Claims that people were being killed by zidovudine (AZT) instead of AIDS are unsubstantiated - Health Feedback
Lacks context: During the early years of HIV treatment when few drugs were available, zidovudine was given to patients by most doctors. As the main spokesperson on AIDS for the federal government, Fauci was often the government official who spoke about HIV treatments, including promoting zidovudine, however, Fauci was not the only doctor or government official recommending zidovudine, nor was he instrumental in the recommendation
FULL CLAIM: Remember that one time in the 80's-90's when people died from the AIDS treatment (AZT) and not the actual AIDS virus? Remember that one doctor [Anthony Fauci] who promoted that treatment?"
REVIEW
Since the beginning of the COVID-19 pandemic, Anthony Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and President Joe Biden's chief medical advisor on COVID-19, has been the target of attacks primarily from those who oppose emergency measures; these attacks have only become more intense and conspiratorial.
Two recent Facebook posts with the same claim (see here and here), are representative of certain claims aimed at discrediting Fauci. Both mention a period in the 80s and 90s "when people died from the AIDS treatment (AZT) and not the actual virus," and include an image of a younger Fauci speaking on C-SPAN, who the posts claimed was "that one doctor who promoted that treatment." One of the Facebook posts cited a 1989 article in Spin, a former music magazine-turned-webzine, written by journalist Celia Farber as the source for this claim. The version of the article that can be found online is a 2015 reprint with an introduction by Spin's founder Bob Guccione Jr.
As we'll explore below, the claim is unsupported, lacking context about the early years of zidovudine and human immunodeficiency virus (HIV) treatment, and making unsubstantiated claims that are not supported by the 1989 article used as a source.
A short history of Zidovudine (AZT)
There are currently more than 30 HIV drugs, also known as antiretroviral drugs, approved by the U.S. Food and Drug Administration (FDA). These drugs target HIV via a number of strategies, keeping the virus responsible for Acquired Immune Deficiency Syndrome (AIDS) from making countless copies of itself. This is critical, since if HIV is left to replicate unchecked, the infection will develop into AIDS.
For a period in the late 80s, however, there was only one HIV drug available: zidovudine, also known as AZT (azidothymidine). An abandoned cancer drug, zidovudine works by mimicking nucleosides, the building blocks of DNA. When the HIV virus enters a cell, one of the first steps it takes is to convert its RNA genome into DNA, which then gets inserted into the human genome. If these decoy nucleosides get incorporated into the newly-forming strand of HIV DNA, the formation of the DNA is terminated.
When zidovudine was approved by the FDA in 1987, it had been six years since the U.S. Centers for Disease Control and Prevention (CDC) published an article describing five cases of a rare pneumonia in young men in Los Angeles; this was the first official report of the condition that would later be called AIDS[1]. By December of 1987, the World Health Organization (WHO) had reported 71,571 thousand cases of AIDS worldwide (47,022 just in the U.S.), and had estimated that there were between five and ten million people living with HIV worldwide. By the end of 1987, 40,849 deaths from AIDS had been reported in the U.S. since the beginning of the epidemic, and for AIDS activists there was growing frustration and anger with the federal government's lack of urgency about the epidemic. It was in this scenario that zidovudine was approved, with public pressure fast-tracking the drug's approval process.
Zidovudine has been a controversial drug since day one. People criticized the cost of the drug, which at $8,000 a year in 1989 dollars was prohibitively expensive for many AIDS patients. Many were worried about zidovudine's side effects, which varied from patient to patient. While some who took it described renewed energy and weight gain, in others it caused nausea, vomiting and anemia. And many others, such as AIDS activist Larry Kramer in a 1987 op-ed in The New York Times, criticized the quick approval of AZT (25 months from demonstration in the lab to approval) when other drugs that were considered less toxic were not yet available.
One of the criticisms of zidovudine was that it seemed to decrease mortality—until it didn't. In 1989, the manufacturer of zidovudine, Burroughs Wellcome Company, mailed a letter to American doctors about resistant HIV strains found in 11 patients who had taken the drug for over six months. The development of viral resistance to zidovudine was seen in other studies, and these helped the HIV community realize that monotherapy–treating HIV with a single drug–was not a solution for managing HIV infections.
When HIV replicates, it accumulates mutations. These mutations can happen anywhere in the virus' genome, but in a situation where an individual is taking a single HIV drug—as was the case in the first years of zidovudine—the drug will kill off the susceptible viruses, while the viruses that carry mutations that allow them to evade the drug's effect, continue to replicate and eventually become the dominant strain; this is how resistant HIV strains emerge. According to the WHO, "all current antiretroviral drugs, including newer classes, are at risk of becoming partly or fully inactive because of the emergence of drug-resistant virus strains."
The solution HIV researchers found for this issue is combination therapy, which The New York Times called a "clear watershed in the treatment of AIDS". Combination therapy involves using three or more different HIV drugs instead of just one. Using a combination can delay and prevent the appearance of HIV drug resistance. Early studies into combination therapy combined zidovudine with two other HIV drugs.
Zidovudine is still used in combination with other drugs to treat HIV. Due to its toxicity, the drug is often replaced with newer HIV drugs with fewer side-effects, but some patients are still prescribed combinations that include zidovudine.
Claims in Facebook post about AZT are unsubstantiated and lack context
The main claim in the Facebook posts is that "people died from the AIDS treatment (AZT) and not the actual virus" for a period in the 1980s and 1990s. This claim is repeated in Farber's 1989 article in Spin. Farber asked one doctor, Harvey Bialy, "if he thought it was possible that people have been killed as a result of AZT poisoning rather than AIDS," and Bialy answered that "it's more than possible." Bialy, who died in 2020, was an AIDS denialist. The claim is also repeated in the introduction written by Guccione Jr for the 2015 reprint of Farber's article, who described zidovudine as "a drug that was worse than the disease, and killed faster than the natural progression of AIDS left untreated."
From Farber's article, it's clear that the claim is in reality speculation from one individual (and an AIDS denialist at that), and no evidence is provided for this speculation in either the Farber article or the 2015 introduction. As mentioned previously in this review, studies found that zidovudine, at least in the short term, decreased mortality. An Anglo-French study that began in 1988 with 1,750 participants, called the Concorde, concluded in 1993 that early treatment with zidovudine didn't halt the progress of AIDS nor did it lengthen the life of study participants[2]. As such, while zidovudine alone does not decrease mortality in the long-term, there is no evidence that it was the treatment's toxicity that killed people rather than AIDS.
The second claim in the Facebook posts is that Fauci promoted zidovudine. While this is true in a strict sense, it provides no context for the time and suggests that Fauci was alone in promoting zidovudine. In 1984, Fauci became the director of NIAID, an institute within the U.S. National Institutes of Health that both conducts and supports basic and applied research into infectious, immunologic, and allergic diseases. In 1986, NIAID created an AIDS program to coordinate research in HIV/AIDS. With this, Fauci became the one of the main government scientists focused on AIDS, appearing in the media to discuss the epidemic. "My face was the face of the federal government," Fauci told Michael Specter in a 2020 profile in The New Yorker.
Neither NIAID nor Fauci approve HIV drugs; approval of zidovudine and other HIV drugs was and continues to be done by the FDA. Articles that examine the history of zidovudine, such as this one by TIME and this one by VICE, never mention Fauci.
Still, Fauci did speak of and promote zidovudine and other HIV drugs in the media. Articles related to zidovudine in The New York Times archives, contain a handful of examples in which Fauci provided journalists with comments about the drug, such as this one about Burroughs Wellcome Company's letter on resistant strains—where Fauci urged caution on the results—and this 1992 article about growing doubts about zidovudine's effectiveness. In the 1992 article, Fauci told science journalist Gina Kolata that he believed the data was still sound enough to advise zidovudine for individuals whose immune system had begun to fail. At the time, most doctors remained in favor of zidovudine's usage.
Conclusion
Facebook posts concerning the use of zidovudine in the 1980s and 1990s, and Fauci's promotion of the drug, misleads in two ways. It claimed that the AIDS drug zidovudine, more commonly known as AZT in the 1980s and 1990s, killed more people than AIDS itself. However this is unsubstantiated, and the source given for this claim is in reality speculation from an AIDS denialist in a 1989 article.
The second claim about how Fauci promoted zidovudine lacks context. As the director of NIAID, Fauci became one of the main faces of the government in discussions about public health, and therefore was involved in commenting and promoting zidovudine after it was approved by the FDA in 1987. However, Fauci wasn't the only one to do so; based on the scientific evidence available at the time, many doctors at the time were also in favor of using the drug.
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