Microbicides: new HIV prevention technology empowers women

The International Partnership for Microbicides has developed a vaginal microbicide ring to help women protect themselves against HIV infection.

The International Partnership for Microbicides has developed a vaginal microbicide ring to help women protect themselves against HIV infection. Researchers hope the product could be rolled out by early 2016.

Antiretroviral medicines have extended and saved millions of lives across the globe. These drugs are now being adapted by organisations like International Partnership for Microbicides (IPM) to protect healthy adults from acquiring HIV. Dapivirine belongs to the same class of antiretrovirals being used successfully to treat HIV and prevent mother-to-child transmission.

Study coordinator at the University of North Carolina Tchangani Tembo says a range of microbicides containing different antiretrovirals are undergoing preclinical development and clinical trials.

“Women urgently need new HIV prevention strategies like microbicides that they can use themselves. Microbicides for women could come in many forms, such as vaginal rings, tablets or films. The dapivirine ring, which women insert and leave in place for one month, is the first long-acting microbicide to be tested in large-scale safety and efficacy trials for HIV prevention,” says Tembo.

The ring is designed to protect women during heterosexual sex. According to the 2013 World Health Organization (WHO) Women Health Report, this is the main way in which HIV is transmitted in southern African countries.

Condoms are not always the solution for protecting women from HIV. For example, many women are unable to negotiate condom use with their male partners and it is certainly impossible in situations of sexual violence. However, the ring has the potential to increase women’s ability to protect themselves from the disease.

The advantage of microbicides

The 2013 UNAIDS report on the global AIDS epidemic says that despite progress in the last decade, women in low and middle-income countries still bear a disproportionate burden of HIV and AIDS, which is the leading cause of death globally among women aged 15-44. It exacts an especially high toll in sub-Saharan Africa, where young women are at least twice as likely to be infected as young men. Although a range of prevention strategies exist, they are not enough to stop the virus’s transmission.

“We are currently evaluating whether the ring is effective and safe for long-term use” says Tembo. He added that two pivotal studies are currently underway: the Ring Study (led by IPM) and ASPIRE (led the US National Institutes of Health-funded Microbicide Trials Network).

Janssen Sciences Ireland UC (part of Johnson & Johnson), first tested dapivirine in oral formulations in 11 safety studies before 2004 and later partnered with IPM, which has tested dapivirine as a vaginal gel or ring in 16 safety studies. In all clinical studies to date, dapivirine has been found to be safe and well-tolerated in healthy, HIV-negative women in Africa, Europe and the United States.

HIV prevention

Tembo says stopping HIV will require a variety of effective options including pre-exposure prophylaxis (PrEPrings and, one day, a vaccine. Because there will be no single solution to stopping HIV, having multiple prevention options is not simply a best-case scenario, it is the only way to end the epidemic. This is especially true for women.

New prevention tools are needed that match women’s needs and fit within the context of their lives. Microbicides can be used discreetly, giving women who may not be able to discuss HIV prevention with their partners the ability to protect their own health. As well as the dapivirine ring, other promising technologies being tested include long-acting injectable antiretrovirals, new vaginal and rectal products and vaccines.

Microbicides would expand the HIV prevention toolkit with products that can meet the needs of different women at different times in their lives.

Raising awareness in Malawi

The 2015-2020 Malawi National HIV Strategic Plan estimates national HIV prevalence among the 15-49 year old population as 10.3 per cent.

The Journalists Association against AIDS in Malawi (JournAIDS), working with IPM, is raising awareness in Malawi on the need to promote microbicides as an important HIV prevention technology, especially among women. The organisation seeks to ensure that research information on microbicides is used to shape policy and make a meaningful contribution to the national HIV response.

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