Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS

Satish Kumar Gupta, Nutan Reproductive Cell Biology Laboratory, National Institute of Immunology, New Delhi, India 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...

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Autores principales:	Gupta SK, Nutan
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/6fb0ba5a3ec141338cb385c317a8ad61
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spelling	oai:doaj.org-article:6fb0ba5a3ec141338cb385c317a8ad612021-12-02T02:48:51ZClinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS1179-1373https://doaj.org/article/6fb0ba5a3ec141338cb385c317a8ad612013-10-01T00:00:00Zhttp://www.dovepress.com/clinical-use-of-vaginal-or-rectally-applied-microbicides-in-patients-s-a14755https://doaj.org/toc/1179-1373Satish Kumar Gupta, Nutan Reproductive Cell Biology Laboratory, National Institute of Immunology, New Delhi, India 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.    Keywords: AIDS, microbicides, pre-exposure prophylaxis, sexual transmission of HIV, vaginal/rectal gelGupta SKNutanDove Medical PressarticleImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol 2013, Iss default, Pp 295-307 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607
spellingShingle	Immunologic diseases. Allergy RC581-607 Gupta SK Nutan Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS
description	Satish Kumar Gupta, Nutan Reproductive Cell Biology Laboratory, National Institute of Immunology, New Delhi, India 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.    Keywords: AIDS, microbicides, pre-exposure prophylaxis, sexual transmission of HIV, vaginal/rectal gel
format	article
author	Gupta SK Nutan
author_facet	Gupta SK Nutan
author_sort	Gupta SK
title	Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS
title_short	Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS
title_full	Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS
title_fullStr	Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS
title_full_unstemmed	Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS
title_sort	clinical use of vaginal or rectally applied microbicides in patients suffering from hiv/aids
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/6fb0ba5a3ec141338cb385c317a8ad61
work_keys_str_mv	AT guptask clinicaluseofvaginalorrectallyappliedmicrobicidesinpatientssufferingfromhivaids AT nutan clinicaluseofvaginalorrectallyappliedmicrobicidesinpatientssufferingfromhivaids
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Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS

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