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VIENNA - A woman's
risk of infection with HIV can be significantly cut by the use
of a vaginal gel, a study has found. The research marks the
first success in a 15-year search for a way women can
independently protect themselves from contracting HIV infection
through sex.
Short of a vaccine, an
effective vaginal microbicide has been the most elusive goal in
the epidemic.
The research, which
was conducted in South Africa and will be presented Tuesday at
the 18th International AIDS Conference in Vienna, tested a gel
containing the antiretroviral drug tenofovir. While far from
perfect, it was unambiguously helpful, reducing the risk of HIV
infection by 39 percent in a group of women who used it for
about three-quarters of their sexual encounters. Those who used
it more consistently experienced 54 percent fewer infections.
If development follows
the expected course, more-potent formulations, combined with
campaigns to make the product appealing (or even sexy), could
result in vastly better protection.
Of the 33 million
people worldwide infected with the AIDS virus, 16 million are
women. In Africa, 60 percent of people with HIV infection are
women, nearly all of whom acquired the virus through sex. For
many, the proven methods of preventing infection, such as
abstinence, being faithful and using condoms, are either not an
option or out of their control. A vaginal microbicide that could
be used with or without a man's knowledge is considered
essential, missing until now.
News of the results of
the Caprisa-004 study, which leaked out a day before they were
to be presented, sent a wave of optimism through the AIDS
research community.
"We have never had any
kind of tool that has effectively allowed women to protect
themselves," said Bruce Walker, an AIDS researcher at Harvard
Medical School. "This is really a game-changer."
"It's groundbreaking,"
said Catherine Hankins, chief scientific officer of the United
Nations' AIDS agency, UNAIDS. "This in combination with [male]
circumcision in places where the epidemic is generalized could
really turn the tide."
"Everyone is just
delighted. There were a lot of skeptics that the concept would
work at all," said Zeda Rosenberg, head of the International
Partnership for Microbicides in Silver Spring.
Researchers would need
to show that the microbicide is effective in at least one other
group of women before it could be licensed for commercial use,
several people said Monday. That effort now climbs to the top of
the international research agenda, although at a minimum the
work will take several years.
A larger study testing
tenofovir gel and antiretroviral drugs in pill form as a way to
protect women against sexual transmission of HIV is underway in
four African countries but will not be finished until 2013.
Several other experiments, including ones in which the drug is
in a long-acting vaginal ring, are in earlier stages. A
microbicide might also be useful in protecting men who acquire
the virus through anal sex.
"I think the big
challenge is to get confirmatory studies done quickly," Hankins
said.
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