Science, ethics, and the future of research into maternal infant transmission of HIV-1

Effective, feasible Interventions to prevent perinatal transmission of HIV- 1 in developing nations are an urgent necessity. Scientific issues of conce rn include a need to identify other effective antiretroviral agents; to def ine the shortest effective course of therapy; to assess interventions other than antiretroviral agents; and to investigate interventions that may redu ce HIV-1 transmission via breastfeeding. Sound scientific design is fundame ntal to all research studies. Ethical standards must guide such studies and include the necessity that the problem studied be a health priority in the host country; that the highest standard of care attainable in the country be assured to participants; that the health-care resources of the country n ot be harmed; that the informed consent of participants be obtained; and th at a process of discussion ensure that a successful intervention will be co nsidered for implementation. There are circumstances in which a no-antiretr oviral comparison may be ethically justified.