lasercave | fine tangible and intangible media

a week or so ago a second interim analysis was conducted, examining two hiv/aids trials being conducted in rakai, uganda and kisumu, kenya. these trials were looking at circumcision as a public health intervention method.* earlier today the WHO and NIAID released the information that these trials, like the orange farm trial which was halted in 2005, these two trials will also be interrupted because of strong correlate of protection. the rate was approximately 50% (48% and 53% i think?) and 61% in south africa. this is because the foreskin contains langerhans’ cells, which are more susceptible to viral infection (this is the prevailing theory, i don’t know if anyone has actually proven yet).

the impact of this is…mind-blowing. first all the fact that circumcision is by far the most effective preventative ever? and that no one really looked into it (or came up with anything better) in twenty five years of money being thrown at this problem. all right, the first few were a little rough but once people (sort of) got over that whole gay disease thing, the situation improved. which brings me to another problem – most of the money allocated to aids right now is for vaccines and drugs. i’m not certain how much money bill gates has given to circumcision training services recently…and then there’s the obvious problem of trying to convince adult men (of the populations that are most at risk for hiv) to let someone cut part of their penis off. i sure as hell wouldn’t want to. and there is a very strong anti-circumcision sentiment in the world these days. there’s also the problem of how and where are people going to get circumcised. sub-suharan africa isn’t exactly rife with medical facilities. which is where mohels without borders would come into the picture. i’m not kidding, it’s been seriously discussed. and on a less urgent level, i wonder how this factors into the way data has been analyzed in previous vaccine or drug trials for any std?

so this is going to be a large part of my job for the next few months. there are very mixed in my office about what iavi’s role should be in this. to me, it seems pretty clear – every possible resource should be put to addressing the problems stated above. finally something has been found that works, far better than anything else to date. but how do you balance that with continuing vaccine research work? especially when an efficacious vaccine still seems pretty far off? i’m not entirely certain there will ever be a vaccine. right now, microbicides seem far more promising.

*i’m not certain about other types of clinical resarch but in typical hiv drug or vaccine related trials in humans the standard is one interim analysis. because of the ethical issues involved with withholding this strong of a correlate of protection, multiple analyes were part of the protocol for all three trials)