The authors first tried to publish the article in the Journal of AIDS as a commentary on the Harvard study. But Duesberg was rejected after peer review. Of course Duesberg accuses the review process of corruption and unfairness. The authors said the following, “A precursor of this paper was rejected by the Journal of AIDS, which published the Chigwedere et al. article, with political and ad hominem arguments but without offering even one reference for an incorrect number or statement of our paper (available on request).”
Not surprisingly, requests for the reviewer comments are not honored; leaving us to imagine what the peer reviewers said about Duesberg's article. I decided to undertake a simulated peer review of the Duesberg article.
As the Editor in Chief of a peer reviewed journal, I figured, why not?
I took several steps to perform as close to a true peer review as possible. I stripped the text of all identifying information – the authors' names were removed from the paper. The text, tables and figures were cut and pasted to create a double spaced manuscript document suitable for blind review. I asked three leading researchers with expertise in South African AIDS to review the paper. None of the reviewers had any interest in AIDS denialism and none was aware of the Duesberg article. Here are my instructions:
"The attached manuscript is not under consideration at the journal which I edit, AIDS and Behavior. The paper is a critique of a modeling study of AIDS in Africa. This critique is a real manuscript and I am seeking peer reviews. Once you complete the task, I will inform you of what this is all about. I am asking that you, (1) Review the paper as if it were submitted to a journal of the caliber of Journal of AIDS or an equal level public health journal. (2) Provide written comments for the authors (no more than 1 single spaced page). (3) Recommend a decision to reject outright, reject with the option to resubmit, or accept the paper.”
All three reviewers recommended rejection. The simulated reviews offer a glimpse of what may have been raised by the Journal of AIDS. The consistency of our three independent reviews is remarkable.
Medical Hypotheses would probably have rejected the paper if only they sent it out for peer review.
Why Peter Duesberg continues to humiliate himself by ignoring science and affiliating with pseudoscientists remains a mystery.
This paper is an attempt to rebut a recently-published estimation of the lost benefits of antiretroviral therapy (ART) use in South Africa. The original paper essentially argued that by failing to implement an ART program that was “reasonably feasible” at the time, the South African government failed to prevent 330,000 deaths and 2.2 million person-years. The authors of the current article believe that the estimate is overblown and unrealistic; furthermore they argue that HIV does not cause AIDS. For the latter argument, apart from a very few scientists who believe HIV does not cause AIDS, there is broad scientific agreement and decades of scientific evidence that contradicts this claim of the authors. I cannot see why JAIDS would want to (re) engage in this obviously dead-end debate.
You fault Chigwedere and colleagues for overestimating the number of deaths averted, but the data that you use to revise (downward) his estimate is obviously wrong. Who but an AIDS denialist would believe that a) the South African mortality registration system would yield an accurate count of deaths due to HIV/AIDS and b) that 1 death per 1000 HIV-positive people per year were anything close to an accurate measure of the rate at which people with HIV/AIDS die. Even a back of the envelope calculation is enough to show that this estimate is off by several orders of magnitude: If the average person, untreated, with HIV/AIDS in South Africa lives 10 years as has been roughly shown in several other African natural history studies, then on average (assuming constant rates of infection) about 10% will die per year. This number is clearly much closer to the truth and 1 death per 1000 HIV-positive person per year is obviously wildly off target. In short, mortality registration is a very poor and inaccurate measure of HIV/AIDS deaths and cannot and should not be trusted to estimate how many people with HIV are likely to die per year.
I think we are long past the issue of whether HIV causes AIDS. I think it is very important to be open to other ideas including controversial ones. But even this primary issue is not taken on in a very convincing manner.
The basic argument is that if HIV is really responsible for so many deaths, why aren't they reflected in the death rates. I'm not a demographer, but the demographic projections I have seen for almost all of the hyperendemic countries still allow for substantial population growth even with AIDS.
South Africa is a country where there is a lot of denial and silence about when and whether someone dies of AIDS, so it would not be surprising to see a lot of underreporting in official cause of death. So the 1 per 1000 reported HIV-death rate (or even 2.5%) is not at all credible.
The rates of HIV prevalence are grossly overstated (given as 25-30%). Actually the overall rate for the population over 2 in South Africa in 2008 in the HSRC survey was only 10.9%. So the author's HIV-attributable mortality is widely off the mark.
As I look at the numbers, it is not unreasonable that a country such as South Africa could be growing at about 600,000 per year while at the same time experiencing 66,000 excess deaths per year from HIV/AIDS.
The authors do make a valid point that we may be underestimating the long-term toxicity of ARVs.
But I do not see value over all in this paper and would not recommend if for publication (i.e. reject outright.)
This manuscript responds to a recent study that found that in South Africa, at least 3.8 million person-years were lost due to delays in implementing ARV/prevention of mother to child transmission (PMTCT) programs because of beliefs that HIV was not the cause of AIDS and that ARV were not useful to patients (Chigwedere). The manuscript raises two issues: (1) What evidence exists for the huge loss of lives? And (2) What is the evidence that anyone would have benefited from the ARVs? The manuscript also raises the question as to whether HIV is a passenger virus.
The authors point to data that only 2.5% of total registered mortality were due to HIV-deaths.
Page 9 – the authors assume that all pathogenic viruses “act” the same in a given population. What is the basis of this assumption? Are there exceptions to this (e.g. other viral STIs?)
In the second section of the manuscript, the authors state that there are unresolved problems with the belief that AZT/Nevirapine inhibit HIV. The authors do not address the evidence (notably those cited by Chigwedere) that indicate (using “gold-standard” epidemiological studies) that AZT/ZDV are effective.
On pages 10-11, the authors point out some of the negative outcomes resulting from ART and PMTCT. However, the authors do not indicate how common these outcomes are and whether the burden of these outcomes are greater than the burden associated with HIV infection. The authors then make a conclusion that the negative impacts of treatment means that they do not have any benefit, which is not a logical conclusion.