Marseille 2007
| Abstract #617 - Psychosocial and Ethical Dilemmas Facing HAART as a Prevention Method | ||||
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Session: 49.7: Late Breakers (Parallel) on Wednesday @ 08.30-10.30 in HC Chaired by Bruno Spire, Kate Hankins Authors: Presenting Author: Prof Jean-Pierre Routy - Royal Victoria Hospital, Canada |
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| Additional Authors: Dr Bertrand Lebouche, Dr Bluma Brenner, Dr Michel Roger, Dr Rjean Thomas, Dr Ccile Tremblay, Dr Danielle Rouleau, Dr Julie Bruneau, Dr Jean-Guy Baril, Mrs Claire Duchesneau, Dr Franois Raffi, Dr Mark A Wainberg, Dr Norbert Gilmore, | ||||
| Aim: Data on mother-to-child transmission, on serodiscordant couples and from our Montreal HIV Primary Infection Study show transmission risk is related to the level of viral load. So, 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. | ||||
| Method / Issue: Clinicians, social workers, virologists, epidemiologists, ethicists and HIV-infected spokespersons, from France and Quebec, were asked to examine the scientific merits of using HAART preventively. | ||||
| Results / Comments: Arguments in favor of preventive HAART are: (1) HAART can reduce 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) blame, shame and fear could be reduced, thereby improving social attitudes. Negative arguments include (1) risks from HAART may 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. | ||||
| Discussion: Whether physicians should counsel their patients to initiate HAART, as a prevention strategy is not yet resolved. 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 in order to counsel and empower partners about avoiding risks of infection; (3) safe sex prevention should also be reinforced and partners encouraged to always protect themselves, even when infected partners are being treated successfully; (4) uninfected partners should be counselled whenever possible and have immediate access to HAART for post-exposure prophylaxis (5) infected partners seeking early HAART, as a preventive strategy, should never be denied this intervention. | ||||
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