Activism Change

Long-Term Mitochondrial Toxicity

Question:

AZT ROULETTE The impossible choices facing HIV-positive women. By Celia Farber

Indeed, there are some very difficult choices. These women are HIV+. So again, it seems Celia is on the side that says HIV exists. Yet she can’t yet seem to grasp that such infection results in illness for the majority of infected people. There are MANY things people can do, including a powerful antioxidant protocol. Yet that for many is as out of the question as antivirals due the high cost and lack of availability (especially agents like N-acetylcysteine, carnitine or acetylcarnitine, alpha lipoic acid). Not EVER taking ARV is a bad idea to push. One that will–and has due to the infamous indifference and cruelty of George Bush, the pharmaceutical industry and most corrupt governments globally–killed many women. And men. And kids. We SHOULD be trying to figure out, at this point, how to help ameliorate serious side effects…but most people with HIV in the world continue to die at a very young age.                 George M. Carter

Response:

Excellent–and thanks for posting this. On the one hand, it shows a potential future problem with AZT therapy in HIV+ pregnant women. Nevirapine may be a better bet if used in single doses (to prevent hepatotoxicity). Reduction in mother to child transmission may be achieved without mitochondrial toxicity.

I did ask about this recently: surprisingly there’s no real plans to replace AZT in the "PEP" protocol for babies born to infected mothers. Yet. GTG, a peds ID meeting in 5 ) Bennett

Response:

AZT ROULETTE The impossible choices facing HIV-positive women. By Celia Farber Mothering Kris Chmiel is a housewife and mother of two young children, living in Denver. When she was pregnant with her second child, a movement had just gotten under way to test all pregnant women in the state of Colorado for HIV, the virus widely believed to cause AIDS. (Critics remind us that what is tested for is not, in fact, HIV, but antibodies to HIV.) She was perfectly healthy and in her first month of pregnancy. She wasn’t worried — she had been monogamous with her husband for the past nine years. When the test came back "positive," she literally did not believe it. Her doctors strongly urged her to immediately start taking the AIDS drug AZT, in an effort to prevent transmission to her child. "They finally wore me down," she says, "even though it was totally against my intuition." In her fifth month of pregnancy, Chmiel began taking 500 milligrams of AZT, a drug that has been routinely given to pregnant HIV-positive women following a 1994 study — ACTG 076 — which claimed efficacy in reducing the transmission from mother to child. (1) (AZT stands for azidothymidine and is marketed under the names Zidovudine or Retrovir.) Chmiel’s daughter is two years old today, and has twice tested negative for HIV infection. By the standards of the AIDS establishment, she is not only a success story, but the very epitome of medicinal victory — perhaps the only "victory" in the entire realm of AIDS research. She is precisely the kind of baby who would serve as a poster child for those forces that are pushing hard for mandatory testing, as well as mandatory treatment, and maybe even mandatory AZT use by all pregnant women — a "saved" baby. But to Chmiel, there are strong undertones of regret, anger, and even despair when she thinks back on her choice to take AZT. Follow-up HIV tests after her child was born gave results different from the first one, throwing into question whether she ever did have HIV. One test was indeterminate, and another was negative. She soon started doing her own research, and found a paper citing all the underlying conditions — as many as 64 — that can cause a false positive HIV- antibody test. One of them is pregnancy. (See "How Accurate Is the HIV Test" on page 60.) She also became more and more aware of the potential toxic effects of AZT, which, although it is said to be "safe" for both mother and child, is a known carcinogen, mutagen, and teratogen — a drug long classified as "contraindicated" in pregnancy. For Chmiel, who stayed on AZT for a year after her child was born, the breaking point with AZT came when the drug’s toxicity became so overwhelming that she crawled to the bathroom and kept vomiting for hours. "I just couldn’t take it anymore," she says, adding that when she stopped taking the drug, her health returned. There are five categories that the FDA uses for pregnancy drug classification, listed from the safest to most dangerous — A, B, C, D, and X. AZT is listed in Category C and is described as a drug in which "safety in human pregnancies has not been determined, animal studies are either positive for fetal risk or have not been conducted, and the drug should not be used unless the potential benefit outweighs the potential risk to the fetus." In the case of AZT and HIV, the "risk" is a variable that is inextricable from a core question that hasn’t been resolved, namely, "Does a positive HIV antibody test predict an inevitable progression to sickness and death?" Some experts say yes, others say no. (See "Does HIV Cause AIDS?" page 56.) Several studies, particularly in recent years, have noted how an increasing number of children born HIV-positive are growing into adolescence without any sign of sickness. A study that came out of the 1996 International AIDS Conference in Vancouver reported that 37 percent of all HIV- positive babies would never progress into full-blown AIDS. (2) In his landmark book Rethinking AIDS, Dr. Robert Root-Bernstein states, "Less than a third of HIV-sero-positive infants go on to develop AIDS." (3) It may be nearly impossible to ferret out what precisely we mean when we talk about children "progressing," because the waters are clouded from the start. Progressing from what to what? As Root- Bernstein points out, 80 percent of HIV-positive infants in the US are born to drug-addicted mothers — whose immune systems are severely compromised with or without HIV — and those babies all will inherit their mother’s immune system. If the mother is sick, the baby will be sick. Unfortunately, few research efforts have been aimed at truly resolving the fundamental question of how HIV, as distinct from all other factors, affects children, because mainstream HIV dogma holds that there is no question. If a mother has HIV, she and her child will be viewed through the lens of HIV, and not seen in the context of their whole immediate environment — although, as Root-Bernstein documents extensively, babies born to HIV-positive mothers often have identical health profiles to their mothers, whether these babies are positive or negative. (4) The unified voice of AIDS research takes a far more simplistic view of the problem. "There are children, about one third, who we call long-term nonprogressors," says Dr. Ellen Cooper, principal researcher of Women and Infants Transmission Study (WITS), an ongoing federal research program. "We’ve not followed the disease long enough to know absolutely, but the thinking now is, there’s nobody who doesn’t progress, it’s just a question of how quickly you progress, and how good we are at coming up with new therapies to help you maintain your health and predict when you’re going to decline." The thought is, there is nobody who doesn’t progress… Where did this "thought" originate? And how is it influencing HIV- positive women, every day, all around the country? In the fractious, vast, and complex universe of HIV and AIDS, these women are looking through a kaleidoscope of information, both in written form and learned firsthand, and making very difficult decisions about how to handle the news of a positive HIV-antibody test — for themselves, and for their children, both born and unborn. "Do you think that AZT had any adverse effect on your child?" I ask Chmiel. "Yes, I do," she says firmly. "She has a very enlarged cranium. That’s typical of most of the AZT babies I have observed." What she tells me next sounds like a terrible dream. "They’re killing babies," she says emphatically. One young woman who came to Chmiel for counseling at the dissident AIDS activist group HEAL in Denver, had watched her child test positive for HIV shortly after being vaccinated (vaccinations can cause the HIV test to produce a false positive). The baby was put on AZT, despite the fact that the mother was HIV negative. Three months later, the baby was dead. Another mother who contacted Chmiel had a baby with hemophilia, who had received Factor 8 clotting plasma (yet another possible source of false positives). After testing positive, the baby was put on several medications and died after only five months. "That child’s mother is still devastated," Chmiel says. "She believes it was the drugs that killed her son." Even when children taking AZT survive, Chmiel firmly believes, the consequences of the drug use can be dire. "I went to this conference that they held on HIV and pregnancy at Children’s Hospital here in Denver," she says, "and a lot of the mothers there had taken AZT during pregnancy, and they had their kids with them. I looked from one to the other, and every single one of those kids had enlarged craniums. Their heads looked exactly like my kid’s head. They’re all AZT babies." Few, if any, studies in the history of AIDS research have caused such a momentous shift in policy, medical practice, and zeitgeist as the one called ACTG 076. To believers, it is perhaps the single greatest breakthrough in the history of AIDS research; to detractors, it is the most alarming and radical turn prenatal care has ever taken. Call up virtually anybody who works within obstetrics, HIV/AIDS, and pediatrics and they will tell you the same thing: that the protocol now known simply as 076 — the study that first caused the FDA to approve the use of AZT in pregnant women — has been perhaps the most unequivocally encouraging news in all of HIV/AIDS research. Fourteen hundred babies per year in the United States alone, they say, are "saved" by AZT use, which by unknown mechanisms is said to reduce maternal transmission of HIV. They will also tell you that there have been no documented complications from AZT, and that even if there were, they would pale in comparison to the dreadful effects of HIV itself. In ACTG 076, the transmission of HIV during labor was reduced from 25.5 percent in the placebo group to 8.3 percent in the group that was given AZT throughout the second and third trimesters and intravenously during labor. The babies in that group were then given AZT for six weeks after birth. Maternal transmission rates vary greatly — in industrialized countries, 25 percent is certainly the high end. In several European studies, the rate is as low as between about 7 percent and 14 percent — levels that are said to correlate with improved prenatal care. (5) In one quite surprising study from Malawi, it was found that transmission was closely correlated with levels of vitamin A in the mother. Those with the lowest levels transmitted HIV to their babies at a rate of 32.4 percent, while those with the highest levels had a transmission rate of only 7.2 percent — a figure lower than the lowest figures attributed to AZT. (6) And yet, the discourse around this subject is framed inextricably around the notion that toxic medications constitute the only legitimate and, for the mother, "responsible" route to reduced transmission. Such pharmaceutical intervention during … read more »

Response:

Excellent–and thanks for posting this. On the one hand, it shows a potential future problem with AZT therapy in HIV+ pregnant women. Nevirapine may be a better bet if used in single doses (to prevent hepatotoxicity). Reduction in mother to child transmission may be achieved without mitochondrial toxicity. Whether over time these HIV uninfected infants will recover is not known. Whether it will have a clinical effect later in life is not yet known–it may well…and most importantly, could micronutrient supplementation help offset some of this damage? Especially certain minerals (selenium), B complex, carnitine/acetylcarnitine and NAC to replenish intracellular antioxidant status and limit mitochondrial damage? Important questions. Finally, this once again does NOT support the notion that HIV doesn’t exist (it does) or cause AIDS. Indeed, here we see that UNTREATED mothers’ infants had damaged mitochondria. Why? Because one of the pathways to AIDS after HIV infection is the dysregulated redox status, increased oxidative stress and mitochondrial damage induced by HIV and its proteins (e.g., tat). HIV causes AIDS. Maybe Paul will discover if he has the guts to take the HIV challenge–but I see he has very sensibly backed away from this blustering.                 George M. Carter – Hide quoted text — Show quoted text – JAIDS Journal of Acquired Immune Deficiency Syndromes 2003; 33(2):175-183 Long-Term Mitochondrial Toxicity in HIV-Uninfected Infants Born to HIV-Infected Mothers *Miriam C. Poirier; *Rao L. Divi;

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