Microbicide research: current and future directions.
OBJECTIVE
Microbicide research has been in the forefront of scientific literature in recent months. Results of large-scale clinical trials have been announced with resultant investigations into the factors that may have contributed to the disappointing outcomes of the most promising candidates. This review takes into consideration clinical, basic scientific and behavioural research published on microbicides in the past 12-18 months.


RESULTS
Two trials testing PRO 2000, a sulphated polymer, suggested that it has no effect on HIV. Basic science research revealed several facts such as the loss of antiviral activity of microbicides in the presence of seminal plasma. Methodological models suggested that dilution factors might impact on measures of efficacy. Advancement into safety testing of highly specific antiretroviral products such as tenofovir and UC781 for both rectal and vaginal use shows promise. Development of drug delivery systems such as intravaginal rings may alleviate some of the adherence challenges faced when using coitally dependant products.


CONCLUSIONS
In the recent past, microbicide research has had disappointing outcomes. However, it has also provided a better understanding of factors that may reduce effectiveness of promising products, enabling the field to be better equipped to select and test new products.
Ramjee
Gita
G
HIV Prevention Research Unit, Medical Research Council, Durban, South Africa. Gita.Ramjee@mrc.ac.za
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D035843:Biomedical Research / Q000639:trends; D002986:Clinical Trials as Topic; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D016896:Treatment Outcome
D000890:Anti-Infective Agents