Therapeutic ethics and communities at risk in the presence of potential mutation to resistant strains to HIV antiviral medications

Abstract

New combination therapies for HIV/AIDS demand up-to-date knowledge of rapidly developing complex therapeutic regimes. These often arduous regimens require careful adherence by patients regular monitoring and rapid response to adverse reactions. The risk of failure is high since days or weeks of missed or incomplete medication can render antiviral medications ineffective for the individual patient through the rapid development of drug resistance. Although little is yet known about how transmissible such resistant strains really are there has been considerable public discussion of whether physicians should refuse to prescribe combination therapy to patients whose life circumstances make it difficult to follow prescribed regimens and thus make them likely incubators of resistant strains. The ethical issue of denial of treatment is usually posited as a conflict between public health and the individual. From this perspective therapy may potentially benefit individuals but prescribing to non-adherent individuals may pose a risk to public health. Physicians obliged to attend to the interests of both the individual and public health are forced to mediate between these interests. (excerpt)