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Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
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Ethical issues in HIV remission trials.

Nir Eyal1, Lisa G Holtzman1, Steven G Deeks2

  • 1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.

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|July 18, 2018
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Summary

Exploring HIV remission requires careful ethical consideration. Current studies prioritize participant safety but must also address risks to non-participants and maximize societal benefit for global HIV control.

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Area of Science:

  • Medical Ethics
  • Infectious Diseases
  • Clinical Research

Background:

  • Experimental pathways for long-term human immunodeficiency virus (HIV) control without antiretroviral therapy (ART) are under investigation.
  • Early clinical studies are evaluating these HIV remission strategies, presenting unique ethical challenges.

Purpose of the Study:

  • To review the ethical considerations of HIV remission studies.
  • To highlight risks to study participants and non-participants, including fetuses and sexual partners.
  • To assess the adequacy of current ethical analyses and propose improvements.

Main Methods:

  • Review of existing ethical analyses concerning HIV remission studies.
  • Identification of risks associated with invasive study procedures.
  • Evaluation of proposed risk mitigation strategies for participants and non-participants.

Main Results:

  • Ethical focus has predominantly been on participant risks, with established mitigation procedures.
  • Risks to non-participants, such as fetuses and sexual partners, are often inadequately addressed.
  • The societal value of studies, including their impact on the global HIV burden, is rarely prioritized in ethical discussions.

Conclusions:

  • HIV remission studies present complex ethical dilemmas, balancing participant safety with broader societal implications.
  • There is a critical need to address risks to non-participants and enhance the societal value of HIV remission research.
  • Novel ethical frameworks are required to ensure informed consent, minimize participant risk, and maximize the global benefit of HIV remission strategies.