HIV Aids - Effects of ARV Therapy on Mortality

Author

Effects of ARV Therapy on Mortality

GMCarter

2005-10-26, 10:53 am

Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P,
d'Arminio Monforte A, Yust I, Bruun JN, Phillips AN, Lundgren JD.
Changing patterns of mortality across Europe in patients infected with
HIV-1. EuroSIDA Study Group. Lancet. 1998 Nov 28;352(9142):1725-30.

Royal Free Centre for HIV Medicine and Department of Primary Care and
Population Sciences, Royal Free and university college Medical School,
University college London, UK. amanda@rfhsm.ac.uk

BACKGROUND: The introduction of combination antiretroviral therapy and
protease inhibitors has led to reports of falling mortality rates
among people infected with HIV-1. We examined the change in these
mortality rates of HIV-1-infected patients across Europe during
1994-98, and assessed the extent to which changes can be explained by
the use of new therapeutic regimens. METHODS: We analysed data from
EuroSIDA, which is a prospective, observational, European, multicentre
cohort of 4270 HIV-1-infected patients. We compared death rates in
each 6 month period from September, 1994, to March, 1998. FINDINGS: By
March, 1998, 1215 patients had died. The mortality rate from March to
September, 1995, was 23.3 deaths per 100 person-years of follow-up
(95% CI 20.6-26.0), and fell to 4.1 per 100 person-years of follow-up
(2.3-5.9) between September, 1997, and March, 1998. From March to
September, 1997, the death rate was 65.4 per 100 person-years of
follow-up for those on no treatment, 7.5 per 100 person-years of
follow-up for patients on dual therapy, and 3.4 per 100 person-years
of follow-up for patients on triple-combination therapy. Compared with
patients who were followed up from September, 1994, to March, 1995,
patients seen between September, 1997, and March, 1998, had a relative
hazard of death of 0.16 (0.08-0.32), which rose to 0.90 (0.50-1.64)
after adjustment for treatment. INTERPRETATION: Death rates across
Europe among patients infected with HIV-1 have been falling since
September, 1995, and at the beginning of 1998 were less than a fifth
of their previous level. A large proportion of the reduction in
mortality could be explained by new treatments or combinations of
treatments.

Gary Stein

2005-10-26, 10:53 am

"GMCarter" <fiar@verizon.net> wrote in message
news:0s8tl15usju95hmm00nvjlah4rqsqgmacl@4ax.com...
> Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P,
> d'Arminio Monforte A, Yust I, Bruun JN, Phillips AN, Lundgren JD.
> Changing patterns of mortality across Europe in patients infected with
> HIV-1. EuroSIDA Study Group. Lancet. 1998 Nov 28;352(9142):1725-30.
>
> Royal Free Centre for HIV Medicine and Department of Primary Care and
> Population Sciences, Royal Free and university college Medical School,
> university college London, UK. amanda@rfhsm.ac.uk
>
> BACKGROUND: The introduction of combination antiretroviral therapy and
> protease inhibitors has led to reports of falling mortality rates
> among people infected with HIV-1. We examined the change in these
> mortality rates of HIV-1-infected patients across Europe during
> 1994-98, and assessed the extent to which changes can be explained by
> the use of new therapeutic regimens. METHODS: We analysed data from
> EuroSIDA, which is a prospective, observational, European, multicentre
> cohort of 4270 HIV-1-infected patients. We compared death rates in
> each 6 month period from September, 1994, to March, 1998. FINDINGS: By
> March, 1998, 1215 patients had died. The mortality rate from March to
> September, 1995, was 23.3 deaths per 100 person-years of follow-up
> (95% CI 20.6-26.0), and fell to 4.1 per 100 person-years of follow-up
> (2.3-5.9) between September, 1997, and March, 1998. From March to
> September, 1997, the death rate was 65.4 per 100 person-years of
> follow-up for those on no treatment, 7.5 per 100 person-years of
> follow-up for patients on dual therapy, and 3.4 per 100 person-years
> of follow-up for patients on triple-combination therapy. Compared with
> patients who were followed up from September, 1994, to March, 1995,
> patients seen between September, 1997, and March, 1998, had a relative
> hazard of death of 0.16 (0.08-0.32), which rose to 0.90 (0.50-1.64)
> after adjustment for treatment. INTERPRETATION: Death rates across
> Europe among patients infected with HIV-1 have been falling since
> September, 1995, and at the beginning of 1998 were less than a fifth
> of their previous level. A large proportion of the reduction in
> mortality could be explained by new treatments or combinations of
> treatments.
>

But George didn't you get the memo ARV is 'DEADLY' this research just has to
be wrong because Rasnick and Mullis say so.

The entire EuroSIDA dataset a subset of which was used for this study is
even more definitive when it comes to showing the effectiveness of ARV. I
have posted references to the EuroSIDA data a huge number of times yet up to
this point not a single denialist has bothered to study the information or
make any attempt to explain that data's impact on there assertion that ARV
kills.

Gary Stein

GMCarter

2005-10-26, 10:53 am

On Wed, 26 Oct 2005 00:45:50 GMT, "Gary Stein" <ge.stein@verizon.net>
wrote:

snip.
>But George didn't you get the memo ARV is 'DEADLY' this research just has to
>be wrong because Rasnick and Mullis say so.

And within a matter of MINUTES! This according to a rhodochrosite
conclave that informed me...but I chose to ignore them! mwahahahaha!

>The entire EuroSIDA dataset a subset of which was used for this study is
>even more definitive when it comes to showing the effectiveness of ARV. I
>have posted references to the EuroSIDA data a huge number of times yet up to
>this point not a single denialist has bothered to study the information or
>make any attempt to explain that data's impact on there assertion that ARV
>kills.

Data are irrelevant. The intelligent designer done told me so.

We are borg. Resistance is mutable.

George Mary Magnetite

montygram

2005-10-30, 5:51 pm

No, tryingtomakesomesenseofit, you are correct. These kinds of studies
are nonsense. The begin with assumptions that have not been
demonstrated to be acccurate. Often, the studies that supposedly
demonstrate the underlying assumption actually show the opposite.
Here's an easy example: there is a claim that only two kinds of fatty
acid molecules are "essential," yet there is no biochemical reason for
this to be the case. Experiments were done that did not have proper
controls, yet even there, some of the pregnant animals gave birth to
healthy offspring. Thus, if these molecules were truly essential,
there would have been no healthy offspring, yet they use this to say
that it has been "proven" that these molecules are essential. In the
case of "AIDS," there are definitions of what is "AIDS" and what is
not, and these definitions are not scientific, that is, based on
controlled experiments which follow the scientific method. In fact,
they vary from one nation to another, as does "HIV positive" status.
If the underlying assumptions are not accurate, it's a "garbage in,
garbage out" proposition. However, the other problem is that even if
they are correct, it does not mean that the "HIV/AIDS" claims are
correct, because such toxic medication can act as a surrogate immune
system, at least for a while (until the liver begins to fail). Thus,
this would need to be controlled for. I have been suggesting for a
couple of years now that one only needs to keep biochemical activity
low, while ensuring that the body can produce energy efficiently
(mitochondria need to be protected and "fed" properly). I have made
offers to do animal experiments to demonstrate my claims (which are all
based on solid biochemical evidence), but nobody will take me up on any
of my offers. Why? Because the loser must pay for all expenses, and
while these people are generally quite deluded, they seem to be
cheapskates first and foremost.

montygram

2005-10-30, 5:51 pm

Here's something to consider in this context:

A Scientist Rebuts Business Day's Praise Of AIDS Drugs

By David Rasnick, Ph.D.

David Rasnick, a professor of molecular and cell biology at the
University of California at Berkeley, is currently a visiting scholar
in South Africa. The following is a letter he wrote this week to
Business Day.

The headline on an August 2 story by Chris van Gass in Business Day
about a study published in The Lancet announced, "TAC welcomes U.K.
study showing AIDS drugs prolong life."

The article in the July 30 issue of The Lancet did say, "Treatment
Action Campaign (TAC) has welcomed research by British scientists
showing that cocktails of AIDS drugs cut the rate of progression from
HIV infection to full-blown AIDS by 86 percent compared with patients
not receiving treatment."

The article also begins by saying, "For ethical reasons, there has been
no placebo-controlled randomized trial of HAART (Highly Active
Antiretroviral Therapy). The effectiveness of this treatment over
several years is therefore unknown."

This is what I, and many other "dissidents," have been saying for
years. In other words, after American taxpayers have spent a total of
$170 billion on AIDS (through 2005), there is still no controlled
clinical study showing that people taking the antiretroviral drugs live
longer, or at least better, lives than a similar group of people not
taking the drugs. And, as The Lancet authors acknowledge, their study
doesn't qualify either.

The authors state, "Without trial evidence, this information must come
from observational cohort studies. However, estimation of treatment
effects in observational studies is not straightforward...." Indeed it
is not, yet that is exactly what the authors did by using a "novel
methodology to overcome this problem."

To generate the results that so heartened TAC, the authors had to
resort to a statistical method that they acknowledge "is not widely
used in clinical research" and, in fact, "may not be widely known in
the clinical research community." Yet, their results are not
obtainable without this unused and unknown methodology.

Furthermore, their "results depend on the assumption that treated and
untreated individuals with the same values of measured prognostic
factors were similar. Prospective information about the reasons that
patients remain untreated is not recorded in the database, so we cannot
address this issue directly."

They also "assumed that once on therapy, a patient remains on therapy."

Finally, the authors wrote that they "used a combined endpoint of AIDS
or death from all causes, which has been widely used in clinical
HIV/AIDS research. We would have liked to examine the two endpoints
separately. In the era of HAART, an increasing proportion of deaths is
not associated with recent AIDS-defining events, and the current
definition of AIDS is no longer a near-complete marker for overall
progression. We could not do so for two reasons: the number of deaths
during follow-up was small, and good information on causes of deaths is
lacking in the Swiss and other cohort studies."

With the help of these assumptions, considerable hand waving and an
unused and unknown methodology, the authors concluded in the absence of
basic mortality data that "HAART reduced the rate of progression to
AIDS or death by 86 percent, and that its effectiveness compared with
no treatment increased with time since initiation."

The authors' chart titled "Estimated effect of HAART from unweighted
(standard) and weighted Cox models" captures the artificialness of
their results. It shows four different results for the same data
ranging from marginal, if any, effect to their 86 percent effect based
on their "novel methodology."

Why would anyone uncritically accept such a conclusion based on flimsy
data and unproved methodology, when doing so entails tremendous
consequences? Only a placebo-controlled randomized trial can determine
whether or not a therapy prolongs or improves life compared to no
therapy.