HIV answers raise new ethical questions

Experts address the ethical issues raised by the FDA's approval of Truvada for HIV prevention

2013-07-31

(Press-News.org) The Food and Drug Administration's approval last year of the drug Truvada for prevention of HIV infection was a milestone in the fight against HIV/AIDS, but experts are cautioning that it is only the beginning of new ethical concerns for health care professionals, policy makers, researchers and those taking Truvada to prevent HIV infection.

"For the first time, we will have a large number of individuals who are not infected with HIV taking medication for HIV, which introduces ethical concerns of well-being and justice," says Jeremy Sugarman, Deputy Director for Medicine at the Johns Hopkins Berman Institute of Bioethics. He and Kenneth Mayer, the director of HIV prevention research at Beth Israel Deaconess Medical Center, advocate for ethical issues to be considered along with medical data in the Journal of Acquired Immune Deficiency Syndromes.

Sugarman and Mayer argue it is ethically critical to ensure that use of an antiretroviral drug like Truvada for "pre-exposure prophylaxis"(PrEP) does not have the ironic consequence of making individuals and communities less safe and healthy. Inconsistent, rather than daily, use of PrEP could result in HIV transmission and the evolution of drug-resistant strain of HIV, the authors warn. Likewise, misunderstanding of PrEP's prevention capacity could lead to the spread of other sexually transmitted infections.

"Communication and careful monitoring by health care professionals is essential for PrEP to be successful," says Sugarman. "Reinforcing the importance of daily dosing, incorporating safer sex counseling and frequent HIV testing will help meet the moral imperative that HIV be prevented and not exacerbated by PrEP," he says. He and Mayer recommend training programs for health care professionals that include explicit consideration of PrEP's ethical issues and their management.

Additionally, Sugarman and Mayer highlight what they say are 'critical, unanswered questions' of access and allocation. When limited antiretroviral drugs are available, should prevention be prioritized over treatment for those already infected with HIV, or vice-versa? Is a clinic environment the best setting to provide necessary counseling as part of PrEP? These questions, as well as how much PrEP should cost and who should pay for it, need to be answered as PrEP continues to be used and evaluated, the authors say.

"The fundamental moral claim for using PrEP, or any other HIV prevention strategy, is decreasing the burden of new HIV infections," Sugarman says. "For PrEP's full promise and medicine's moral obligations to be fulfilled, these complex ethical issues must be monitored along with the performance of PrEP."

###

More information:

Sugarman and Mayer opinion in the Journal of Acquired Immune Deficiency Syndromes: http://journals.lww.com/jaids/Fulltext/2013/07012/Ethics_and_Pre_exposure_Prophylaxis_for_HIV.5.aspx

Jeremy Sugarman:

http://www.bioethicsinstitute.org/people/jeremy-sugarman-4

About the Johns Hopkins Berman Institute of Bioethics:

One of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental organizations and private sector organizations to address and resolve ethical issues. Institute faculty members represent such disciplines as medicine, nursing, law, philosophy, public health and the social sciences. More information is available at http://www.bioethicsinstitute.org.

ELSE PRESS RELEASES FROM THIS DATE:

Berkeley Lab researchers discover universal law for light absorption in 2D semiconductors

2013-07-31

From solar cells to optoelectronic sensors to lasers and imaging devices, many of today's semiconductor technologies hinge upon the absorption of light. Absorption is especially critical for nano-sized structures at the interface between two energy barriers called quantum wells, in which the movement of charge carriers is confined to two-dimensions. Now, for the first time, a simple law of light absorption for 2D semiconductors has been demonstrated. Working with ultrathin membranes of the semiconductor indium arsenide, a team of researchers with the U.S. Department of ...

Navy turns to UAVs for help with radar, communications

2013-07-31

ARLINGTON, Va.—Scientists recently launched unmanned aerial vehicles (UAVs) from a research vessel in a significant experiment that could help boost the Navy's radar and communications performance at sea. Sailing off Virginia Beach, Va., from July 13 to 18, the Office of Naval Research's (ONR) Research Vessel (R/V) Knorr explored ocean and atmospheric weather variations that can change the angle that radar and radio waves bend, making it more difficult for ships to remain undetected and hindering their ability to communicate or locate adversaries. Sponsored by ONR's ...

Penn: New variants at gene linked to kidney disease, sleeping sickness resistance

2013-07-31

A new study led by University of Pennsylvania researchers involves a classic case of evolution's fickle nature: a genetic mutation that protects against a potentially fatal infectious disease also appears to increase the risk of developing a chronic, debilitating condition. Such a relationship exists between malaria and sickle cell anemia. Individuals who carry a gene to resist the former are carriers for the latter. And recently scientific evidence has suggested that individuals who are resistant to human African trypanosomiasis, or sleeping sickness, are predisposed ...

Boomers hit hardest by 'Great Recession'

2013-07-31

A new study shows what many middle-aged Californians privately suspect: They are the first to lose their jobs and the health benefits that come with those jobs when hard times hit. The analysis by the UCLA Center for Health Policy Research looked at California data on the uninsured between 2007 and 2009 and found that of the approximately 700,000 Californians to lose health insurance during this time, the greatest increase was among residents between the ages of 45 and 64. "Whether because mid-career workers are viewed as too expensive or because there is a deeper ...

Frontiers news briefs: July 30

2013-07-31

Frontiers in Psychology Cross-cultural communication of emotional non-speech sounds Try to remember the last time that you inferred that another person was in an emotional state of mind – chances are that it was the sounds that he or she made that provided the clues. Emotional non-speech sounds (such as crying, hums, laughter, and sighs) are often considered an especially primitive form of emotional communication that in many ways resembles animal expressions more than human speech. But, this intriguing form of emotional signaling has received little attention from ...

A new model can predict a woman's risk of breast, ovarian and womb cancer

2013-07-31

The probability (absolute risk) of a woman developing breast, ovarian, and endometrial (womb) cancer can all be predicted using easily obtainable information on known risk factors for these cancers, according to a study by US researchers published in this week's PLOS Medicine. Ruth Pfeiffer from the National Cancer Institute in Bethesda, USA and colleagues from institutions throughout the US, developed statistical models based on risk factors of these three common cancers that could help with clinical decision making. The authors developed these models by using information ...

Reducing drug costs for patients could improve outcomes for high blood pressure

2013-07-31

Expanding health insurance coverage and reducing drug costs that are paid by patients (drug co-payments) in countries without universal free healthcare, such as the United States, may improve the treatment, and control of high blood pressure (hypertension, a condition which affects one billion people worldwide and leads to 7.5 million deaths), according to a study by UK and Canadian researchers published in this week's PLOS Medicine. Will Maimaris from the London School of Hygiene & Tropical Medicine and colleagues from the Population Health Research Institute and McMaster ...

Cardiovascular risk in type 2 diabetics with dangerously low blood sugar levels

2013-07-31

Type 2 diabetics who have severe hypoglycaemia are at higher risk of cardiovascular disease, a paper published today on bmj.com suggests. Severe hypoglycaemia is a condition where there is an abnormally low content of sugar in the blood. It is often classed as a medical emergency. Severe hypoglycaemia is a potential risk factor for cardiovascular disease in patients with type 2 diabetes and recent clinical trials have failed to demonstrate a beneficial effect of intensive glucose control on overall CVD events. Although observational studies have reported a positive ...

Increased fluctuation in blood pressure linked to impaired cognitive function in older people

2013-07-31

Higher variability in visit-to-visit blood pressure readings, independent of average blood pressure, could be related to impaired cognitive function in old age in those already at high risk of cardiovascular disease, suggests a paper published today on bmj.com. There is increasing evidence that vascular factors contribute in development and progression of dementia. This is of special interest as cardiovascular factors may be amendable and thus potential targets to reduce cognitive decline and the incidence of dementia. Visit-to-visit blood pressure variability has been ...

NHS patient information leaflets are 'inaccurate, inconsistent and confusing'

2013-07-31

The NHS's patient information leaflets are "inaccurate, inconsistent, and confusing – and effort is duplicated" argues GP Margaret McCartney on bmj.com. In a feature published today, Dr McCartney says the NHS is "awash" with patient information and with many trusts commissioning leaflets from external companies and others writing their own, it is difficult to know how efficient and effective these leaflets are. In a personal view, Dr McCartney says the NHS is "awash" with patient information and with many trusts commissioning leaflets from external companies and others ...

HIV answers raise new ethical questions

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: