Toward an AIDS-free generation
An HIV treatment strategy that greatly expands the use of antiretroviral medication may provide a roadmap to an AIDS-free generation, but scientists launching clinical studies may have trouble running the kinds of tests that would find that out. HIV researchers are grappling with an ethical conundrum on the horizon even as they design and launch studies to test whether “treatment as prevention” can dramatically slash HIV transmission rates in the general population. Treatment as prevention initiates the use of powerful antiretroviral drugs as soon after HIV infection as possible, a significant change from earlier treatment guidelines that recommended drug treatment beginning when numbers of a key immune system cell, called a CD4 T-cell, fall to less than 350 cells per cubic millimeter of blood. A healthy person’s CD4 cell count is between 500 and 1,200 cells per cubic millimeter. Ethical concerns arose last June, when the World Health Organization (WHO) changed its recommended...