Monday, August 04, 2008

AIDS Talkfest on the Road

The International AIDS Conference is again on the road, this time in Mexico City (watch carefully whether the surplus sero-conversions that go with that event match those resulting from the last AIDS conference, or whether they're higher or lower - funny counting game). Anyway, more seriously, there are some interesting issues the talk fest crowd is going on about.

For starters, 150+ HIV vaccine trials crashed not exactly without a trace, rather in quite a few of them those participants randomized into the active arm were becoming more (instead of less) susceptible to picking up HIV. So, both HIV vaccine and HIV microbicide trials have hit a wall of sorts.

Interestingly, however, there's possibly some light at the end of the tunnel. A few months back a team of HIV specialists in Switzerland announced that in their opinion people on antiretrovirals are no more likely to transmit HIV than are people who use condoms. The reason for this is that the medicines reduce an infected person's viral load to such low levels that it's next to impossible to pass the bug on to sexual partners. There's all sorts of caveats, but this matters in the face of rising STI rates among people in high HIV prevalence groups in a whole bunch of countries, including Germany, the USA and many others.

Well, fascinating ethical questions abound: Should one tell people on HIV medicines that their risk is that low or would that mean that they would take unreasonable risks - eg by having more unsafe sex with more people than they would otherwise have? Should we put people very early on in their infection on HIV medicines, for public health reasons as opposed to reasons to do with their medical care? What should we do if there ever arose a conflict between public health interests and patient care? Considering that a substantial number of people on medicines are not as compliant in terms of how they should be taking them, and considering that this leads to more drug resistant mutations of the virus, at what point in time would the early introduction of drugs be outweighed by these undesirable consequences? What are the implications for the criminalization of HIV transmission? If someone duly takes her anti HIV drugs and her partner - not knowing about her infection -picks up the bug anyway, would it be acceptable to punish her?

Difficult new questions to ponder.

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