HIV Cure Research: Ethical and Real-World Practical Considerations for Pediatric and Adolescent Populations

Area of Science:

• Pediatric Infectious Diseases
• HIV Cure Research
• Medical Ethics

Background:

• Antiretroviral treatment (ART) has advanced HIV management, but achieving sustained remission or cure remains difficult.
• Children and adolescents with HIV face unique challenges in accessing ART and achieving viral suppression compared to adults.
• Prioritizing pediatric HIV cure research is essential due to these disparities and the long-term implications for affected youth.

Purpose of the Study:

• To outline the ethical considerations and practical challenges specific to pediatric HIV cure research.
• To justify the focus on pediatric populations in HIV cure research, considering life course factors.
• To review unique ethical and practical aspects of cure research for children and adolescents living with HIV.

Main Methods:

• The Pediatric Adolescent Virus Elimination (PAVE) Collaboratory and Community Advisory Board (CAB) convened to discuss ethical frameworks.
• Utilized the Lo and Grady framework for ethical HIV cure research as a guiding principle.
• Reviewed existing literature and global data on pediatric HIV treatment and cure research.

Main Results:

• Identified specific ethical considerations and practical questions pertinent to pediatric HIV cure research.
• Highlighted the necessity of addressing multifaceted life course factors in pediatric cure strategies.
• Emphasized the unique vulnerabilities and requirements of children and adolescents in cure-focused clinical trials.

Conclusions:

• Pediatric HIV cure research requires a distinct ethical and practical approach compared to adult research.
• Addressing the unique needs of children and adolescents is crucial for advancing HIV cure strategies.
• Ethical frameworks must be adapted to ensure the safety and well-being of pediatric participants in cure research.