Intended for healthcare professionals

Rapid response to:

Education And Debate

The politics of AIDS in South Africa: beyond the controversies

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:495

Rapid Response:

Don't Confuse CFS with AIDS

One should not confuse CFS with AIDS. CFS results from a hyper-active Th1
immune response. AIDS suppresses the Th1 response.

We have been studying a 'rare' disease, Sarcoidosis, in which Th1
'autoimmune' processes are obvious and dominant [1,2]. Nearly all of these
patients have been diagnosed, at some point or other, as suffering from
'CFS syndrome'. CFS symptoms typically are at their worst when the patient is
presenting a high level of a steroid hormone characteristic of Th1
inflammation, 1,25-dihydroxyvitamin-D. The symptoms can sometimes be modulated by
reducing the ingestion of the hormone's precursor, a Th1 immune stimulant which
history has termed "Vitamin D" [3]. Serum 1,25-dihydroxyvitamin-D drops to negligable
level as AIDS progresses, and it loses its ability to stimulate the Th1
response [4].

Intracellular bacterial pathogens are associated with a vigorous Th1
immune reaction [1,2]. Viral infections, on the other hand, typically
elicit a Th2 immune
response. Indeed, many viruses actively suppress the Th1 activity. An
excellent explanation of how the non-infectious surface antigen of
Hepatitis B (HBsAg) works to directly oppose the differentiation activity of
1,25-dihydroxyvitamin-D is expounded by Vanlandschoot, et al [5]. It is
possible that HIV suppresses Th1 immune proliferation in a similar

In other words, bacterial pathogens produce an excess
of 1,25-dihydroxyvitamin-D in the inflamed tissues while typical viral
infections (including Hepatitis B and HIV)
actively counteract any the effects of 1,25-dihydroxyvitamin-D in those

In our cohort, we found that judicious use of antibiotics, in conjunction with control of Angiotensin
II, eliminated all symptoms of the CFS
syndrome [2].

While it is absolutely true that the U.S. is suffering an epidemic of CFS, it is
totally incorrect to attribute that epidemic to an occult HIV infection. We
believe the CFS syndrome is unlikely to result from a viral pathogen.

1. Berger A: Th1 and Th2 responses: what are they? BMJ

Available from URL

2. Marshall TG, Marshall FE: Sarcoidosis succumbs to antibiotics -
implications for autoimmune disease.

Autoimmunity Reviews, in press, doi:10.1016/j.autrev.2003.10.001

Available from URL

Nov 19, 2003

3. Hewison M, Gacad MA, Lemire J, Adams JS: Vitamin D as a cytokine
and hematopoetic factor.
Rev Endocr Metab Disord 2001, 2(2):217-27.

4. Haug CJ, Muller F, Rollag H, Aukrust P, Degre M, Froland SS: The
effect of 1,25-vitamin D3 on maturation of monocytes from HIV-infected
patients varies with degree of immunodeficiency.
APMIS. 1996
Jul-Aug;104(7-8):539-48. PMID: 8920807

5. Vanlandschoot P, Van Houtte F, Roobrouck A, Farhoudi A, Leroux-Roels
G: Hepatitis B virus surface antigen suppresses the activation of
monocytes through interaction with a serum protein and a monocyte-specific
Journal of General Virology (2002), 83, 1281-1289

Available from
Accessed 4 April 2004

Competing interests:
None declared

Competing interests: No competing interests

07 April 2004
Trevor G Marshall
Research Director
Autoimmunity Research Foundation