Lancet Infect Dis. 2014 Jun 3. pii: S1473-3099(14)70766-2. doi: 10.1016/S1473-3099(14)70766-2. [Epub ahead of print]

Research into a functional cure for HIV in neonates: the need for ethical foresight.

Shah SK1, Persaud D2, Wendler DS3, Taylor HA4, Gay H5, Kruger M6, Grady C3.

Author information

• 1Clinical Center Department of Bioethics, National Institutes of Health, Bethesda, MD, USA. Electronic address: shahse@mail.nih.gov.
• 2Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, MD, USA.
• 3Clinical Center Department of Bioethics, National Institutes of Health, Bethesda, MD, USA.
• 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
• 5Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA.
• 6Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.

Abstract

In 2013, researchers announced that a newborn child from Mississippi, USA might have been functionally cured of HIV by being given combination antiretroviral therapy within hours of birth. Public and media attention has since been captured by the possibility of finding a cure for HIV transmitted from mother to child. Research into the strategy used for the Mississippi patient is crucially important to establish whether it can be replicated and shown to work in diverse populations. At the same time, any ethical issues likely to arise in such studies should be addressed and not ignored in the pursuit of a functional cure. In this Personal View we identify ethical issues that could arise in research towards achievment of a functional cure for HIV in neonates, including difficult trade-offs associated with choosing the study population and questions about the broader social implications of the research, and propose ways to resolve them.