Prioritizing prevention of HIV and sexually transmitted infections: first-generation vaginal microbicides.
OBJECTIVE
As the HIV/AIDS pandemic continues unabated, novel control measures for the spread of HIV and other sexually transmitted infections are urgently needed. Topical microbicides are designed to prevent transmission of sexually transmitted infections when applied vaginally. The microbicides discussed in this review may provide a new opportunity for decreasing the spread of HIV and other sexually transmitted infections.


RESULTS
Epidemiological studies suggest a synergistic relationship between HIV and sexually transmitted infections, particularly between HIV and genital herpes infection. Compounds have been developed to block transmission of HIV-1 and herpes simplex virus, as well as Neisseria gonorrhoea and Chlamydia trachomatis. Several of these compounds have advanced to clinical trials as candidate microbicides. Candidate compounds fall into the following categories: detergents or surfactants that inactivate viral particles, anionic polymers that block attachment of virus to target cells, vaginal acid-buffering agents that maintain a protective vaginal pH, and antiretroviral drugs specific for HIV. Evaluation of the safety of topical microbicides remains problematic. Clinical experiences indicate that current models to assess safety in vitro and in vivo may be insufficient to assess the safety of vaginal microbicides. A critical direction of future studies is to identify which assay(s) provide surrogate laboratory markers of safety that correlate with clinical outcomes.


CONCLUSIONS
The spread of HIV, and its increasing burden of disease in women, necessitates the development of novel prophylactic strategies. Topical microbicides offer women an empowering preventative option but require vigorous testing for safety and effectiveness.
Madan
Rebecca Pellett
RP
Departments of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
Keller
Marla J
MJ
Herold
Betsy C
BC
D000282:Administration, Intravaginal; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D003902:Detergents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006558:Herpes Genitalis / Q000517:prevention & control; D006801:Humans; D012749:Sexually Transmitted Diseases / Q000209:etiology / Q000517:prevention & control*; D013501:Surface-Active Agents / Q000627:therapeutic use
D000891:Anti-Infective Agents, Local; D003902:Detergents; D013501:Surface-Active Agents