title: Drug delivery in multiple indication (multipurpose) prevention technologies: systems to prevent HIV-1 transmission and unintended pregnancies or HSV-2 transmission.
abstract: BACKGROUND
  The development of multiple indication (multipurpose) prevention technologies (MIPTs) is driven by overlapping relationships in the area of female reproductive health.
  
  
  METHODS
  In this review, the basis for MIPTs is detailed. The current state of the field for the use of drug delivery in novel MIPTs is covered. Of particular interest is the application of intravaginal rings (IVRs) for the delivery of two drugs simultaneously, to prevent one STI and pregnancy, or two STIs. IVRs are currently available commercially for contraception and have been developed for release of microbicides to prevent sexual transmission of HIV-1. Novel IVRs capable of releasing relatively large amounts of drugs such as tenofovir are discussed, along with those that contain independent delivery elements, such as pods, that can be used to release drugs at independent rates. The vaginal administration of macromolecules (antibodies and vaccines) is also reviewed in the context of MIPTs.
  
  
  CONCLUSIONS
  The field of MIPTs remains one of potential. There is yet to be a proven microbicide effective at preventing sexual transmission of HIV-1. Development of MIPTs in the near term will proceed under the assumption that one or more antiretroviral (ARV) drugs will eventually be proven successful. IVRs have already demonstrated success in the area of contraception. Prevention of sexual transmission of HIV-1 and herpes simplex virus-2 (HSV-2) (or suppression of recurrence) remains an attractive MIPT target. In the long term, development of MIPTs will require validation of surrogate end points, particularly for prevention of HIV-1 transmission.
authors.affiliation: Eastern Virginia Medical School, CONRAD, Department of Obstetrics and Gynecology, 1911 North Fort Myer Drive, Suite 900, Arlington, VA 22209, USA. dfriend@conrad.org
authors.forename: David R
authors.initials: DR
authors.lastname: Friend
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000282:Administration, Intravaginal; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage*; D001702:Biopharmaceutics / Q000379:methods; D003267:Contraception / Q000379:methods; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects; D006558:Herpes Genitalis / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D018258:Herpesvirus 2, Human / Q000187:drug effects; D006801:Humans; D063065:Organophosphonates / Q000008:administration & dosage; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D049168:Pregnancy, Unplanned; D000068698:Tenofovir
chemical_list: D000890:Anti-Infective Agents; D000998:Antiviral Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine