Claus Koehnlein, MD, was a specialist in internal medicine in the Dept. of Oncology, Univ. of Kiel, Germany between 1983 -1993. Since 1993, he has been in private practice, increasingly treating HIV-positive people who decline antiviral drugs. Dr. Koehnlein welcomes all correspondence, which may be addressed to him directly at: This email address is being protected from spambots. You need JavaScript enabled to view it.. He may, at his discretion, publish selected letters (anonymously), along with his reply, on this web page.


January 22, 2006 — How I Became an AIDS Dissident Doctor

As an "AIDS doctor" following the chemical-AIDS hypothesis you are in a tough place. What I mean is  that you are always with one leg in prison, since you know the guidelines  for therapy, and if you don't follow these guidelines and something happens (some/any disease appears), you easily can face legal action.

And it is difficult to simply say, "Forget about your HIV diagnosis, just get the treatment for the disease which is diagnosed", since we don't know, for example, whether a cerebral toxoplasmosis is more efficiently treated with a protease inhibitor than  with antibiotics. The same is true for generalized mycosis and other AIDS-defining conditions, *because there are no controlled studies.* (more on this in future columns).

So I will start by explaining how I first began to put myself in such an awkward position, and earned the title of a dissident AIDS doctor.

I saw my first AIDS patient in 1990 when I was part of the oncology unit at Kiel University. The patient was a strong, 35 year old man and he was suffering from a lymphoma. Because of a pos. EBV-test, he was said to suffer from Burkitt-Lymphoma. At that time our hospital started HIV antibody testing. The test happened to to be positive in this patient, and instantly the diagnosis changed from EBV related lymphoma to HIV-induced lymphoma and the patient was an AIDS patient from that moment on. I learned that he needed another treatment because AZT was tested in a controlled trial, and shown to be effective. Indeed the lymphoma disappeared, along with the patient, two years later. He died of PCP under bone marrow suppression.

At that time I did not know there was a controversy about the causation of AIDS. My criticism was only on an epidemiological basis. I said something like, "for me that's not a new epidemic, it's just an epidemic of testing,  and consequently giving old diseases a new name. I didn't get many new friends with that idea.

A few months later, a 28 years old female was admitted to the hospital almost dying, breathless with fluid in the pleura. She had been on holiday in Sri Lanka and came back with high fever and severe headache, and because of that she was admitted at the Institute for Tropical Diseases in Hamburg. There she got lots of antibiotics because of the unknown fever. She deteriorated and was put on cortisone under the suggestion of some autoimmune disease. She recovered for some weeks and than deteriorated again and was admitted to our hospital because my chief at that time was a highly estimated Lupus erythematodes specialist. The woman was almost dying had lost a lot of weight and you cold easily call her an AIDS patient.

We started a whole bunch of diagnostic procedures and found nothing, not even HIV. But after a while we got a result from an Institute where we had sent some bone marrow of the patient and they found Histoplasma capsulatum in the bone marrow. We were excited - a treatable disease. We placed the patient on intravenous antimycotics and she recovered completely.

We repeated the discussion of several months previous. That's an AIDS patient, I said. It's an AIDS defining condition. It's not, said the other side. She is HIV negative, so she cannot have AIDS because AIDS is caused by HIV. At that moment I had a certain epiphany as I realized fully the insidiousness of the tautological definition.

HIV- antibody positive plus one of 27 old diseases (histoplasmosis, tuberculosis, lymphoma,cervical cancer etc...) is the new disease AIDS. But the same disease without HIV is simply the old condition.


February 11, 2006 — The AZT Disaster

Remember our Patient with the lymphoma? Instead of getting his courses of chemo (COPP-cyclophosphamide, oncovin, procarbacin, prednisone ) he got 1500 mg AZT daily. The COOP is given in cycles of 3 days, repeated every 4-6 weeks to give the bone marrow time to recover. The AZT was given on a daily basis indefinitely. Under both therapy regimes the lymphoma disappears. But under daily AZT the patient follows quickly. We, the orthodox doctors, were not so much concerned about the early passing away of our patient because we were told AIDS patients have a very poor prognosis- so the one under AZT fulfilled the bleak prognosis he was given from the observations that  AIDS patients were passing away without AZT-treatment.

How could this iatrogenic AIDS tragedy have come about? It was because of Fischle et al. in 1987. Their "double-blind, placebo controlled trial", as it was announced in the NEJM, promoted 1500 mg AZT as the wonder drug against AIDS. Their conclusion was that "these data demonstrate that administration of 1500 mg AZT can decrease mortality and frequency of opportunistic infections in a selected group of subjects with AIDS or AIDS-related-complex, at least over the 8 to 24 week of observation."

What does that mean for an orthodox doctor? It means that you are more or less forced to give your patients this recommended treatment. If you don't, the patient can easily sue.

NEJM is the bible for an orthodox doctor. The end of any discussion is - No,  it's true. I read it in the NEJM.

The placebo arm was stopped after four months because by then the advantage of the verum (AZT) seemed so obvious (1 death in a 145 patient verum against 19 deaths of 137 receiving placebo.)

But the question arises whether the advantage of a treatment after four months can be sustained when you give this treatment longer or even lifelong.  AZT was developed to treat cancer and since it is a nucleoside analog it could be possibly useful there. It works like cytosinarabinoside or hydroxyurea, both well known in the treatment of leukemia.  Gallo even proposed AZT in the treatment of "viral leukemia" . But it is not designed to treat people who are already suffering from a loss of T cells.

So how comes it that there was a survival benefit after 4 months of AZT? The patients included were AIDS and AIDS related complex patients. That means they were quite ill, and were suffering from serious opportunistic infections. AZT kills everything that depends on DNA replication -- that means opportunistic infections and also cancers will respond to the treatment -- but at a high price. At the same time you are killing the opportunists with AZT, you are killing all dividing cells quite effectively - that includes those in the bone marrow, the very source of our immune cells.

That's the dilemma: In treating AIDS patients with AZT,  we bring about the very illness we seek to bring under control. And we all knew, orthodox AIDS doctors and borderline rebels both, was that the initial treatment with 1500 mg was an overkill . Everybody admits that now. Yes, it was too much. Maybe some people died,  but that's history, that's the way medicine has always worked. Let's look forward. Today we have this wonderful triple therapy, and mortality rates are dropping. So what, I say.

We virtually killed a whole generation of AIDS patients without even noticing it because the symptoms of the AZT intoxication were almost indistinguishable from AIDS. And the placebo control, which could have warned us, was for "ethical reasons" cut off prematurely.

Indeed, AZT intoxication has given the HIV infection such a lethal outcome that the whole world still believes that HIV is a deadly virus.

I got angry. I wrote a letter to John Maddox, the editor of Nature.