The increasing femininization of the AIDS pandemic demands that we develop new approaches to HIV prevention that allows women to take control of their reproductive health. In the absence of effective HIV vaccines the two most promising approaches are pre-exposure prophylaxis with antiretrovirals (PREP) or topical application of microbicides. Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections (STIs) including HIV-1. Currently, seven candidate microbicides are in clinical development and three products are being evaluated in large-scale phase 2B/3 effectiveness studies. Initial data from these trials will be available within the next 1–2 years and it is feasible that there could be one or more licensed microbicides by the end of the decade. The first generation of surfactant microbicides had a relatively non-specific mechanism of...
KeywordsTrial Site Serodiscordant Couple Cellulose Sulfate Microbicide Trial Real Time Access
- Alliance for Microbicide Development (2006). Microbicide research and development database. (Accessed December 31, 2006); www.microbicide.org/cs/microbicide_rd_database.
- Cunningham, C. K., Chaix, M. L., Rekacewicz, C., Britto, P., Rouzioux, C., Gelber, R. D., Dorenbaum, A., Delfraissy, J. F., Bazin, B., Mofenson, L., & Sullivan, J. L. (2002). Development of resistance mutations in women receiving standard antiretroviral therapy who received intrapartum nevirapine to prevent perinatal human immunodeficiency virus type 1 transmission: a substudy of pediatric AIDS clinical trials group protocol 316. The Journal of Infectious Diseases, 186(2), 181–188.CrossRefPubMedGoogle Scholar
- Grant, R. M., Buchbinder, S., Cates, W., Jr., Clarke, E., Coates, T., Cohen, M. S., Delaney, M., Flores, G., Goicochea, P., Gonsalves, G., Harrington, M., Lama, J. R., MacQueen, K. M., Moore, J. P., Peterson, L., Sanchez, J., Thompson, M., & Wainberg, M. A. (2005). AIDS. Promote HIV chemoprophylaxis research, don't prevent it. Science, 309(5744), 2170–2171.CrossRefPubMedGoogle Scholar
- Gray, R. H., Kigozi, G., Serwadda, D., Makumbi, F., Watya, S., Nalugoda, F., Kiwanuka, N., Moulton, L. H., Chaudhary, M. A., Chen, M. Z., Sewankambo, N. K., Wabwire-Mangen, F., Bacon, M. C., Williams, C. F., Opendi, P., Reynolds, S. J., Laeyendecker, O., Quinn, T. C., & Wawer, M. J. (2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet, 369(9562), 657–666.CrossRefPubMedGoogle Scholar
- Koblin, B., Chesney, M., Coates, T., & EXPLORE Study Team. (2004). Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet, 364(9428), 41–50.Google Scholar
- Lard-Whiteford, S. L., Matecka, D., O'Rear, J. J., Yuen, I.S., Litterst, C., Reichelderfer, P., & International Working Group on Microbicides. (2004). Recommendations for the nonclinical development of topical microbicides for prevention of HIV transmission: an update. Journal of Acquired Immune Deficiency Syndromes, 36(1), 541–552.CrossRefPubMedGoogle Scholar
- Padian, N. S., van der, Straten A., Ramjee, G., Chipato, T., de, Bruyn G., Blanchard, K., Shiboski, S., Montgomery, E. T., Fancher, H., Cheng, H., Rosenblum, M., van der, Laan M., Jewell, N., & McIntyre, J. (2007). Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet, 370(9583), 251–261.CrossRefPubMedGoogle Scholar
- Shattock, R. J. (2006). Protection of macaques against rectal SIV challenge by mucosally-applied PMPA. Presented at Microbicides 2006, Cape Town, South Africa (Abstract OA15).Google Scholar
- UNAIDS. (2006). 2006 Report on the global AIDS epidemic. Geneva. www.unaids.org:80/en/KnowledgeCentre/HIVData/GlobalReport/Default.asp.
- US Food and Drug Administration. (2006). Additional resources regarding drug development of topical microbicides. (Accessed December 31, 2006); www.fda.gov/cder/ode4/preind/Top_Links.htm.
- Van Damme, L., Ramjee, G., Alary, M., Vuylsteke, B., Chandeying, V., Rees, H., Sirivongrangson, P., Mukenge-Tshibaka, L., Ettiegne-Traore, V., Uaheowitchai, C., Karim, S. S., Masse, B., Perriens, J., & Laga, M. (2002). Effectiveness of COL-1492, a nonoxynol-9 vaginal gel, on HIV-1 transmission in female sex workers: a randomised controlled trial. Lancet, 360(9338), 971–977.CrossRefPubMedGoogle Scholar
- Veazey, R. S., Klasse, P. J., Schader, S. M., Hu, Q., Ketas, T. J., Lu, M., Marx, P. A., Dufour, J., Colonno, R. J., Shattock, R. J., Springer, M. S., & Moore, J. P. (2005). Protection of macaques from vaginal SHIV challenge by vaginally delivered inhibitors of virus-cell fusion. Nature, 438(7064), 99–102.CrossRefPubMedGoogle Scholar