Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
How can epidemiology assist in guiding interventions for the acquired immunodeficiency syndrome/human immunodeficiency virus?
Ann Epidemiol. 1990 Dec;1(2):141-55. Unique Identifier : AIDSLINE MED/94093740 Vermund SH; Hoth DF; Division of AIDS, National Institute of Allergy and Infectious; Diseases, National Institutes of Health, Bethesda, MD 20892.
Abstract:
In a single decade, the pandemic of human immunodeficiency virus (HIV) infection has become an international health, social, and economic emergency. Early and effective intervention is urgently needed for both prevention of HIV infection and for the amelioration of clinical disease. Results of therapeutic trials have suggested expanding the population for which chemotherapy is indicated. In this paper, we first review the findings from selected recent drug trials, using zidovudine and pentamidine as examples. We then discuss six issues that we believe to be crucial for future epidemiologic research in the service of vaccine and drug development: 1. To identify which complications of HIV infection most urgently require development of new therapies, we must characterize the frequency and severity of specific medical events (outcomes) in persons taking a variety of treatments. 2. Currently, acquired immunodeficiency syndrome (AIDS) therapeutic trials gauge the effectiveness of new therapies by their impact on such clinical parameters as the time to development of AIDS or death. These approaches take too long to provide information. We urgently need to identify surrogate markers of clinical outcome that will be useful in the early assessment of treatment efficacy. 3. Progress in vaccine development is being retarded because we do not have enough data from natural history studies on host immunologic responses to suggest that a given response is protective. We therefore need to identify natural correlates of immunity, which can help set priorities in vaccine development. 4. Discovery that a therapy works in the setting of a clinical trial is only a first step in intervention. We must also assess the impact of new therapies on the health of the public, evaluating access to health care, compliance, and other barriers to treatment. 5. Clinical trials are usually associated with the effort to prevent disease in infected persons. However, other trials are needed to assess efforts to interrupt viral transmission through use of condoms, use of virucides, and treatment of sexually transmitted diseases, and by effecting specific behavioral changes. 6. Traditional methods of conducting clinical therapeutic research may not be adequate to address urgent questions in the AIDS/HIV epidemic. We must develop innovative clinical research methods, including better use of data from observational studies, to infer what we can about the effect of treatment on the clinical course.
Keywords: Acquired Immunodeficiency Syndrome/*DRUG THERAPY/*EPIDEMIOLOGY/ TRANSMISSION Aerosols Biological Markers Clinical Trials Cohort Studies Human Pentamidine/*ADMINISTRATION & DOSAGE Pneumonia, Pneumocystis carinii/PREVENTION & CONTROL Population Surveillance Prognosis Public Health Zidovudine/*THERAPEUTIC USE JOURNAL ARTICLE REVIEW REVIEW, ACADEMIC 940430
M9440908
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
