a Department of Anthropology, School of Interdisciplinary Arts and Sciences , University of Washington-Bothell , Bothell , WA , USA.
b Department of Immunology, Institute for Cellular and Molecular Medicine , University of Pretoria , Pretoria , South Africa.
Glob Public Health. 2017 Feb;12(2):220-235. doi: 10.1080/17441692.2016.1211162. Epub 2016 Jul 25.
In 2013, physician-researchers announced that a baby in Mississippi had been 'functionally cured' of HIV [Persaud, D., Gay, H., Ziemniak, C. F., Chen, Y. H., Piatak, M., Chun, T.-W., … Luzuriaga, K. (2013b, March). Functional HIV cure after very early ART of an infected infant. Paper presented at the 20th conference on retroviruses and opportunistic infections, Atlanta, GA]. Though the child later developed a detectable viral load, the case remains unprecedented, and trials to build on the findings are planned [National Institute of Allergy and Infectious Diseases. (2014). 'Mississippi baby' now has detectable HIV, researchers find. Retrieved from http://www.niaid.nih.gov/news/newsreleases/2014/pages/mississippibabyhiv.aspx ]. Whether addressing HIV 'cure' or 'remission', scrutiny of this case has focused largely on scientific questions, with only introductory attention to ethics. The social inequalities and gaps in care that made the discovery possible - and their ethical implications for paediatric HIV remission - have gone largely unexamined. This paper describes structural inequalities surrounding the 'Mississippi baby' case and a parallel case in South Africa, where proof-of-concept studies are in the early stages. We argue that an ethical programme of research into infant HIV remission ought to be 'structurally competent', and recommend that paediatric remission studies consider including a research component focused on social protection and barriers to care.
2013 年，医生研究人员宣布密西西比州的一名婴儿已“从功能上治愈”艾滋病[Persaud, D., Gay, H., Ziemniak, C. F., Chen, Y. H., Piatak, M., Chun, T.-W., … Luzuriaga, K. (2013b, March). 早期接受抗逆转录病毒治疗的感染婴儿实现功能性治愈。Paper presented at the 20th conference on retroviruses and opportunistic infections, Atlanta, GA]. 尽管这名儿童后来出现了可检测到的病毒载量，但该病例仍是前所未有的，并且计划开展试验以进一步研究这一发现[National Institute of Allergy and Infectious Diseases. (2014). 'Mississippi baby' now has detectable HIV, researchers find. Retrieved from http://www.niaid.nih.gov/news/newsreleases/2014/pages/mississippibabyhiv.aspx ]. 无论研究的是艾滋病的“治愈”还是“缓解”，对该病例的审查主要集中在科学问题上，仅初步关注了伦理问题。使这一发现成为可能的社会不平等和护理差距，以及它们对儿科艾滋病缓解的伦理影响，在很大程度上没有得到检验。本文描述了围绕“密西西比婴儿”案例和南非类似案例的结构性不平等，并描述了概念验证研究处于早期阶段的情况。我们认为，针对婴儿艾滋病毒缓解的伦理研究方案应该是“结构上有能力的”，并建议儿科缓解研究考虑纳入一个研究部分，重点关注社会保护和护理障碍。
