Cautious optimism for new HIV/AIDS prevention strategies.

摘要

The 2006 International AIDS Conference, showcased in the special (Lancet)Red issue, was filled with promises for effective prevention strategies. Media attention and plenary speeches suggested that effective strategies, notably male circumcision and pre-exposure prophylaxis (PREP), are imminent.Instead we advise cautious optimism.The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early.2 In a systematic review of RCTs stopped early for benefit,3 such RCTs were found to overestimate treatment effects. When trials with events fewerthan the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11-73)- The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation.We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done.