title: Microbicides: topical prevention against HIV.
abstract: Microbicides represent a potential intervention strategy for preventing HIV transmission. Vaginal microbicides would meet the need for a discreet method that women could use to protect themselves against HIV. Although early-generation microbicides failed to demonstrate efficacy, newer candidates are based on more potent antiretroviral (ARV) products. Positive data from the CAPRISA 004 trial of tenofovir gel support use in women and represent a turning point for the field. This article reviews current progress in development of ARV-based microbicides. We discuss the consensus on selection criteria, the potential for drug resistance, rationale for drug combinations, and the use of pharmacokinetic (PK)/pharmacodynamic (PD) assessment in product development. The urgent need for continued progress in development of formulations for sustained delivery is emphasized. Finally, as the boundaries between different prevention technologies become increasingly blurred, consideration is given to the potential synergy of diverse approaches across the prevention landscape.
authors.affiliation: Centre for Infection and Immunity, Division of Clinical Sciences, St. George's, University of London, London SW17 0RE, United Kingdom. shattock@sgul.ac.uk
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Shattock
authors.forename: Zeda
authors.initials: Z
authors.lastname: Rosenberg
mesh_terms: D000282:Administration, Intravaginal; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D015704:CD4 Antigens / Q000187:drug effects; D015536:Down-Regulation / Q000187:drug effects; D015195:Drug Design; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D054387:Receptors, CXCR / Q000502:physiology; D018894:Reverse Transcriptase Inhibitors / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D013678:Technology, Pharmaceutical; D016662:Virus Integration / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D015704:CD4 Antigens; D054387:Receptors, CXCR; D018894:Reverse Transcriptase Inhibitors