Saturday, February 20, 2010

Study: SF PWA Drug-Resistance =
'Minor Public Health Problem'

We are well aware that a broad array of public health officials, media outlets and bloggers, gays and people with AIDS are raising serious questions about the Sally Blower of UCLA and James Kahn of UCSF math model study, alleging mini-epidemics of drug-resistant HIV strains.

Of particular concern is the last sentence of the study that was published in Science last month:

"Consequently, currently circulating [AIDS drug]-resistant strains in San Francisco pose a great and immediate threat to global public health."

And who exactly are the terrible people responsible for this threat to human life on the planet as we know now it? The same old gay boogeymen usually trotted out by homophobes who use homo-sex to make claims of civilization on the brink of extinction.

Blower and Kahn make clear
who the guilty people are behind this immediate threat:

"We calibrated and parameterized the model to represent the HIV epidemic in San Francisco in the community of men who have sex with men (MSM), where levels of [AIDS drug resistance] are already high."

But a 2003 report in AIDScience didn't predict high rates of drug resistance for San Francisco PWAs. Indeed, the researchers predicted the exact opposite, emphases mine:

Both the incidence of resistance (number of cases of transmitted resistance per year) and the prevalence of resistance have been predicted for San Francisco. Surprisingly, it has been predicted that, even with a very high usage of [AIDS drugs] transmitted resistance will initially increase and then fairly quickly stabilize at a relatively low level. These modeling predictions for transmitted resistance have been compared with recently collected empirical data in San Francisco and have been shown to be correct.

Guess who one of the co-authors is. None other than Blower. One of her key citations backing up her 2003 claims, is a study presented in Nature Medicine in 2001, which made the following remarkable statements:

[1] In contrast, we calculate that transmission of resistance is currently low, and predict it will remain low.

[2] We show that the epidemic of resistance is being generated mainly by the conversion of drug-sensitive cases to drug-resistant cases, and not by the transmission of resistant strains.

[3] We also show that transmission of resistant strains has not increased the overall number of new HIV infections.

[4] Our results indicate that transmission of resistant strains is, and will remain, a relatively minor public health problem.

You don't need three guesses to learn who two of the co-authors are. Yep, Blower and Kahn, again. Isn't great how Blower cites her previous work? So much for independent verification. I shouldn't really complain that Blower cites Blower, after all, because of this habit, I've learned that earlier crystal ball predictions from Madame Sally are at serious odds with her 2010 claim roiling San Francisco. But I digress.

Let's go over the statements, one by one. The first recognizes the good news about resistance back in 2001. Second statement about use of AIDS drugs had lead to resistance, not unsafe sexual practices of gay PWAs. This says much about the responsible behaviors of gay men.

Third statement is good news, but confusing. Who exactly was alleging that resistance would potentially equal more transmission in general of HIV?

Finally, the fourth statement and prediction has none of the alarmist and doomsday tone of Blower and Kahn's 2010 apocalyptic dangers facing the world because of gay/PWA drug resistance in San Francisco.

How the hell did we go from "a relatively minor public health problem," to a "great and immediate threat to global public health" in nine years? Sure, it's possible such a grave shift could occur, but the researchers have not addresses their apparent contradictions. Were the 2001 and 2003 allegations by Blower, Kahn, et al., wrong? Hard to say.

These, and a host of other legitimate questions need to be addressed by the UCLA and UCSF researchers. Wish I knew what it will take to force Blower and Kahn to abandon their stonewalling and silence. Communication between AIDS experts and PWAs and gays is required for sane public health policies.

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