HIV/AIDS – a new preventive treatment on the way?

[23 July 2010 - 13h52]

A vaginal gel containing 1% Tenofovir – an antiretroviral reverse transcriptase inhibitor drug – appears to reduce the risk of HIV/AIDS infection in women by 39%. This is the (much awaited) finding of an important study presented at the 18th International AIDS Conference in Vienna (Austria). While it raises great hope regarding the development of new preventive measures, the CAPRISA study does have its limitations … and calls for further studies to be conducted.

“The microbicide gel containing an antiretroviral drug does not reduce the risk of infection to nil”, we are reminded by Professor Jean-Michel Molina, an infectious disease specialist and head of the infectious and tropical disease unit at the Saint Louis hospital in Paris. However, it does undoubtedly represent a first and promising step in perfecting preventive measures that are combined with an antiretroviral. The study was conducted in 2009 in South Africa by the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and involved 889 women at high risk of infection. The gel has to be applied around 12 hours before sexual intercourse, then shortly afterwards. These conditions are considered essential to its effectiveness. The women were divided into two equal groups: in the group using the gel only 38 became infected with HIV, whereas in the placebo group, 60 women became infected.

This discovery offers real hope in the battle against an epidemic that affects women in particular. According to UNAIDS, women account for 59% of all infected adults in sub-Saharan Africa. Furthermore “it is the first time that a tool for prevention has been developed that women can control 100%”, reports a delighted Yves Souteyrand, coordinator of the WHO’s HIV/AIDS strategic information unit. A virucidal vaginal gel to start with and perhaps in future a rectal gel or tablets to be used preventively, immediately before at-risk sexual relations take place. Thanks to the CAPRISA study, these options now appear to be a realistic possibility. At present the trials being carried out relate to antiretroviral drugs taken on a daily basis as a preventive measure and the first results are expected in 2011.

The publication of these findings by CAPRISA is most certainly good news. Particularly so for couples who are serodivergent: ie where one of the partners only is HIV positive. “For such couples, the quality of life could return to something comparable to that of other couples”, as Fabrice Bilorge of TRT5 (an interassociation group that brings together 8 different organisations fighting against HIV/AIDS) points out with cautious enthusiasm. “But this won’t happen straight away …”. For its part, the AIDES association gives a more measured reaction expressing itself “disappointed” by the results of CAPRISA. It does point out, however, that “the gel also works against herpes, with a 51% reduction in risk of infection. It is (therefore) doubly good news as the presence of herpes increases the risk of HIV transmission and acquisition”.

Source : FHI, CONRAD, USAID, TIA, science and technology, University of Kwazulu-Natal, CAPRISA, 20 July 2010; from our special correspondent at the 18th International IAS Conference in Vienna – interview with Professor Jean-Michel Molina, 21 July 2010; interview with Fabrice Bilorge, 21 July 2010; AIDES, 21 July 2010, Science, 20 July 2010.

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