The New York Times

Thursday, March 30, 2000

Criticized Research Quantifies the Risk of AIDS Infection

By REUTERS

BOSTON, March 29 -- A study of more than 15,000 people in Uganda that has raised ethical questions about AIDS research in poor countries concluded that the risk of spreading AIDS through heterosexual sex rose and fell with the amount of virus in the blood.

The study, in Thursday's issue of The New England Journal of Medicine, also confirmed earlier research suggesting that circumcision guarded against the spread of H.I.V., the virus that causes AIDS.

The research was controversial, not because of its conclusions, but because of its methodology.

Unlike studies of H.I.V. in developed countries, the volunteers in the Uganda study were not offered treatment, nor did doctors inform the healthy spouse of an infected person that his or her partner harbored the virus.

Instead, the team led by Dr. Thomas Quinn of the National Institute of Allergy and Infectious Diseases, tested the volunteers and tracked the spread of their illness.

Marcia Angell, editor of the journal, said she was bothered by the methods, but acknowledged that experts were divided over whether it was ethical to deny treatment to people in poor countries, even if they would not normally be receiving the latest in care.

Dr. Angell and other medical experts fear that researchers will prefer to do AIDS research in poor countries because it is cheaper and enounters fewer logistical hurdles. She said the journal decided to publish the Quinn study because the findings were significant and the ethical questions still a matter of debate.

Focusing on 415 couples in which only one person was infected with H.I.V., Dr. Quinn and his colleagues found that the disease was not spread when the infected partner had fewer than 1,500 copies of the virus in every milliliter of blood.

But Dr. Quinn said that "with every tenfold rise in the concentration of H.I.V. in the bloodstream, transmission more than doubled."