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P
RESIDENTIAL
AIDS A
DVISORY
P
ANEL
R
EPORT
 A synthesis report of the deliberations by the panel of expertsinvited by the President of the Republic of South Africa,the Honourable Mr Thabo Mbeki
March 2001
 
Presidential Aids Advisory Panel Report
2
Contents
CONTENTS.....................................................................................................................2 ACKNOWLEDGEMENTS...................................................................................................7 ABBREVIATIONS............................................................................................................8CHAPTER 1 – SETTING THE SCENE..................................................................................9
1.1B
 ACKGROUND
.............................................................................................................................91.2C
OMPOSITION OF THE
P
RESIDENTIAL
 AIDS A 
DVISORY 
P
 ANEL
............................................................101.3T
ERMS OF REFERENCE FOR THE
P
RESIDENTIAL
 AIDS A 
DVISORY 
P
 ANEL
................................................111.4T
HE REPORT
.............................................................................................................................13
CHAPTER 2 - AETIOLOGY AND TRANSMISSION OF AIDS................................................15
2.1I
NTRODUCTION
.........................................................................................................................152.2D
OES
HIV
CAUSE
 AIDS?............................................................................................................16
2.2.1 Visualisation and Isolation of the Virus..........................................................................162.2.2 PCR (Polymerase Chain Reaction) and ELISAs...............................................................182.2.3 Clinical and Laboratory Evidence of Causation...............................................................192.2.4Evidence from Animal Models........................................................................................222.2.5 Epidemiological Evidence..............................................................................................22
2.3A 
LTERNATIVE HYPOTHESIS ON THE CAUSE OF
 AIDS..........................................................................23
2.3.1The Chemical AIDS Hypothesis......................................................................................232.3.2The Immunotoxicological Hypothesis.............................................................................242.3.3The Oxidation Hypothesis..............................................................................................24
2.4 T
HE INVOLVEMENT OF COFACTORS
(
OR RISK FACTORS
)
IN
 AIDS.........................................................24
2.4.1Involvement of cofactors in HIV-causes-AIDS Hypothesis..............................................252.4.2Risk factors that are the primary cause of AIDS according to alternativehypotheses/theories......................................................................................................27
2.5T
RANSMISSION OF
HIV
 AND
 AIDS...............................................................................................28
2.5.1HIV Transmission as Estimated from ‘AIDS Deaths’.......................................................292.5.2Sexual Transmission......................................................................................................302.5.3Mother-to-Child Transmission........................................................................................322.5.4 Blood-borne transmission and Occupational Exposure...................................................332.5.5Epidemiology of Transmission.......................................................................................34
CHAPTER 3 – SURVEILLANCE........................................................................................37
3.1W
HAT ARE THE QUESTIONS AND ISSUES
?.......................................................................................37
 
Presidential Aids Advisory Panel Report
3
3.2O
 VERVIEW ON THE NECESSITY FOR SURVEILLANCE
............................................................................373.3S
OUTH
 A 
FRICAN EPIDEMIC
 – F
 ACT OR FICTION
................................................................................38
3.3.1AIDS mortality...............................................................................................................39
3.4E
PIDEMIOLOGICAL
T
HEORY OF
C
 AUSAL
I
NFERENCE
...........................................................................413.5S
OCIO
-
ECONOMIC RISK FACTORS
..................................................................................................423.6D
IFFERENCES IN THE
 A 
FRICAN EPIDEMIC
,
COMPARED WITH
E
UROPE AND THE
USA.................................433.7T
HE ROLE OF MATHEMATICAL MODELS IN FORECASTING THE EPIDEMIC
..................................................443.8S
URVEILLANCE RECOMMENDATIONS
 –
WHAT SHOULD BE DONE ABOUT THE
S
OUTH
 A 
FRICAN EPIDEMIC
?.......45
3.8.1Deliberations of the panel.............................................................................................45
R 
ECOMMENDATION
..............................................................................................................................45
3.8.2Discussion on mortality data.........................................................................................45
R 
ECOMMENDATION
..............................................................................................................................45
3.8.3Recommendations from panellists who do not subscribe to the causal linkage betweenHIV and AIDS................................................................................................................453.8.4Recommendations from panellists who subscribe to HIV as the cause of AIDS..............463.8.5General recommendation..............................................................................................48
CHAPTER 4 - HIV TESTS AND THEIR ACCURACY
............................................................494.1HIV
TESTING
...........................................................................................................................49
4.1.1ELISA test....................................................................................................................504.1.2Western Blot.................................................................................................................514.1.3PCR test for viral load...................................................................................................524.1.4CD4 count.....................................................................................................................53
4.2V
IRUS ISOLATION OR CO
-
CULTURING
.............................................................................................534.3M
ORATORIUM ON
HIV
TESTING
...................................................................................................534.4R 
ECOMMENDATIONS ON
HIV
TESTING
...........................................................................................54
4.4.1Proposed studies and experiments................................................................................544.4.2Recommendation on future HIV testing.........................................................................554.4.3General recommendations on testing............................................................................55
CHAPTER 5 –THE TREATMENT OF AIDS AND THE USE OF ANTI-RETROVIRAL DRUGS......56
5.1I
NTRODUCTION
.........................................................................................................................565.2E
 VIDENCE IN SUPPORT OF THE USE OF ANTI
-
RETROVIRAL DRUGS
.........................................................565.3E
 VIDENCE AGAINST THE USE OF ANTI
-
RETROVIRAL DRUGS
..................................................................575.4R 
ECOMMENDATIONS ON TREATMENT WITH ANTI
-
RETROVIRAL DRUG
.....................................................59
5.4.1Recommendations on the use of anti-retroviral drugs from the group opposed to theiruse................................................................................................................................595.4.2Recommendations from the proponents of anti-retroviral drug use................................60
R 
ECOMMENDATIONS
:...........................................................................................................................61
CHAPTER 6: PREVENTIVE AND PROPHYLACTIC MEASURES AGAINST AIDS...................63
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