New HIV prevention treatments for women may be available as early as 2009, a sign of hope for fighting a world AIDS epidemic with an increasingly feminine face, a top researcher said on Thursday.
Microbicides, which women might one day be able to use in gel or cream form to shield themselves from HIV infection, hold some of the best promise for fighting a disease that continues to defy efforts to create a vaccine, said Salim Abdool Karim.
“We need some kind of prevention technology that is designed for and under the control of women,” Abdool Karim, of South Africa’s University of KwaZulu-Natal, told an AIDS conference in Durban.
“Microbicides can be used completely surreptitiously, it does not need a partner’s consent,” he said.
U.N. estimates show 60 percent of almost 30 million people with HIV infection or AIDS in sub-Saharan Africa are women, a proportion growing particularly in societies where women are less able to refuse sex or negotiate condom use with a male partner.
Even female condoms, introduced in an effort to give women more control over their sexual health, have proven less than completely effective as men may sometimes refuse to agree to having sex with a woman who is wearing one, Abdool Karim said.
Microbicides, which use a variety of means to either kill HIV in the vagina, block it from infecting other cells or prevent it from multiplying, could be an important tool and advanced studies are under way in South Africa and elsewhere to assess their effectiveness, he said.
“South Africa has a huge epidemic among younger women and therefore there is a huge need for microbicides in this setting,” he said.
South Africa has the world’s biggest single HIV/AIDS caseload with over 5 million of its 45 million people infected.
Abdool Karim said initial results from the most promising microbicide human trials could be available by early 2008. If they prove effective, fast-track regulatory approval, manufacturing and distribution could make the treatments available to women one or two years after that, he said.
AIDS experts estimate microbicides, some of which have names such as “Invisible Condom,” could prevent 2.5 million deaths from AIDS over three years.
Abdool Karim, who is overseeing one of five advanced human clinical trials of microbicides, cautioned that it was still too early to say if the treatment would prove effective.
But he said in theory microbicides could protect women from HIV over a period of days, or could be applied after sex as a kind of “morning after pill” to prevent infection.
Microbicide research is complicated because no animal testing can exactly replicate the effects of human treatment.
Researchers only find out how effective their treatment is when they learn that it has failed - and a subject has become HIV-positive despite using it.
Abdool Karim said another major obstacle was the lack of involvement by major pharmaceutical companies.
Most microbicide projects are being undertaken by small biotechnology companies, often funded only through donations from groups such as the U.S. National Institutes of Health and the Bill and Melinda Gates Foundation.
“If we were working on a microbicide for men, I’m sure we’d have every big pharmaceutical company involved,” he said.
Revision date: June 22, 2011
Last revised: by Janet A. Staessen, MD, PhD