Ethics of HIV research in children.

In their Personal View, Seema Shah and colleagues1 addressed ethical issues to be considered in paediatric HIV cure research.1 The recent rebound of HIV RNA in the so-called Mississippi baby dispelled hopes of a cure, and cautions against use of the term cure.2 In a subsequent Correspondence,3 the same investigators accepted the limits of our knowledge and the complexity of the scientific questions that remain unanswered, including the optimum time to interrupt antiretroviral therapy (ART) to assess whether therapy initiated in acute infection can eradicate or prevent long-term HIV reservoirs. Shah and colleagues first proposed that therapy be maintained “until ample time has been given for the strategy to work on the basis of existing data”,1 and then conceded that “how long treatment should be given for the strategy to work is unclear”.3 We wish to emphasise that, although some data exist on the possible safe interruption of ART,4 current data does not inform the optimum time to interrupt infant treatment, which depends on the postulated mechanisms responsible for clearing infection—ie, post-exposure prophylaxis or decay of acutely infected cells.