Dear Professor Makgoba,


You have been reported as saying that scientific problems cannot be solved by consensus (Sunday Independent, 19 March 2000) and that President Mbeki's panel should not address the question as to "whether malnutrition or TB causes AIDS or any of those things that come from the dissidents.  We're undertaking a series of projects to try to understand the peculiarities of the disease in SA".  (Financial Mail, 12 May 2000).


In a commentary by Michael Cherry, (Nature, 11 May 2000) regarding your proposal to conduct experiments in an effort to "establish conclusively the link between HIV and AIDS" (Financial Mail, 12 May 2000) one reads:  'According to MRC President Malegapuru Makgoba, the surveys could involve the clinical identification of a sample of AIDS sufferers , who would be tested for HIV.  Another possibility is an epidemiological study correlating HIV-positive children with the HIV status of their parents".


We agree with you that scientific problems cannot be solved by consensus and that the role of HIV in AIDS cannot be answered by addressing such questions as "whether malnutrition or TB" or "any of those things that come from the dissidents", such as "environmental pollutants and other unspecified chemicals" (Financial Mail, 12 May 2000).  As you say, any attempt to answer the role of HIV in AIDS must involve HIV.  We also agree that the best way to solve a scientific problem is to conduct experiments. However, we do have some questions regarding the suggested experiments.


(1)           According to a Lancet editorial, (Horton R, Lancet 1998;352:122) the developing world "bears more than 90% of the global burden of HIV infection" and that "Tuberculosis (TB) is the leading cause of death worldwide among the people with HIV".  And one of the most eminent experts on HIV/AIDS in Africa, De Cock, and his associates, state that the prevalent cases of TB in the developing World is 12-16 million; annual incidence of TB is 3.5 - 10.7 million and the annual deaths 1.14 - 3.96 million.  In sub-Sahara Africa these numbers are 2-3;  0.66 - 1.66 and 0.27 - 0.79 million respectively (De Cock KM, et al. JAMA 1992; 268:1581-7).


                By the end of the 1980's, long before TB became a "clinical identification" of AIDS, ample evidence existed that the vast majority of TB patients had a positive antibody test.  In other words ample evidence already exists for a correlation between a positive antibody test and the clinical identification of AIDS.  Why then repeat all these experiments if the answers are already known ?.


(2)           In a paper published by researchers from Harvard, including one of the best known retrovirologists, Max Essex, they found that "... leprosy patients and their contacts show an unexpectedly high rate of false positive reactivity of HIV-1 proteins on WB [83.6% patients; 64.1% contacts] and ELISA….sera from 63.6% of leprosy patients and 23% of their contacts were repeatedly positive for HIV-1 by ELISA".  They went one step further and proved that the antibodies which reacted with the proteins in the ELISA and WB kits were directed against two major carbohydrate-containing Mycobacterium leprae antigens-phenolic glycolipid I and especially lipoarabinomannan which is also present in Mycobacterium tuberculosis and other mycobacteria.  They also suggested that at least some of the antibodies in patient sera reacting  with the proteins in the ELISA and WB may be auto-antibodies induced by mycobacterial infections.


                They concluded:  "ELISA and WB may not be sufficient for HIV diagnosis in AIDS-endemic areas of Central Africa where the prevalence of mycobacterial diseases is quite high (Kashala O, et al.  J Infec Dis.  1994;169:296-304).



                The questions then are:


(i)            How are you going to determine in which, if any, TB patients the positive WB or repeated ELISA prove HIV infection, that is the tests are true positives?


(ii)           In which patients the underlying cause of TB and thus of the majority of AIDS cases in the developing world, including SA, is HIV and in which is not?


(3)           In regard to the "epidemiological study correlating HIV-positive children with the HIV status of their parents":


                (a)           As you know antibodies can and do cross the placenta.


(b) A significant proportion of pregnant women in sub-Sahara Africa will suffer from mycobacterial infections or come in contact with such individuals. "Tuberculosis may spread via the placenta or the foetus may acquire it from ingestion of contaminated amniotic fluid.  Congenital TB may affect the liver, spleen lymph nodes and other organs"(Harrison's Principles of Internal Medicine).


They may also suffer from malaria which is also known to be associated with a false positive HIV antibody test.  As far back as 1985, Biggar and his colleagues found that in Africa a positive HIV antibody test "correlated strongly with level of antibodies against Plasmodium falciparum", the microorganism which causes malaria (Biggar RJ. Lancet 1985;2:520-3). One year later, researchers from the USA and Venezuela reported that 3 out of 12 patients (25%) with Plasmodium vivax at no risk of AIDS and 5 of 12 (41%) of patients with Plasmodium falciparum, also at no risk of AIDS, 'were found to be positive for HTLV-III/LAV [HIV] antibodies by the indirect immunofluorescence, Western blot and radioimmunoprecipitation tests, … The frequency of antibodies of HTLV-III/LAV among healthy blood donors in this area was less than 1 percent" (Volsky et al. NEJM 1986;314:647-648). In one study it was found that Amazonian Indians who have no contact with individuals outside their tribes and have no AIDS have a 3.3-13.3% HIV WB seropositivity rate depending on the tribe studied (Rodriquez L, et al. Lancet 1985;2:1098-1100)


(c)           Such a study cannot be conducted in Australia because such cases are extremely rare.  In the USA and Europe, the majority of mother-infant pairs reported to have a positive antibody test originated from Africa or Asia or belonged to such communities, that is, in countries and communities where the prevalence of mycobacterial diseases is quite high.  For example, in the Women and Infants Transmission Study from the USA published in 1996, 56% of women were either black or Hispanic (Rodriguez EM, et al. AIDS 1996;10:273-82).  In another study from the USA published in 1997, 41% of the women were black and 42% Hispanic (Turner BJ, et al. 1997;14:327-37).  In the Paediatric AIDS Clinical Trials Group Protocol 185, USA, 51% of the women were black and 35% Hispanic (Stiehm ER, et al. J  Infec Dis 1999;179:567-75).  In the French Perinatal Cohort 40% of the women "were born in sub-Sahara Africa or the Caribean" (Mandelbrot L, et al. JAMA 1998;280:55-60).  By April 1996, 276 of the 389 (71%) children with HIV infection or AIDS reported to the UK combined obstetric and paediatric national confidential registers were from London, 80% of whom were born in sub-Saharan Africa (Gibb DM, et al.. Arch  Dis Childhood 1997;77:478-82).


How are you going then to know in which, if any, mother-child pair the positive antibody tests is true positive?


If we assume that in all patients a positive antibody test proves HIV infection and that a perfect correlation exists between HIV infection and the "clinical identification" of AIDS, is the virological correlation sufficient to prove causation?  Should not one also have immunological data which proves that the decrease in T4 cells in AIDS patients is due to their destruction by HIV?


It is our view that the experiments as reported in the media and some scientific publications are not going to clarify the role of HIV in AIDS.  We have been working on the AIDS problem from the very first beginning and conceptualised experiments which in our view may clarify the role of HIV in AIDS.  If you are interested, we would very much appreciate your comments and would be delighted to collaborate with you on such experiments.


Yours sincerely,



Eleni Papadopulos-Eleopulos



Fax int + 618 92241138





From: "Malegapuru William Makgoba" <>

To: Val F Turner <>

Date: Tue, 16 May 2000 15:14:18 +0200

Subject: Re: Letter from Eleni Papadopulos-Eleopulos


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Dear Val,

Thank you very much for your letter. It appears to me that your

understanding of clinical medicine and diagnosis is limited.

First of all I agree entirely with the notioon of false positive results.

However you must agree that in Africa, the diagnosis of AIDS

follows a history, a physical examination, laboratory investigations

and treatment. All these four essential steps are used to come to a

probable diagnosis.

Secondly, I spelt out this morning a cohort of 504 infants of whom

54 were found to be HIV positive by antibody test and by PCR.

Even you would agree that while the antibody crosses the placenta

the finding of positive viral DNA is significant. The mere presence of

a positive antibody test in a neonate is by itself not significant

provided it does not persist over time.

Thirdly I have also mentioned that the highest TB area in South

Africa has the lowest HIV antibody positivity. If the correclation was

simply with TB then the reverse would be found. There is no

correlation between TB and a positive antibody test in our setting.

We are the authorities here and not you mind you!!

The point I am trying to get you to undertand is that the diagnosis

of AIDS in South Africa is based on solid clinical grounds that are

supported by laboratory tests. Clinicians are trained to work in this

manner. The importance of a false positive antibody tests is usually

seen in the light of good clinical and other laboratory tests.

For a practising physician it is not usually difficult to discriminate.


I hope you find this helpful but I resent the notion that what we see

and diagnose is somehow wrong because you continue to confuse

good clinical practice and the accurate interpretation of laboratory

tests in a clinical setting.


yours sincerely,


MW Makgoba  DPhil(Oxon);FRCP(Lond); FRS(SAFr)








Dear Professor Makgoba:


My colleagues and I are sorry that we apparently confused you by our email with regards to the sender since your answer was addressed to me instead of E P-E who "signed" our letter to you.  Generally we use my email address as a central address for all correspondence.     Since you may not be aware who I am, permit me to give some information.    I belong to a group which over the years others have called "The Perth Group" in AIDS research.  The group is led by E P-E who put forward a theory on the cause of AIDS before the HIV theory was introduced.   Since then the group has published extensively on the questions surrounding the cause of AIDS.  The group includes three medically qualified individuals, namely, a professor of Pathology, a medical researcher and myself. I've been in Emergency Medicine since 1979 and am probably the oldest practising Emergency Physician in Australia.   I'm a foundation Fellow of my College and I've taught hundreds of medical students, interns and residents.   I've seen thousands of patients and even had a few wins.  I would never question your clinical abilities without seeing you in action at the bedside for a long period of time.  How you can pass judgement on mine is impossible to tell.


Please find below our comments to your answer as follows:


· "I really look forward to a discussion in which you respect the authority of those that are at the coal face of this epidemic."


We apologise if you thought that we do not respect your authority.    In fact, we have written to you because:


* We know that you are the authority there and respect you.

* Your people are said to have the highest incidence of AIDS.

* You care about them.

* We have been working on AIDS since it was first diagnosed and we believe that we may be able to contribute to find a solution.


However, we would also like to point out that if one always respects authorities in science, science would never progress.


Permit me to quote Giordano Bruno's Latin Frankfurt Trilogy, published in 1591:


"He who desires to philosophize must first of all doubt all things.  He must not assume a position in a debate before he has listened to the various opinions, and considered and compared the reasons for and against.  He must never judge or take up a position on the evidence of what he has heard, on the opinion of the majority, the age, the merits, or prestige of the speaker concerned, but he must proceed according to the persuasion of an organic doctrine which adheres to real things, and to a truth that can be understood by the light of reason".


· "I agree entirely with the notion of false positive results". 

We are glad.  The question then is how does one know that a positive antibody test, even in a single patient with TB, for example, is due to HIV infection?  This is a question you did not answer.


· "In Africa, the diagnosis of AIDS follows a history, a physical examination and treatment".


Although I am well aware that clinicians may elect to treat patients "on the balance of probabilities" or because not to treat may lead to disaster (eg meningococcal septicamia), it is scieintifically impossible to use treatment as a criteria for diagnosis.  (Otherwise we might have to conclude that heart failure for example is due to deficiency of foxglove).  I do not believe that pragmatism has any place in discovering scientific truths.


The use of the other three criteria for the diagnosis of AIDS, is best illustrated by an example:


In a paper published in 1992, researchers from the University of Ghana collected blood samples from 227 Ghanian patients diagnosed as having AIDS, without testing for HIV.  Of the 227 patients, 59% had neither a positive or indeterminate result for either HIV-1 or HIV-2.  (74% were negative for HIV-1).  This means either:

(i)            AIDS cannot be diagnosed in the absence of an HIV laboratory test,

(ii)           The vast majority of AIDS cases in Africa are not caused by HIV, and as the Ghanian researchers urge, one should search for "novel aetiological agents of the disease".  (Hishida et al Lancet 1992; 340:971-72).


· "I spelt out this morning a cohort of 504 infants of whom 54 were found to be HIV positive by antibody test and by PCR. Even you would agree that while the antibody crosses the placenta the finding of positive viral DNA is significant".


Significant of what? With the available data, it is not possible to consider it significant for HIV infection. As we pointed out to Harvey Bialy, in a court of law even the most inept lawyer would have no problem convincing a jury that a PCR or indeed any genomic study does not prove the detection of a retroviral genome much less that of a specific retrovirus HIV, when he presents proof that the RNA (cDNA) used to prove infection originated from material:


 (a) which contained no particles "with morphology typical of retroviruses" (Tahi D. Did Luc Montagnier discover HIV?  Text of video interview with Professor Luc Montagnier at the Pasteur Institute July 18th 1997. Continuum 1998;5:30-34);


(b) consisting of "purified microvesicles" (Gluschankof P, Mondor I, Gelderblom HR, Sattentau QJ. Cell membrane vesicles are a major contaminant of gradient-enriched human immunodeficiency virus type-1 preparations. Virol. 1997;230:125-133.)


Apparently HIV experts are either incapable or unwilling to consider that the possession of antibodies which react with a selection of proteins deemed unique to HIV (that is, being HIV seropositive) is not proof of infection although our group do agree it does correlate with a risk of either having or developing the diseases which constitute AIDS.  Yet the same clinicians, yourself included, have no problem reconciling the rate with which red blood cells fall through a column of normal saline (the ESR) being predicitive of the presence of or the propensity to develop a variety of diseases more extensive than AIDS.


· "the highest TB area in South Africa has the lowest HIV antibody positivity. If the correlation was simply with TB then the reverse would be found. There is no correlation between TB and a positive antibody test in our setting. We are the authorities here and not you mind you!!"


a) We never said that a positive "HIV" antibody test in SA is related "simply with TB". There are many diseases, including leprosy and malaria not to mention weight loss (weight loss leads to a positive antibody test and not vice versa (Moore PS, Allen S, Sowell AL, et al. (1993). Role of nutritional status and weight loss in HIV seroconversion among Rwandan women. J. Acquir. Immune Defic. Syndr. 6:611-616) which are also related to a positive test.

It is important to notice that your finding is in contradiction with many papers which report "co-infection" with mycobacteria and "HIV".  And if TB is a predominant AIDS defining illness in Africa, and if HIV causes AIDS and the tests specific, then one can only conclude that in your part of the world TB is not an predominant AIDS defining disease.  If not then what is?


b) In the "Profile of South African Medicine", Lancet May 24, 1997, in which you are a contributor, in the contribution headed "HIV and Tuberculosis" by Dr Abdool Karim one reads: "Clinically, pulmonary tuberculosis (TB) is the main presenting illness among HIV infected persons. The incidence rate of TB in South Africa is one of the highest in the world at 341 per 100 000 per year. To illustrate the burden in the era of HIV, the incidence rate of TB in one rural district with a population of about 200 000 rose from 154/100 000 in 1991 to 413/100 000 in 1995. At the same time, prevalence of HIV infection among these TB patients rose from 29% to 55%. Drug resistant in TB is closely monitored. Multiple-drug resistant TB has not increased as a fraction of all TB cases over the past two decades".


c) If :

i) The lancet editorial of July 11, 1998, is wrong; that is, in SA unlike anywhere else in the developing world TB is not "the leading cause of death among people with HIV";

ii) In SA, AIDS is a sexually transmitted disease caused by a sexually transmitted virus, whose transmission can be prevented by the use of condoms;

how do you explain the South African Demographic and Health Survey 1998, which shows no relationship between condom use and a positive "HIV" antibody test? (data below)


· "I resent the notion that what we see and diagnose is somehow wrong because you continue to confuse good clinical practice and the accurate interpretation of laboratory tests in a clinical setting".


I assure you I have no confusion about the application of diagnostic tests in clinical medicine.  And as I am sure you will agree, the predictive value of such tests is determined by their specificity and the prevalence of the condition for which the tests are used.  In this case HIV infection.  Let me point out that the clinical syndrome of AIDS cannot be used to define the specificity of an antibody test, no matter how good the clinical practice. For the HIV antibody test this is impossible. You cannot, on the one hand, say that a disease is caused by HIV because the patient has a positive antibody test; and on the other hand, that the antibody test is specific because the patient has the disease.  The only way to detemine the specificity of the antibody tests for HIV infection is to measure them against an independent gold standard, HIV isolation.  This has never been reported.  Why do you think manufactures such as Abbott Laboratories include the following in their packet inserts:


"At present there is no recognized standard for establishing the presence or absence of HIV-1 antibody in human  blood".  The identical statement is present in their 1988 and 1998 packet inserts.



My colleagues and I have spent nearly twenty years researching AIDS.  In this quest we are the only people to question whether HIV has been isolated and for us this in now the only question of relevance.  Even you must agree that without HIV there can be no HIV theory of AIDS or of anything.  If you find the notion that the phenomena said to prove the existence of HIV are a misinterpration and too hard to bear, then may I ask you to spend some time reading our papers and respond to them point by point.  As I have to your letter.  If you find the idea that a group of scientists could mistakenly identify a retrovirus then I urge to you to study the papers that relate to the isolation, the antibody tests and the demise of HL23V.  This was the "first" human retrovirus, discovered in the mid 1970s by Gallo and now recognised as an embarrassing error.  There are uncanny parallels between HIV and HL23V.



Yours sincerely,



Val Turner




From: "Malegapuru William Makgoba" <>

To: Val F Turner <>

Date: Fri, 2 Jun 2000 14:21:56 +0200

Subject: Re: Reply to your email 16/5/00


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Priority: normal

X-mailer: Pegasus Mail for Win32 (v3.01b)


Dear Val,

Thank you for your replies, unfortunately you have got things wrong

and this is not surprising. To say that a response to foxglove in

patient with heart failure implies that the patient is foxglove

deficient is an intepretation that is ridiculous and laughable but that

is how you interpret my statement that a response to treatment

constitutes evidence in causation in medicine when taken into with

the other three criteria.

Secondly patient who are TB positive and are HIV positive would

not have HIV specific cytotoxic T cells if this is due to false positive


In the interest of my own sanity, I hope you understand how my

logic is derived and I am quite confident that you can distinguish

false positives easily if you are well trained and you reason


Again I want to thank you I wish you well. I do not need any further

replies or responses.


Bye now.


yours sincerely,


MW Makgoba










KwaZulu Natal
















Free State
















North West








Eastern Cape
















Northern Cape








Western Cape

















































percentage of sexually active women currently using condoms as their method of contraception


HIV POSITIVE=women attending antenatal clinics.  Not the same group of women.