Many HIV cure studies are planned or expected. These studies often involve high or unknown risks, raising serious ethical challenges concerning (I) risk/benefit ratios, (II) informed consent, and (III) trust in investigators. Little empirical r philosophical research into these challenges is available. The proposed study will use modeling to assess objective risks from various HIV cure interventions, use surveys to assess patients' and investigators' risk ethical approval and willingness to partake in those studies, and use philosophical analysis to make related recommendations on the ethical conduct of HIV cure studies. Innovation: The proposed study is innovative in several ways: (a) It will apply CEPAC modeling, which has been validated in other contexts, to investigate the new area of HIV cure interventions; (b) It will use our ready access to the large ACTG network, which has successfully supported other surveys, for a large survey of patients and clinicians on something for which no survey currently exists-ethics and willingness to participate in risky HIV cure studies; (c) It is the first large study to thoroughly examine these philosophical challenges in HIV cure studies; (d) It will translate ethics insights from early phase cancer studies, other first-in-human studies and elsewhere into practical recommendations for ethical HIV cure research, to guide investigators, funders, and IRBs, honed with key stakeholders. Approach: We will first compile and catalogue conceivable responses to the ethical challenge of HIV cure studies. Some responses will be immediately screened out for obvious logical, practical, or ethical flaws (Filte A). Among remaining responses, we shall assess the risks of cure interventions comprising them (Aim 1). We shall also conduct surveys to check how much HIV patients and clinicians in 34 US-based ACTG sites are willing to partake in studies that involve similar risk levels, and how morally acceptable they would find such studies (Aim 2). Combined, Aims 1 and 2 will rule out some responses to the challenge as infeasible (Filter B). Then, we shall assess the ethics of remaining responses to the challenge (Filter C) and make recommendations on how to conduct HIV cure studies ethically (Aim 3). Our draft recommendations will be presented to HIV cure decision makers, IRB members, and other key stakeholders to obtain feedback and hone the recommendations. (Filter D). We propose the following aims: 1. Assess through modeling the risk from HIV cure study participation for various patient populations. 2. Empirically assess HIV investigators' and HIV patients' ethical evaluation and willingness to partake in HIV cure studies involving given risk levels. 3. Use these results, along with philosophical analysis, published ethics literature, feedback from our Board of Advisors, and feedback from key stakeholders, to form model ethical recommendations for HIV cure research.

Public Health Relevance

Research toward a cure for HIV is a high priority, but it may impose serious or unknown risks on participants to whom antiretrovirals already give safe alternatives. This raises ethical challenges surrounding (I) the risk/benefit ratios for participans, (II) their informed consent, and (III) public trust in investigators, which have not been thoroughl explored, empirically or philosophically. The proposed research will assess the objective risks from HIV cure study participation, assess HIV investigators' and HIV patients' ethical evaluation and willingness to partake in such studies, and recommend ethical ways to conduct HIV cure studies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI114617-05
Application #
9533444
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Dawson, Liza
Project Start
2015-08-03
Project End
2019-07-31
Budget Start
2018-08-01
Budget End
2019-07-31
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Harvard University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
149617367
City
Boston
State
MA
Country
United States
Zip Code
Eyal, Nir (2018) What can the lived experience of participating in risky HIV cure-related studies establish? J Med Ethics 44:277-278
Eyal, Nir; Lipsitch, Marc; Bärnighausen, Till et al. (2018) Opinion: Risk to study nonparticipants: A procedural approach. Proc Natl Acad Sci U S A 115:8051-8053
Eyal, Nir; Holtzman, Lisa G (2018) Invited Commentary on Dubé et al. (Perceptions of Equipoise, Risk/Benefit Ratios, and ""Otherwise Healthy Volunteers"" in the Context of Early-Phase HIV Cure Research in the United States-A Qualitative Inquiry): Are HIV-Infected Candidates for Participati J Empir Res Hum Res Ethics 13:18-22
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Eyal, Nir; Holtzman, Lisa G; Deeks, Steven G (2018) Ethical issues in HIV remission trials. Curr Opin HIV AIDS 13:422-427
Wu, Feng; Zhang, Alice; Babbitt, Andrew et al. (2018) Overcoming HIV Stigma? A Qualitative Analysis of HIV Cure Research and Stigma Among Men Who Have Sex with Men Living with HIV. Arch Sex Behav 47:2061-2069
Nguyen, Annie L; Brown, Brandon; Taylor, Jeff et al. (2017) Eliciting community perspectives on research with older adults living with HIV through focus groups. Medicine (Baltimore) 96:e8495
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Kumar, Rahul (2017) Contractualist reasoning, HIV cure clinical trials, and the moral (ir)relevance of the risk/benefit ratio. J Med Ethics 43:124-127
Dresser, Rebecca (2017) First-in-human HIV-remission studies: reducing and justifying risk. J Med Ethics 43:78-81

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