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Microbicides, pre-exposure prophylaxis may still be viable prevention strategies

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Antiretroviral-based microbicides may be strong candidates to make up for previous failures in microbicide trials, according to a speaker at the 14th International Congress on Infectious Diseases.

Patrick Ndase MD, MPH,who is a regional physician with the Microbicide Trials Network & Partners in Prevention expressed hope that microbicides and pre-exposure prophylaxis strategies could still play a role in the battle against HIV.

“In the end it may prove a lot easier to end HIV through prevention than through any other field,” Ndase said. “However, we still do not have definitive answers in pre-exposure prophylaxis and microbicides.”

He said recent failures with agents such as N9, Buffergel and PRO2000, have prompted more research into ART-based microbicides, including TMC120 and MIV150.

“These products have three critical components: potency, safety and ease of use,” Ndase said. “User-friendliness is critical to adherence. New interventions are developed all the time, but just because they exist does not mean that they will be used.”

A key question is whether a single pill taken once a day or a gel applied topically will be the most effective strategy, according to Ndase.

Six ongoing planned efficacy trials of pre-exposure prophylaxis involving more than 20,000 HIV-negative participants are currently being conducted in 13 countries, according to Ndase.

Ndase said that if pre-exposure prophylaxis proves an effective strategy, the next challenge will be implementation. This will involve maintaining frequent HIV testing and safety monitoring; it will also entail determining whether intermittent use is feasible and whether the product is safe for pregnant and breast-feeding women.

“Funding mechanisms in the context of sub-optimal ART coverage may also be of concern,” Ndase said. “Trying to get an antiviral agent into prevention when many individuals still need it for survival will be a big challenge.” – by Rob Volansky

For more information:

• Ndase P. # 17.004. The hope and progress in microbicides and pre-exposure prophylaxis to prevent HIV. Presented at: 14th International Congress on Infectious Diseases; March 9-12, 2010; Miami.