Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Features

New ethical obligations accompany new HIV drugs, conference told

Ann Silversides
CMAJ July 27, 1999 161 (2) 187;
Ann Silversides
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Researchers recruiting people who are newly infected with HIV for clinical trials should accept supplementary ethical obligations, a recent research conference in Victoria was told.

"Today's newly infected people are not at risk of short-term death," said Jean-Pierre Belisle, a researcher with l'Ecole des hautes etudes commerciales in Montreal. "Yet they are often pressured to enter clinical trials within days of testing positive, when they are very vulnerable because of the emotional shock."

Belisle told the conference of Canadian Association of HIV Research that many of these newly diagnosed patients are young, with low literacy levels. Although all clinical trials undergo ethical review and require signed informed consent, said Belisle, "many [newly infected persons] cannot read or understand long texts, so a written information sheet is not enough. Research ethic boards need to explore new ways to convey information, perhaps through videotapes or obligatory information sessions with independent counsellors."

To give truly informed consent for an aggressive early start on antiretroviral therapy, these patients need sophisticated treatment information and a lot of basic information about living with HIV. For example, "they need to know they could be well for years without treatment."

They also need to know the practical consequences of embarking on drug therapy: it may be a lifetime commitment, it's difficult to take so many pills each day and it can be costly to do so, and it is difficult to hide both the pill taking and drug side effects from acquaintances.

Several sessions at the conference concerned the difficulty that all patients have adhering to treatment that includes protease inhibitor therapy. Patients say the disadvantages include the number of pills that have to be taken and the limitations that strict drug schedules place on spontaneous activity. Side effects, which can include weight redistribution and intestinal problems, are also a problem.

In a study of 53 HIV-positive women in Ontario, only 6% reported that they weren't sure whether they had taken all their medication exactly as prescribed. However, when asked "when was the last time you missed taking any of your medication," 47% reported missing within the last week. The researchers concluded that additional time should be spent addressing potential barriers to adherence before embarking on antiretroviral drug regimens.

Dr. Joep Lange of the University of Amsterdam noted that "only a year ago, long-term toxicity [of antiretroviral therapy] was a nonissue." However, because of the side effects that are now known to accompany protease inhibitors - these include lipodystrophy, hyperlipidemia and insulin resistance - lifelong therapy with these drugs "may not be attainable. We have to search for protease-inhibitor-sparing regimens, and alternating treatment options."

Lange thinks poor prescribing is a major contributor to drug failure. "You can't go to just any clinic - [you have to see] people who know and understand these drugs."

Lange added that despite talk of protease-inhibitor toxicity, "we should not forget" the toxicity associated with the earlier HIV-fighting drugs, such as zidovudine.

Living longer with AIDS

Researchers reported some good news about the life expectancy of Vancouver's gay and bisexual men, which improved between 1990/92 and 1995/97. However, it still lags significantly behind life expectancy in the general population.

The study of men who live in Vancouver's West End was an attempt to evaluate the impact of newer antiretroviral drugs. It was undertaken by the British Columbia Centre for Excellence in HIV/AIDS and the Department of Psychology at Simon Fraser University.

Between the 2 time periods, gay and bisexual men experienced an increase of almost 4 years in life expectancy at age 20, researcher Keith Chan told the conference. At age 20, life expectancy for the men was an additional 37 years in the 1990/92 period, and 40.8 years in the 1995/97 period.

However, "life expectancy among gay men is quite low compared with the general population," he noted. At age 20, life expectancy within the general population is roughly 55 years, for an average life span of 75 years.

Researchers say the life-expectancy gains for gay and bisexual men "are likely attributed to rapid use of more potent antiretroviral drugs" among HIV-positive men.

A separate telephone survey within the same population found that the HIV-infection rate among the men was about 15.7%, and that 83% of the members of this group were receiving antiretroviral therapy.

It found no difference in age and education between HIV-positive and HIV-negative men, but HIV-positive men were more likely to have an annual income of less than $10 000.

Ann Silversides is a Toronto journalist.

PreviousNext
Back to top

In this issue

CMAJ
Vol. 161, Issue 2
27 Jul 1999
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
New ethical obligations accompany new HIV drugs, conference told
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
New ethical obligations accompany new HIV drugs, conference told
Ann Silversides
CMAJ Jul 1999, 161 (2) 187;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
New ethical obligations accompany new HIV drugs, conference told
Ann Silversides
CMAJ Jul 1999, 161 (2) 187;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Living longer with AIDS
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Dr. Krop gets knuckles rapped, but vows to fight college's "Inquisition"
  • Staffing crisis looms, radiologists warn
  • Ball rolling on research into heading injuries
Show more Features

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire