Thursday, September 24, 2009

Quick Hit: AIDS Vaccine

Quick hit for me, anyway. There's some stuff circulating now about a new AIDS vaccine that was tested in Thailand and reduced AIDS transmission by 31%. Some thoughts:

- This study was totally and completely immoral, which is why it was done in a third world country. It's like using human subjects to test whether a new bullet-proof helmet will work, by shooting people in the head with bullets. It's only a small step above intentionally having these people have sex with someone who has AIDS. Working with an at-risk population and standing mutely by while you know some of them are going to get infected is obscene.

- A population that's adjudged to be at-risk for HIV tends not to be a population that medical researchers can rely on for clinical honesty; there are cultural barriers, issues of mistrust between researcher and patient, and, with regard to the particular communities at risk for HIV, issues of mental illness (not all hookers or heroin addicts are crazy, but lots and lots are) and understanding of veracity and consent.

- There are different strains of HIV, and I haven't seen any discussion of whether that accounts for the weird statistics here: why 31%? Maybe this just works on certain strains, in which case those strains should be deduced and some level of statistical analysis done on which strains are prevalent in which geographic and demographic populations.

- Going back to the morality issues and cultural issues: why do you think this was done in Thailand? I'm going to go read the research and update this if necessary, but it seems like Thailand's a good place to do this kind of study because of the huge sex trade, which means we're using a tragedy of humanity as the forum for medical research, and while it makes sense, it's discomforting. Why not do this in South Africa, where 10% of the population has AIDS/HIV? My point is that the forum selection in this case is not irrelevant to the clinical findings-- sex-work-driven epidemiology is a factor in interpreting these results, just as rape-driven epidemiology would be a factor in interpreting results in an African population. AIDS is a highly-demographically sensitive epidemic, and these differences are more salient factors in understanding the usefulness of any vaccines than they would be for many other diseases-- even STD/Is.

- Every year we have to update the flu vaccine, because the flu is a virus, and viruses mutate rapidly. If we do find a vaccine for AIDS, we're going to need to update it constantly to accommodate different strains, UNLESS the AIDS vaccine represents a leap forward in Basic Science understandings, which it sounds like it might, and the lessons will be applicable to all virus vaccines, not just AIDS.

- Asshole-blunt: you can't trust studies conducted in third world countries.

- There's moral hazard left, right and center on this. Post coming.

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