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Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS.
HIV AIDS (Auckl). 2013 Oct 22; 5:295-307.HA

Abstract

Microbicides, primarily used as topical pre-exposure prophylaxis, have been proposed to prevent sexual transmission of HIV. This review covers the trends and challenges in the development of safe and effective microbicides to prevent sexual transmission of HIV Initial phases of microbicide development used such surfactants as nonoxynol-9 (N-9), C13G, and sodium lauryl sulfate, aiming to inactivate the virus. Clinical trials of microbicides based on N-9 and C31G failed to inhibit sexual transmission of HIV. On the contrary, N-9 enhanced susceptibility to sexual transmission of HIV-1. Subsequently, microbicides based on polyanions and a variety of other compounds that inhibit the binding, fusion, or entry of virus to the host cells were evaluated for their efficacy in different clinical setups. Most of these trials failed to show either safety or efficacy for prevention of HIV transmission. The next phase of microbicide development involved antiretroviral drugs. Microbicide in the form of 1% tenofovir vaginal gel when tested in a Phase IIb trial (CAPRISA 004) in a coitally dependent manner revealed that tenofovir gel users were 39% less likely to become HIV-infected compared to placebo control. However, in another trial (VOICE MTN 003), tenofovir gel used once daily in a coitally independent mode failed to show any efficacy to prevent HIV infection. Tenofovir gel is currently in a Phase III safety and efficacy trial in South Africa (FACTS 001) employing a coitally dependent dosing regimen. Further, long-acting microbicide-delivery systems (vaginal ring) for slow release of such antiretroviral drugs as dapivirine are also undergoing clinical trials. Discovering new markers as correlates of protective efficacy, novel long-acting delivery systems with improved adherence in the use of microbicides, discovering new compounds effective against a broad spectrum of HIV strains, developing multipurpose technologies incorporating additional features of efficacy against other sexually transmitted infections, and contraception will help in moving the field of microbicide development forward.

Authors+Show Affiliations

Reproductive Cell Biology Laboratory, National Institute of Immunology, New Delhi, India.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24174883

Citation

Gupta, Satish Kumar, and Nutan. "Clinical Use of Vaginal or Rectally Applied Microbicides in Patients Suffering From HIV/AIDS." HIV/AIDS (Auckland, N.Z.), vol. 5, 2013, pp. 295-307.
Gupta SK, Nutan . Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS. HIV AIDS (Auckl). 2013;5:295-307.
Gupta, S. K., & Nutan, . (2013). Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS. HIV/AIDS (Auckland, N.Z.), 5, 295-307. https://doi.org/10.2147/HIV.S39164
Gupta SK, Nutan . Clinical Use of Vaginal or Rectally Applied Microbicides in Patients Suffering From HIV/AIDS. HIV AIDS (Auckl). 2013 Oct 22;5:295-307. PubMed PMID: 24174883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS. AU - Gupta,Satish Kumar, AU - Nutan,, Y1 - 2013/10/22/ PY - 2013/11/1/entrez PY - 2013/11/1/pubmed PY - 2013/11/1/medline KW - AIDS KW - microbicides KW - pre-exposure prophylaxis KW - sexual transmission of HIV KW - vaginal/rectal gel SP - 295 EP - 307 JF - HIV/AIDS (Auckland, N.Z.) JO - HIV AIDS (Auckl) VL - 5 N2 - Microbicides, primarily used as topical pre-exposure prophylaxis, have been proposed to prevent sexual transmission of HIV. This review covers the trends and challenges in the development of safe and effective microbicides to prevent sexual transmission of HIV Initial phases of microbicide development used such surfactants as nonoxynol-9 (N-9), C13G, and sodium lauryl sulfate, aiming to inactivate the virus. Clinical trials of microbicides based on N-9 and C31G failed to inhibit sexual transmission of HIV. On the contrary, N-9 enhanced susceptibility to sexual transmission of HIV-1. Subsequently, microbicides based on polyanions and a variety of other compounds that inhibit the binding, fusion, or entry of virus to the host cells were evaluated for their efficacy in different clinical setups. Most of these trials failed to show either safety or efficacy for prevention of HIV transmission. The next phase of microbicide development involved antiretroviral drugs. Microbicide in the form of 1% tenofovir vaginal gel when tested in a Phase IIb trial (CAPRISA 004) in a coitally dependent manner revealed that tenofovir gel users were 39% less likely to become HIV-infected compared to placebo control. However, in another trial (VOICE MTN 003), tenofovir gel used once daily in a coitally independent mode failed to show any efficacy to prevent HIV infection. Tenofovir gel is currently in a Phase III safety and efficacy trial in South Africa (FACTS 001) employing a coitally dependent dosing regimen. Further, long-acting microbicide-delivery systems (vaginal ring) for slow release of such antiretroviral drugs as dapivirine are also undergoing clinical trials. Discovering new markers as correlates of protective efficacy, novel long-acting delivery systems with improved adherence in the use of microbicides, discovering new compounds effective against a broad spectrum of HIV strains, developing multipurpose technologies incorporating additional features of efficacy against other sexually transmitted infections, and contraception will help in moving the field of microbicide development forward. SN - 1179-1373 UR - https://www.unboundmedicine.com/medline/citation/24174883/Clinical_use_of_vaginal_or_rectally_applied_microbicides_in_patients_suffering_from_HIV/AIDS_ L2 - https://dx.doi.org/10.2147/HIV.S39164 DB - PRIME DP - Unbound Medicine ER -
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