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1 January 2006

Volume 193, Number 1
The Journal of Infectious Diseases 2006;193:36–44
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2006/19301-0007$15.00
DOI: 10.1086/499163
PERSPECTIVE

Microbicides to Prevent HIV Transmission: Overcoming Obstacles to Chemical Barrier Protection

Darpun Dhawan1 and

Kenneth H. Mayer1,2,3

1Brown Medical School, and 2Infectious Disease Division, The Miriam Hospital, Brown University, Providence, Rhode Island; 3Fenway Community Health, Boston, Massachusetts

Background.Microbicides are topical compounds that could prevent sexually transmitted infections. Several compounds have demonstrated activity both in vitro and in animal models, but none has been approved for use in humans.

Methods.A review of >100 recent publications from MEDLINE (through October 2005) and abstracts presented at recent conferences was undertaken to describe the current status of microbicide research and to delineate why microbicides are not yet available.

Results.More than 15 candidate microbicides are currently being studied in clinical trials. Their mechanisms of action include disruption of the viral membrane by surfactants, maintenance of an acidic vaginal pH, binding to the viral envelope to block receptor binding, and blocking of receptors; they may also be combined with antiretroviral drugs. The development of safe and effective microbicides has been delayed by limitations in understanding the biological processes of human immunodeficiency virus (HIV) transmission, difficulties in extrapolation from animal models, lack of established correlates of protection, and the need to enroll and follow large cohorts of high‐risk participants for several years in order to demonstrate efficacy.

Conclusions.Safe and effective topical microbicides are biologically plausible. Several trials that are under way may demonstrate the ability of microbicides to protect against transmission of HIV, but multiple challenges remain.

Received 11 July 2005; accepted 27 October 2005; electronically published 17 November 2005.

Reprints or correspondence: Dr. Kenneth H. Mayer, The Miriam Hospital, Infectious Disease Div., 164 Summit Ave., Providence, RI 02906 ().

Cited by

John M Kaldor, Rebecca J Guy, David Wilson. (2008) Efficacy trials of biomedical strategies to prevent HIV infection. Current Opinion in HIV and AIDS 3:4, 504-508
Online publication date: 1-Aug-2008.
CrossRef
Valence M. K. Ndesendo, Viness Pillay, Yahya E. Choonara, Eckhart Buchmann, David N. Bayever, Leith C. R. Meyer. (2008) A Review of Current Intravaginal Drug Delivery Approaches Employed for the Prophylaxis of HIV/AIDS and Prevention of Sexually Transmitted Infections. AAPS PharmSciTech 9:2, 505-520
Online publication date: 1-Jul-2008.
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Per Johan Klasse, Robin Shattock, John P. Moore. (2008) Antiretroviral Drug–Based Microbicides to Prevent HIV-1 Sexual Transmission. Annual Review of Medicine 59:1, 455-471
Online publication date: 1-Mar-2008.
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Lisa A. Eaton, Seth C. Kalichman. (2007) Risk compensation in HIV prevention: Implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Current HIV/AIDS Reports 4:4, 165-172
Online publication date: 1-Dec-2007.
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Darren B. Russell. (2006) Herpes and HIV infection—has the time come to act?. Sexual Health 3:2, 67
Online publication date: 1-Feb-2006.
CrossRef

  • Potential conflicts of interest: none reported.

    Financial support: Lifespan/Tufts/Brown Center for AIDS Research, through the National Institutes of Health (grant P30 AI42853).

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