Microbicides: stopping HIV at the gate

New York Blood Center, New York, New York, United States
The Lancet (Impact Factor: 45.22). 09/2006; 368(9534):431-3. DOI: 10.1016/S0140-6736(06)69131-9
Source: PubMed
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Available from: Shibo Jiang, Dec 14, 2013
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    • "Microbicides are compounds that can be applied locally to genital mucosal surfaces to protect against sexually transmitted infections (STIs) including HIV [10]. They can be formulated as gels, creams, films, or suppositories, and may or may not have spermicidal activity (contraceptive effect). "
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    ABSTRACT: Background The findings of the CAPRISA tenofovir studies have raised expectations that soon an approved microbicide would be available. However it is in only a limited number of countries in sub-Saharan Africa that the acceptability of microbicides has been evaluated. We conducted a study to assess the acceptability of vaginal microbicides among women in rural Ghana. Methods The study employs a mixed method design, using cross-sectional survey and focus group discussions to further understand issues related to awareness and attitudes towards microbicide development, acceptability and perceived partner attitudes among pregnant women attending antenatal clinic in two health facilities in the Kintampo North municipality of Ghana. We used logistic regression to identify possible predictors of microbicide acceptability among the women surveyed. Results Although only 2% of the 504 women were aware of the development of microbicides, 95% were willing to use one when it became available. The cost of a microbicide that will be considered affordable to 50% of women was US$0.75. Although there were concerns about possible wetting effect, gel or creams were the most preferred (68% of women) formulation. Although 71% thought their partners will find microbicide acceptable, apprehensions about the feasibility of and consequences of failed discreet use were evident. 49% of women were concerned about possible negative effect of microbicide on sexual pleasure. Perceived partner acceptability (O.R. =17.7; 95%C.I. 5.03-62.5) and possibility of discreet use (O.R. =8.9 95%C.I. 2.63-30.13) were the important predictors of microbicide acceptability. Conclusion Achieving microbicide acceptability among male partners should be made a part of the promotive interventions for ensuring effective use among women in rural Ghana.
    Full-text · Article · Nov 2012 · BMC Women's Health
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    • "Despite initial high expectations, recent clinical trials with non-specific entry inhibitors such as cellulose sulfate and PRO-2000 did not reveal large-scale clinical benefits, which can be explained by possible drug-induced mucosal damage or inconsistent microbicide use [8]. Among the various microbicides , one polymer which has been given due consideration in developing anti-HIV-1 strategies is CAP [9] [10]. CAP acts by inducing conformational changes in HIV glycoproteins (gp41 and gp120) which are responsible for recognizing and binding the human CD4 receptor and CCR-5 and CXCR-4 co-receptors, which is essential for cellular entry. "
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    ABSTRACT: Despite many advances in modern medicine, human immunodeficiency virus (HIV) still affects the health of millions of people world-wide and much effort is put in developing methods to either prevent infection or to eradicate the virus after infection has occurred. Here, we describe the potential use of electrospun cellulose acetate phthalate (CAP) fibers as a tool to prevent HIV transmission. During the electrospinning process, anti-viral drugs can easily be incorporated in CAP fibers. Interestingly, as a result of the pH-dependent solubility of CAP, the fibers are stable in vaginal fluid (the healthy vaginal flora has a pH of below 4.5), whereas the addition of small amounts of human semen (pH between 7.4 and 8.4) immediately dissolves the fibers which results in the release of the encapsulated drugs. The pH-dependent release properties have been carefully studied and we show that the released anti-viral drugs, together with the CAP which has been reported to have intrinsic antimicrobial activity, efficiently neutralize HIV in vitro.
    Full-text · Article · Jan 2012 · Biomaterials
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    • "Microbicides are products in the form of a gel, tablet, film or sponge that need to be introduced into the vagina before sexual intercourse. Microbicides are being extensively studied in Africa and other regions as regards the development of female-controlled methods of HIV prevention (Stone and Jiang, 2006). Unfortunately, the results reported so far have been disappointing. "
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    ABSTRACT: More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV. Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception. Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness. All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.
    Full-text · Article · Dec 2008 · Human Reproduction Update
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