Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men.
BACKGROUND
There is a need for female-controlled methods of HIV prevention. Vaginal microbicides, substances inserted into the vagina to prevent women acquiring HIV and sexually transmitted infections (STIs) from men, could be useful in this regard. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9).


OBJECTIVE
To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of HIV infection by women from men.


METHODS
Extensive searches of electronic databases, conference abstracts, reference lists of relevant studies and contact with experts and funders.


METHODS
Randomised controlled trials meeting pre-determined quality criteria with HIV infection as the outcome.


METHODS
Data were extracted by one reviewer and checked by the another. Any discrepancies were adjudicated by a third reviewer.


RESULTS
Five trials were included in the review and four contributed to a meta-analysis. Overall, the risk of HIV infection was not statistically significantly different among women receiving N-9 (relative risk [RR] 1.12, 95% CI 0.88-1.42; p=0.4). The risk of genital lesions was statistically significantly greater among women receiving N-9 (RR 1.18, 95%CI 1.02-1.36; p=0.02).


CONCLUSIONS
There is no evidence that nonoxynol-9 protects against vaginal acquisition of HIV infection by women from men. There is evidence that it may do harm by increasing the frequency of genital lesions.
Wilkinson
D
D
Division of Health Sciences, University of South Australia, 15 Bishop Street, Skye, South Australia, Australia, 5072. david.wilkinson@unisa.edu.au
Ramjee
G
G
Tholandi
M
M
Rutherford
G
G
D003075:Coitus; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D017137:Nonoxynol / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013089:Spermatocidal Agents / Q000627:therapeutic use*
D013089:Spermatocidal Agents; D017137:Nonoxynol