus but rather the presence of antibodies against the virus. They also return cross-reactions, meaning that you can test positive without ever having been in contact with the virus simply due to a cross-reaction with another protein, either a protein in your own proteins or a protein from another virus.
There are some groups, such as the Perth Group, that claim the HIV virus has never been properly isolated. Someone could go even further and try to demonstrate that our genomes contain a sequence that is identical to the HIV sequence. The human genome has been sequenced from the first to the last base and HIV has also been sequenced from the first to the last base, so it should be easy to compare them; however, I am not aware of any study demonstrating that the human genome "contains" sequences of HIV. Therefore, in my opinion, HIV should simply be considered one of the thousands of retroviruses that are known to exist.
But coming back to the tests, it's also true that numerous studies have concluded that one brand of test is better or the test used in one country works better than the one used in another country, etc. In reality, you can test positive and then you can test negative, but this does not necessarily mean that you have eradicated the virus. It simply means that the tests are not 100% accurate. I would encourage you to take a look Dr. Daniele Mandrioli's presentation, which can be seen on YouTube. He shows that when the same person was given the western blot test – which is the confirmation test – in numerous different laboratories in the US, results were all different. Therefore, even within the same country, the US in this case, there are many different results returned for the same person with the same blood. This state of affairs is also dramatically highlighted in a well-known documentary titled The House of Numbers. In it, a journalist standing on the US–Canadian border observes that on the Canadian side he could have AIDS and on the US side he could be considered in good health. That's because the two countries have different criteria for an HIV-positive diagnosis.
JFS: Disturbing, to say the least! What does it actually mean to be HIV positive and, in your view, how can we interpret the link between HIV and AIDS?
MR: As a scientist, I cannot deny the link between HIV or the signs of HIV infection (since the tests do not detect the virus itself but, supposedly, the signs of HIV infection) and AIDS. There is a connection between the two just as there is a connection between smoking and lung cancer. Yet, one has to ask: What type of connection? Is it a cause-and-effect connection? There is a connection and that fact cannot be argued, but one must ask oneself if HIV is always the only cause of AIDS, as the dogmatists believe. My response is no. We should be asking ourselves whether HIV might merely be a symptom of a preexisting immune deficiency, which is what Professor Montagnier has said. I believe that, a priori, we should not rule out the idea that this might be the case. One can apply the same logic to HIV and AIDS for the simple reason that if your immune system is deficient, you cannot not get rid of pathogens, of any type of pathogen. If you become immune deficient because you are being treated with cortisone, your body stops fighting disease-causing microbes. That's a well-known fact and nobody disagrees with it. So, theoretically at least, we should consider the possibility that if someone is immune deficient, his or her body cannot rid itself of the microbe we call HIV. Professor Montagnier puts it his way, "If you have a good immune system, your body will rid itself of the virus within a few weeks but if you do not have a good immune system – for some reason – chronic HIV infection will remain."
Once again, back to the US government website, which states that although antiretroviral drugs effectively block viral replication, they do not cure AIDS. Putting all of this together, the only conclusion I can reach is that HIV is not the cause of AIDS. However, if I wanted to be politically correct, I would say that HIV is not always the only cause of AIDS.
JFS: Don't ARV drugs sometimes help? Can AIDS be caused only by the depletion of CD4 cells?
MR: By definition, since the CD4 cells are important for the functioning of the immune system, if you have a low number, you have an immune deficiency, but this is just a definition. The question that must be kept in mind is, do antiretroviral drugs help? They do not cure AIDS, but do they help AIDS patients who have an infection such as fungal pneumonia or a bacterial infection? The answer is yes, they do. But is that proof that HIV is the cause of AIDS? Not at all, because these drugs are potent unspecific antimicrobial drugs and they even act temporarily against cancer. Therefore, let's put it this way: You have immune deficiency, you have HIV and you have pneumonia, you take AZT and you feel much better and you recover. These are facts that no one can dispute. The problem is that you can interpret these facts in two ways: (1) the dogmatists would say that AZT blocked HIV, the immune system became stronger and therefore you overcame pneumonia; (2) others might say that you have immune deficiency, you have pneumonia because of a bacterial or fungal infection, and you also have HIV. AZT will kill the fungus, the bacteria and also the HIV and you will feel much better. Even Peter Duesberg, who is considered a heretic because he has always believed that HIV alone cannot cause AIDS, stated recently, "We do not deny that antiretroviral drugs, owing to their inherent toxicity, may be beneficial for certain opportunistic diseases if prescribed for limited periods of time."
JFS: What should be the criteria for giving antiretroviral drugs to patients? As you know, in many countries the official criteria means starting ARV drugs when the patient's CD4 count is below 350 per uL.
MR: The criteria are simply nonexistent. Physicians are still studying the question and seem to be coming to the conclusion that antiretroviral drugs should be prescribed as late as possible rather than as soon as possible. Last year at the mainstream HIV-AIDS conference in Vienna, a major Italian institution, the Istituto Superiore di Sanità (the equivalent of the UK's National Health Service) along with the University of Modena, the Ospedale Malattie Infettive di Reggio Emilia, and a major hospital in Torino presented a joint study designed to determine whether patients should start antiretroviral drug treatment earlier or later. Their conclusion: "Our findings raise a number of questions with regard to the pathogenesis of HIV [these are the same words that Peter Duesberg used], which could reassure clinicians who believe that ARV therapy should not be given to patients with stable CD4 counts." Stable is the key word in that statement – not high or low CD4 count, but a stable CD4 count. Orthodox mainstream scientists are actually reassuring clinicians about not starting ARV therapy. By the way, the study also questioned the role of HIV.
Another study recently published by a Spanish team at a hospital in Madrid (Source: Servicio de Enfermedades Infecciosas, Medicina Tropical, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain [email@example.com]; PMID:21388936 [PubMed - indexed for Medline]) found that there is no difference in CD4+ recovery or end results whether ARV treatment is begun early or late.
JFS: That is extremely interesting when you consider that, for many years, the normal protocol has been to start ARV when the patient's CD4 count falls below 350.
MR: The official bureaucratic definition is that if your count is above 200 you are not immune deficient, and if your count is below 200 you have AIDS. This definition is often used simply as marketing tool to sell drugs. "Test and treat" is a slogan that is seen on many stands at AIDS conferences.
JFS: Some orthodox MDs and hospitals in countries such as Canada or Spain are already trying immune therapy approaches and practicing HAART (ARV) discontinuation. What can you tell us about these new approaches?
MR: Indeed HAART discontinuation and immune therapy trials are already under way in many places. For instance, a very important trial is being conducted in Montreal, Canada. The researchers involved are highly orthodox and they come from the McGill University Health Centre Immunodeficiency Department and other Canadian institutions. They stopped giving HIV patients ARV therapy and replaced it with dendritic cell immune therapy. The conclusion was that all of the patients had improved quality of life after discontinuation of HAART (ARV) treatment.
JFS: So would these findings challenge the widely accepted theory that once ARV treatments are begun the patient must take them for the rest of his or her life?
MR: Yes that's correct. These researchers came to the opposite conclusion.
JFS: I have read that female sex workers do not develop AIDS. Is that correct?
MR: Even more perturbing is the fact that they rarely even get HIV! Theoretically, they should be the leading group affected but they rarely get HIV. As a matter of fact, a Spanish study found that HIV incidence was higher among women who were not sex workers than among women who were sex workers!
JFS: Most of the time, only HIV-positive persons are given CD4 tests. If it were possible to give the general population CD4 tests, would we be surprised by the number of people who had low CD4 counts? In other words, are low CD4 counts unique to HIV-positive persons?
MR: Yes, the test is rarely given unless you are HIV positive. And it's important to note that CD4 count varies even throughout the course of the day and depends on stress levels. Numerous studies have been conducted on this topic. Professor Bauer has conducted many studies on CD4 cells and found that they go up and down independently of HIV infection. This makes sense, as HIV is not the only pathogen that targets the immune system and even endogenous conditions such as stress, nutrition, or sleep deprivation also play a role. For example, a few weeks ago I had a mild case of the flu with a sore throat and a little fever. My CD4 cell count was well below normal; i.e., 372/ul, which is well below that of most HIV+ people.
JFS: What is the psychological effect of being diagnosed HIV positive?
MR: This has been the subject of a great deal of study. It's called the nocebo effect, the exact opposite of the placebo effect. The nocebo effect can severely impact the immune system but the damage is difficult to quantify.
JFS: Is it true that CD4 counts can vary from 250 to 500 overnight and can vary in quite short periods of time?
MR: Yes, they can vary dramatically in a very short period of time. The key question, however, is whether they remain stable. The Italian study emphasizes that it's better not to start ARV therapy if the CD4 count stays stable, even if it's low.
JFS: What can rightly be considered normal with regard to CD4?
MR: According to Italian law, normal CD4 count is anything above 200. If it's above 200, mainstream scientific literature says that doing nothing runs no risk. The literature also deals with the matter of CD counts below 200, but which are stable. At this point things are up to the individual doctor, as every case is different. In the end, what we are talking about is protocols. The problem is well recognized. In preparing for the AIDS conference in Rome last July, the Ministry of Health brought up the issue of "black holes" in our knowledge, and one of these "black holes" is "when to start the therapy." But this is a matter of daily medical practice and not a matter of scientific viewpoint. As well, it's important to emphasize that you can be a dissident like Peter Duesberg and still prescribe antiretroviral drugs. Conversely, you can take a mainstream approach to a study, such as the Italian study, and still advise not prescribing antiretroviral drugs. This is not a matter of faith or dogma, not a matter of "I am a dissident therefore I prefer to die rather than take ARV." That would be stupid. In the past, antibiotics were prescribed all of the time for everything, even for flu, which is a virus, and antibiotics do not act against viruses. The use of antibiotics has now become more rational, but people had already developed various and sometimes quite serious forms of resistance to many common antibiotics.
JFS: So we may end up adopting the same attitude to ARV therapy that we eventually came to adopt with regard to antibiotics – only in cases where they are really necessary and only for limited periods of time?
MR: Absolutely. ARV drugs are antimicrobial, which means that they not only act against viruses but against other microorganisms as well. For example, ARVs have already been proposed as a treatment for malaria and other diseases caused by parasites. Once again, in the Italian study mentioned above, they recommend waiting and only prescribing ARV if they are really needed. If this were the generally accepted protocol, clinicians could feel freer to do what they really believe would be best for each individual patient.
JFS: Do medical personnel feel they must follow the accepted protocol in order to protect themselves from sanctions or litigation?
MR: Yes, of course. But if physicians read what is written on the US government website they would realize that, by giving ARV drugs to every HIV-positive patient, they are not protecting themselves at all.
JFS: What we observe, however, is that many people taking ARV see improvements in the numbers; i.e., their viral load goes often down to undetectable levels and their CD4 counts frequently increase dramatically ...
MR: That fact is actually quite easy to understand, and you don't need to be an immunologist to comprehend why. If you kill every microbe and pathogen, immune cells and lymphocytes no longer have to do that job. In which case, it's easier for them to proliferate.
JFS: Just a few last questions on immune deficiency parameters. How would you define immune deficiency with regard to lymphocyte counts and ratios?
MR: A low CD4+ count is considered immune deficiency, as CD4+ cells are called helpers whereas CD8+ are called suppressors because they suppress the immune response. This happens in a number of chronic infections, regardless of the nature of the infectious agent. However, low circulating CD4+ can occur for a variety of conditions, including conditions totally unrelated to HIV infection. A sore throat can drastically lower CD4+. CD4+ and CD8+ counts do not always move inversely. As well, variations can be significant, even throughout the course of the same day. In general terms, very low CD4+ (below 100) and high CD8+ indicate immunodeficiency, a condition that can occur independently of any signs of HIV infection.
JFS: Are there other factors or white cells involved that would keep individuals with low CD4 counts healthy?
MR: Most likely yes. Natural killer cells and macrophages may play a very important role, albeit a role that is not yet completely understood.
JFS: Why is the immune restoration approach not more widespread in the worldwide medical community?
MR: I have my own hypotheses and perceptions, but that's not my field. I will say, however, that there may be two reasons for this: (1) pressure from pharmaceutical companies. They have drugs that target the virus, and even though the government says that these drugs do not cure AIDS or prevent HIV infection, they do nevertheless target the virus. That gives these companies a reason to sell the drugs, and selling drugs is their job; (2) it's much easier for physicians to simply accept mainstream protocols and approaches rather than applying their own reasoning powers to the problem or doing their own research. You have to remember that physicians are not researchers; they have a great deal to do and very little time to think, at least most of them. Due to this combination of factors, most physicians do not even consider questioning anything. Basically, if you have HIV, just take these drugs and next patient, please.
JFS: How do you see the "HIV-AIDS issue" evolving in the years to come?
MR: That question reminds me of one of my textbooks when I was in medical school, which was many years ago, as I got my MD in 1980. One of the longest chapters was on gastric ulcers, a nasty disease whose cause was quite unknown. Then researchers discovered Helicobacter pylori, the bacteria responsible for gastric ulcers, and found that very cheap antibiotics would kill the bacteria. The chapter is no longer in the textbook – 100 pages gone, problem solved. The same thing could happen at some point, perhaps soon, to HIV and its relationship to AIDS.
JFS: You've mentioned Dr. Claus Koehnlein in other interviews, a physician who does not give ARV to his patients. What is his approach?
MR: Basically, he takes a highly pragmatic approach to treatment. If you have TB, he treats TB; if you have pneumonia, he treats pneumonia. He found that certain ARV drugs, which have quite powerful antimicrobial effects, work very well against fungal infections and some forms of fungal pneumonia. He is purely pragmatic. What he does not do is blindly prescribe ARV drugs to everybody for life. He prescribes them sometimes for limited periods of time, only as long as it takes to clear up the disease. Once the disease has been overcome, he stops. He also makes it very clear to his patients that they must not take any sort of recreational drugs such cocaine, poppers, etc.
JFS: Let's turn to the immune therapy approaches you've been working on. You started your work based on Professor Yamamoto's studies of a substance called GcMAF, a macrophage inductor, which is a specialized phagocytic cell that attacks foreign proteins, infectious microbes, and cancer cells. Your work in this area is still evolving, but what are your provisional conclusions regarding GcMAF?
MR: Our team is researching therapeutic approaches to immune deficiency and cancer. Professor Yamamoto's studies were done with 15 asymptomatic HIV-infected patients and he was able to eradicate the HIV infection by administering GcMAF. Our team and an MD in Vienna worked together with a group of patients to test GcMAF with symptomatic patients. I personally monitored one of the patients, and the results were impressive, results that I presented at the Florence AIDS conference last March (ICAR 2011). The patient, 45 years old, had been HIV positive since 1984 and developed full-blown AIDS in 2001. He was in critical condition, as he had been taking ARV for years and had a number of serious side effects such as, among others, a neuropathic condition. He stopped ARV medication and gave himself GcMAF injections for 10 weeks. His viral load went down dramatically and his CD4 count, which was 58 prior to start the GcMAF treatment, increased to nearly 300 after several weeks of the injections. Other subjects in the Vienna study reported improvements in their condition but also suffered from side effects like fever which, although quite unpleasant, proves that GcMAF actually does induce immune restoration. However, the rest of the trial with chemical GcMAF in HIV+ patients performed in Austria did not yield completely satisfactory results.
Our team has also seen impressive results with breast cancer cells in vitro. When treated with GcMAF, the number of cancer cells significantly decreased in within 72 hours. Compared with the untreated sample, in less than 3 days there were almost zero cancer cells in the GcMAF-treated sample. Another example of the potential of chemical GcMAF is the effect that it has on cells that are seeking out a protein called vimentin. Normally, the more vimentin, which is visible in the form of brown spots around the cells, the more malignant those cells are. After being treated with GcMAF, there were no longer any brown spots. GcMAF's effects on angiogenesis are also very impressive. Experimentally, our approach is to focus on strengthening the immune system so that it can naturally get rid of the cancer or the HIV.
JFS: GcMAF is, after all, a chemical product and its use on humans has not been approved. As you stated above, it did not yield completely satisfactory results. This led to the implementation of a procedure to prepare a probiotic yogurt, which stimulates a significant immune response via macrophage activation. How would you expand on this important discovery?
MR: At the 6th IAS2011 Rome conference on HIV Pathogenesis, Treatment and Prevention, we demonstrated that stimulating the immune system with probiotic yogurt increased CD4+ count and NK count and decreased CD8+ count, thus normalizing the immune function. These results were achieved after 3 weeks and are much more significant than the expected average effects of antiretroviral drugs. The conclusion is that the probiotic yogurt which resulted from the procedure that our team implemented could help restore the immune system. In addition, in the follow-up study after the conference, we observed that consuming probiotic yogurt led to the near disappearance of HAART side effects, enabling subjects to tolerate HAART to an extent that they never could before.
It's noteworthy that consumption of this probiotic yogurt was associated with a significant improvement in overall health conditions, if compromised. For example, one subject consuming our yogurt produced with a special procedure, while on HAART, noticed regularization of intestinal function and disappearance of the chronic diarrhea that had afflicted him since beginning HAART as well as normalization of body temperature, which had tended to rise after minor exertion. We attribute the improvement of these symptoms to a decrease of the pro-inflammatory state that is often associated with chronic HIV infection and/or HAART. This hypothesis was corroborated by the observed decrease in gamma-globulins together with the trend toward normalization of other hematological parameters. It is also interesting to note that this subject reported disappearance of gum bleeding while brushing his teeth, a phenomenon that we attribute to increased platelet number. We interpreted normalization of hematological parameters in this subject as a sign of restoration of bone marrow function, a fundamental issue in HIV/AIDS patients. In fact, thrombocytopenia is observed in about 10% to 50% of HIV patients as one of the first clinical signs of infection, and anemia was consistently shown to be a predictor for increased disease progression and decreased survival of patients infected by HIV.
Therefore, it can be hypothesized that restoration of bone marrow function will reduce the risk of disease progression in HIV-infected individuals. Other subjective symptoms in this subject included increased stamina and resistance during physical exercise as well as a generalized feeling of well-being. While certain symptoms can be easily associated with restored immune system and bone marrow function, these latter subjective feelings could be interpreted in light of the recently described role of the gut microbiome. It has been demonstrated that gut bacteria affect mood and behavior, and it has been suggested that "we need to change the focus from the brain and look at the role of the gut in what have traditionally been thought of as brain based disorders." Therefore, we hypothesize that the clinical and laboratory results that we observed can be attributed to the combination of reestablishment of a healthy gut microbiome associated with direct stimulation of the immune system by naturally produced GcMAF, a task that cannot be accomplished by administration of encapsulated probiotics or chemically produced GcMAF alone.
We are well aware that these subjective reports are merely anecdotal and in an era of evidence-based medicine have low value or are not even considered medical evidence. However, a very recent study on the evaluation of clinical practice challenges the deprecation of stories like those reported above. Thus, it is well known that some studies present large and impressive statistics obtained from many observations while others report a small number of noteworthy events, as we did in this study. However, according to this authoritative epistemological approach, "all of these stories become evidence of what works in medicine."
As if to confirm these words, while writing the last sentence of a manuscript describing these results, one of the authors received a text message from a patient hospitalized at the National Institute for Infectious Diseases "Lazzaro Spallanzani" in Rome. The patient, who is HIV positive and severely immunocompromised, had consumed the probiotic yogurt for one week, in the absence, as yet, of HAART, and reported an increase of CD4 cells from 42 to 68 cells/µL. Once again, "merely anecdotal"; nevertheless of great importance for this individual patient.
JFS: As you say "merely anecdotal" but of key importance for patients. Last summer you went to the US to conduct a trial with the special probiotic yogurt aforementioned. How did the probiotic yogurt compare to GcMAF?
MR: There is little or no comparison. This yogurt prepared with a special procedure is much more potent, it's all-natural, it's legal and doesn't require a prescription. It can be easily prepared by the patient in his or her home kitchen. Due to its probiotic properties, it has a very wide range of positive effects on the human microbiome. We observed such a number of positive effects that we were quite astonished. For us, the use of chemical GcMAF as a nonapproved, nonauthorized, nonlegal, noncontrolled, injected foreign protein, is history. GcMAF, as a molecule, continues to show very interesting properties from the point of view of basic science and we shall continue to study it in the laboratory, but only for the purpose of understanding basic molecular mechanisms. This is one of the reasons that we developed this yogurt prepared with a special procedure, which is a totally natural product that can be consumed for life. However, we do not yet know whether the effects of this special yogurt are permanent or transient. Only time will tell.
JFS: Is there any connection between VDR response and this yogurt prepared with a special procedure response?
MR: With this special yogurt we observed results in a few weeks as reported at IAS2011. However, for some subjects it could take longer just because of VDR polymorphisms. We are studying this topic right now.
JFS: Since it's in the form of probiotic yogurt, it would seem extremely easy to ingest. How are you and your team planning to make it available in Europe and what are the challenges with regard to storage so that its properties stay intact?
MR: We do not want this yogurt prepared with a special procedure to be taken over by ruthless speculators. That's why we decided to teach every single patient how to prepare it in his or her home kitchen. The classes were successful in the US and are being replicated there. We are planning to give similar classes in Europe as well.
JFS: In Europe, it is difficult to implement a major trial for this sort of approach.
MR: In Italy it is very difficult. There's so much bureaucracy.
JFS: Are there other such immunotherapy trials under way?
MR: Yes. As I mentioned earlier, there's the dendritic cell approach which, inappropriately from a scientific point of view, is called the "dendritic therapeutic vaccine." In fact, all of the "therapeutic vaccines" that we've been talking about are not actually vaccines. They are forms of immunotherapy, which means stimulating the immune system so that it can fight the pathogen by itself.
JFS: As a last question, we understand that you have been harassed and accused by some anonymous groups of scientific misconduct in order to discredit you at the University of Florence as well as to discredit your work and views regarding the HIV-AIDS issue. Is that correct?
MR: Yes, it is correct. However, it should be said that in these days, the rector of the University, who was forced to initiate an investigation because of an anonymous letter, is receiving letters signed by real people who ask him to support and protect my research and teaching activities. These letters are signed by students, researchers, doctors, individual patients, and associations of patients and cultural associations. All these letters are signed by real people who are not afraid to expose themselves to protect the freedom of teaching and research. As you know, there is also an online petition started by a gentleman from Malaga, Spain, that so far collected more than 400 signatures. This event is backfiring on those who initiated it; it demonstrates that there are hundreds of real people who want to know more about the HIV-AIDS issue and are not content with the opinions currently provided as dogmas. From now on, nobody will be able to say that the so called "dissidents" are a handful of freaks. Among those signatures there are well-respected professors and even the director of a famed research institution, not to mention researchers, doctors, students, and patients. After that anonymous letter and all the related media clamor, I am routinely called more than ever by "orthodox" doctors working in infectious disease departments, who want to discuss my opinions with their patients. These discussions are extremely enriching, always collaborative; and sometimes I discover that some young doctors are even more "dissident" than I am! It is a wonderful experience; and I guess that the patients obtain the best benefit by having two doctors, with different views but willing to collaborate, taking care of them.