The program "AIDS United Nations, UNAIDS, next week plans to hold a closed meeting in Geneva which will begin new sort thorny questions about the ethics of conducting vaccine trials against HIV. A similar ethical dilemma is also discussed in today's New England Journal of Medicine ( NEJM ): if anti-HIV drugs considered standard care in the world developed should be available to people in developing countries who participate in clinical trials.
Peter Lurie and Sidney Wolfe of the advocacy organization focused on public health Citizen Research Group several trials around the world comparing placebo to various schemes of anti-HIV drug AZT to reduce HIV transmission of an infected pregnant mother to her child. The tests are designed to test patterns that are more affordable in poor countries. But Lurie and Wolfe - and NEJM editor Marcia Angell in an accompanying editorial. - Argue that because research has already shown that intensive treatment with AZT can reduce transmission by almost 70%, these trials are unethical
the issue is also critical for testing vaccines against AIDS, because ethics demands that people who are infected during a trial be given the best treatment available. Yet if everyone in a vaccine trial that becomes infected offered powerful anti-HIV drugs, it is extremely difficult - if not impossible - to detect whether the vaccine can delay or prevent the disease. Barry Bloom of the Albert Einstein College of Medicine in New York, who heads the UNAIDS Vaccine subcommittee, made this point at a congressional hearing last spring. Some researchers also claim that it is morally acceptable to use placebos to test treatments in countries where new HIV treatments are not available.
At the meeting of the UNAIDS subcommittee, scheduled for September 23 and 24, the panel will discuss "a framework for formulating these questions, and after a consultation period to try to reach a global consensus that protects the rights of everyone, "says Bloom. Lurie Public Citizen says that there should be one standard of care, but said," agreeably, it is a difficult situation. "Bloom hopes UNAIDS will hold a public meeting on the issue next spring.
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