Posted on August 12, 2013
Source: Annals of Internal Medicine
Jeremy Sugarman, MD, MPH, MA
Bioethics and Human Rights Co-director
Mounting evidence is fueling excitement over the possibility of curing HIV infection. Two “Boston patients” who had bone marrow transplantations (1) and a “Mississippi baby” who was given aggressive antiretroviral therapy (2) soon after birth seem to be free of HIV infection. These accounts add to earlier reports of the “Berlin patient” who lacks evidence of HIV infection after transplantation with cells conferring HIV resistance (3) and members of the Visconti cohort who seem to be free of HIV infection after stopping antiretroviral therapy (4). In aggregate, these findings support the plausibility of “HIV cure research” aimed at eliminating the need for continuous antiretroviral therapy, with its inherent burdens and costs.
HIV cure research includes diverse approaches, ranging from bone marrow transplantation, to aggressive early treatment of HIV infection, to withdrawal of antiretroviral therapy to permit killing HIV in biological reservoirs perhaps augmented by activating the latent virus (5). Although substantial resources are being directed toward advancing this agenda, the research raises complex ethical issues.
Lo and Grady (6) outline a key set of ethical points to consider in HIV cure research, including collaborative partnership, social value, scientific validity, fair selection of participants, favorable risk–benefit balance, independent review, informed consent, and respect for enrolled participants and communities. Undoubtedly, these basic and familiar issues must be addressed. However, this approach should be supplemented with an expanded view of the inherent ethical issues as well as the use of comprehensive approaches to protecting participants, including robust consent processes, oversight that includes relevant expertise, and empirical data to help inform trial design and consent.