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By Bob Huff

Better drugs are urgently needed for most of the people in the world who still lack treatment for HIV. Yet physician contentment with current treatment options in Europe and the United States may hold back research to develop new drugs.

“We’ve never had it so good.” So say some AIDS doctors who are enjoying a respite of unprecedented clinical calm due to a wave of recently approved medications that have allowed longtime problem patients to finally achieve viral suppression, and a dependable set of drugs that can keep HIV in first-timers reliably suppressed with minimal maintenance. Apparently they think that if treatment fails due to patients’ inability to stick to their drugtaking schedules, then those patients have no one to blame but themselves.

So when clinical trials of new drugs for first-line therapy are proposed to prominent clinician/investigators in the United States, the answer is, “No thanks; we’re happy with what we have.”

This complacency is shortsighted.

While current first-line options are relatively trouble-free in the States and in Europe (and that is debatable), they are far from optimal for the developing world where—due to cost, side effects, and drug interactions—a better first-line regimen is one of the critical unmet medical needs. And it is crucial that new drugs are supported by substantial evidence from U.S.- and European-based trials if they are to become viable options.

Martin Delaney has noted that U.S. patients have always been motivated to enter clinical trials as much or more by altruism as self-interest. But if patients do not hear from their doctors that there is important research going on that could help people all around the world, then they will not have an opportunity to choose to participate.

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