4th International AIDS Society Conference on HIV Pathogenesis and Treatment


Sydney, Australia - July 22 - 25, 2007

HAART AS PREVENTION: THE ETHICS OF SUPPRESSING HIV REPLICATION IN INFECTED INDIVIDUALS TO PROTECT THEIR UNINFECTED PARTNERS

IAS Conf HIV Pathog Treat 2007 Jul 22-25;4th: Abstract No. MOAC302

Routy J.-P.1, Lebouché B.2, Brenner B.3, Thomas R.4, Tremblay C.5, Rouleau D.5, Bruneau J.6, Baril J.-G.7, Shenker H.8, Raffi F.9, Wainberg M.3, Gilmore N.1
1McGill University Health Centre, Immunodeficiency Service, Montreal, Canada, 2Hospice Civil de Lyon, Service d'hepatologie, Lyon, France, 3Lady Davis Research Institute, McGill AIDS Centre, Montreal, Canada, 4Clinique l'Actuel, Montreal, Canada, 5Centre Hospitalier de l'Universite de Montreal, Service Microbiologie et de Maladies Infecieuses, Montreal, Canada, 6Centre Hospitalier de l'Universite de Montreal, Departments of Psychiatry and Family Medicine, Montreal, Canada, 7Clinique du Quartier Latin, Montreal, Canada, 8McGill University Health Centre, Family Medicine, Montreal, Canada, 9Hotel-Dieu, Sevice de Maladies Infectieuses, Nantes, France

OBJECTIVES: Growing consensus that HIV transmission risk is related to HIV inoculum size asks whether controlling viral replication with HAART can reduce this risk. Data on mother-to-child transmission, serodiscordant couples and from our Montreal HIV Primary Infection Study show that transmission risk is related to the level of viral load. Then, is the early initiation of HAART in infected persons justifiable to protect their uninfected partners? This dilemma asks whether exposing someone to therapy without immediate benefit but potential harms is justifiable in order to bring potential benefits to others.

METHODS: Ethicists, virologists, epidemiologists, clinicians and HIV-infected spokespersons, from France and Quebec, were asked to examine the merits of using HAART preventively.

RESULTS: Arguments in favour of preventive HAART are: (1) evidence indicates that HAART reduces viral replication in a durable way with manageable toxicity (2) the immediate cost of HAART will be compensated by cost-savings from avoided infections (3) intervention could reduce blame, shame and fear, improving social attitude. Negative arguments include (1) risks from HAART outweigh their preventive benefits (2) Converting physicians from patients’ advocates to public health agents (3) increased sexual risk-taking (4) development of HIV resistance could lead to failure of protection and transmission of resistant virus.

CONCLUSIONS: Whether physicians should counsel their patients to initiate HAART, as a prevention strategy is still unresolved. In the meantime, prevention efforts should focus on: (1) development of prospective clinical trails to confirm the role of HAART in reducing transmission (2) identifying HIV infection as early as possible to counsel partners about avoiding risks of infection (3) encouraging partners to always protect themselves, even when the infected partners are being treated successfully (4) infected persons seeking early HAART, as a preventive strategy, should never be denied this intervention.

Acrobat ReaderDownload PDF of this abstract.

Power Point PresentationDownload Power Point Presentation.

2007-07-22
MOAC302
Ethics In Biomedical Prevention

Copyright © 2007 - International AIDS Society (IAS). All information and content relating to the abstracts from the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment, such as text, graphics, logos, button icons, images, audio clips, and software is protected by copyright. Permission is hereby granted for the non-commercial use or reproduction of the information on this web site, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.

AEGiS is made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. Permission is hereby granted for the non-commercial use or reproduction of the information herein, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.