Good News At a Price

By MICHAEL D. LEMONICK

Nobody is saying the scientists who presented their findings at the big retrovirus conference in Chicago last week had anything but the noblest of intentions. Their target was HIV, the AIDS virus, and their focus was on its smallest victims: babies born to infected mothers. Doctors knew that months of intravenous drug treatment during pregnancy can keep HIV from passing from mother to child, but the $1,000-a-day regimen is out of the question in Third World countries, where basic medical care and even clean drinking water are hard to come by. So the researchers launched a study to see whether babies could be protected with shorter-term therapy telescoped into the weeks before, during and after delivery.

From the start, the research was dogged by controversy. As in many scientific studies, some of the women and babies--from Uganda, South Africa and Tanzania--received real medications while others got sugar pills. Normally such double-blind tests are considered unethical if an effective therapy exists.

Indeed, the research was roundly criticized in 1997 by Dr. Marcia Angell, executive editor of the New England Journal of Medicine, who compared it to the infamous Tuskegee experiment in which African-American men with syphilis were left untreated, even though penicillin was available during the study, just to see what would happen.

Scientists from the U.N. AIDS Program, which organized the experiment, argue that the situations are hardly comparable. Yes, an anti-HIV treatment was available, but at a cost that would have kept the study from being carried out at all. Unlike the Tuskegee victims, moreover, the African women were told about the nature of the research, in some cases by African health officials who had helped design it.

And, as the scientists reported last week, the results seemed to justify the risk: although it isn't as good as full-bore treatment, a shorter regimen of two pills a day significantly cuts down on transmission. But even as the news was presented, two new issues arose to complicate matters. The first was an observation that if you cure babies without curing their mothers, you will create a generation of orphans. The alternative, however, is letting the babies die.

The second problem: in a French study of the same drugs, two infants died from a rare neurological disease. It is by no means clear that the drugs--AZT and 3TC--are the cause, but the possibility has researchers poring over their data. Even if it proves to be true, though, the benefit in AIDS prevention probably outweighs the harm. On balance, the fact that a treatment the poor can afford may save their babies' lives seems like something to celebrate.

--Reported by Alice Park/New York

With reporting by Alice Park/New York