May 16, 1990


JAMA. 1990;263(19):2641-2642. doi:10.1001/jama.1990.03440190097050

Treatment of human immunodeficiency virus infection poses some of the most difficult dilemmas in clinical medicine. As new data on natural history, treatment, and prevention appear, some new ethical questions are raised and older ones reexamined. This review focuses on the ethical impact of recent research, particularly the availability of early treatment.

The most significant recent findings include the potential effectiveness of the early use of zidovudine (formerly known as azidothymidine [AZT]) in delaying the emergence of the acquired immunodeficiency syndrome (AIDS) and the use of sulfamethoxazole and aerosolized pentamidine isethionate in preventing opportunistic infections.1-3 In addition, zidovudine has shown some reversing effect on AIDS dementia in children.4 Dideoxyinosine seems effective in zidovudine-resistant and intolerant patients. Other more promising and more sophisticated therapies are in the offing.5

None of these measures is curative, but they change the physician's approach to management dramatically. Early diagnosis, early treatment, and