Libya AIDS trial concludes29th October 2006
A scientific report being used in the case against six foreign medical workers facing the death penalty in Libya is nothing but conjecture and supposition, according to international experts.
The evidence, commissioned from Libyan medics, has been produced to support the charge that the six knowingly infected more than 400 children with HIV at the Al-Fateh Hospital in Benghazi in 1998.
The court has denied requests by defence lawyers to hear evidence from international experts. Instead, five Libyan physicians testified in August that they stood by the conclusions of their 2003 report, commissioned by the court in an earlier trial, and on 29 August the prosecution called for the medics to be given the death penalty.
Janine Jagger, an epidemiologist and MacArthur fellow who heads the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, said she saw no evidence in the report. "It wouldn't meet the lowest standards of epidemiological evidence for establishing any causal relationship."
In 2003, the court also ordered a report from Luc Montagnier, who discovered the AIDS virus and is president of the World Foundation for AIDS Research and Prevention, and Vittorio Colizzi, an AIDS researcher at Rome's Tor Vergata University. They concluded that the infections were caused by poor hospital hygiene, and started before the medics arrived in Libya. But the court threw out this report, on the grounds that the Libyan panel had reached the opposite conclusion.
Robin Weiss, an AIDS virologist at University College London, said: "It wrongly turns lack of evidence into evidence of absence."
The report argues that HIV and hospital hygiene were not a problem in Libya (the prosecution describes the Al-Fateh Hospital as a "model") and that the outbreak was so large that deliberate, malicious infection of HIV could not be excluded.
The Libyan report also suggests that because the genetic sequence of the Benghazi HIV strain is different from any lodged in public databases, there are grounds for suspecting foul play. Montagnier pointed out however that the virus was a new natural recombinant of a highly infectious strain common in Central and West Africa, which has replaced most other strains in the region over the past few years.
To firmly establish any cause, a case-control study should also have been done, Jagger said, comparing risk factors and medical procedures used between the HIV-infected patients and a similar uninfected group to try and explain transmission.
Luc Perrin, a clinical virologist at Geneva University Hospital in Switzerland, who has treated many of the infected children, said the report also failed to provide any evidence for its assertion that HIV infection has not been seen in children at other Libyan hospitals.
Perrin is an expert on primary HIV infection. He has analysed samples from 148 of the infected children, collected in September 1998, and has obtained further data on 37 of them and 46 of their parents, when they were treated in Switzerland. Perrin says his genetic data support Colizzi's analysis, and that many of the 1998 samples have protein profiles corresponding to infections well over a year old. The accused medics first arrived in Libya in March 1998.
The Libyan report is also silent on the prevalence of hepatitis at Al-Fateh Hospital and other Libyan hospitals, noted Perrin — who found that half of the HIV-infected children were also infected with hepatitis B or C.
The purported 'smoking gun' in the Libyan report is the detection of HIV antibodies in vials allegedly found at one of the nurses' homes during a raid in 1999, but not tested until 2003. Both Montagnier and Colizzi have seen the results of a western blot, a test to detect proteins: they are "indeterminate", says Montagnier. "They say nothing," adds Colizzi. In 2002 Libya promised that they could test the samples independently, but neither has ever been given access.
Even a positive test could detect only antibodies to HIV. It would not show that the vials had contained the virus, according to Massimo Amicosante, a biologist also at Tor Vergata. Finding the virus would require testing for HIV RNA, which has not been done.
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