ETHICAL AND LEGAL ISSUES RELATED TO IRIS/AIDS PATIENTS

The emergence of the AIDS/IRIS pandemic has challenged traditional ethical values of the health care profession. Antiretroviral therapy (ART) initiation in HIV-infected patients leads to recovery of CD4+T cell numbers and restoration of protective immune responses against a wide variety of pathogens, resulting in reduction in the frequency of opportunistic infections and prolonged survival. However, in a subset of patients, deregulated immune response after initiation of ART leads to the phenomenon of immune reconstitution inflammatory syndrome (IRIS). The hallmark of the syndrome is paradoxical worsening of an existing infection or disease process or appearance of a new infection/disease process soon after initiation of therapy. The overall incidence of IRIS is unknown, but is dependent on the population studied and the burden of underlying opportunistic infections. Law & medical ethics are two disciplines with a considerable overlap. Law lays down the established rule for conduct, the violation of which creates criminal or civil liability; ethics is more about expected conduct, that is, what ought to be? The two key issues in medical ethics are confidentiality and consent. In no other disease scenario do these two take on such importance as in AIDS/IRIS. The article examines the dynamics of such issues, citing examples from India and abroad and the present status of the draft bill prepared in 2006 is that it has been and submitted to the government.