Posted by: shigman | 08/13/2010

Hope for microbicides

VIENNA, Austria – The nature of scientific research is iterative and incremental – adding to the evidence base, moving a step forward here and there. But not all steps are created equal and every so often the next step is downright exciting.

HIV/AIDS has had a few of those exciting steps: identifying the virus that causes HIV and developing the first drug to treat HIV/AIDS were groundbreaking, not only because they were great achievements, but because they changed the course of history by opening up new possibilities. Such is the case with the results of the CAPRISA microbicide trial – finally, we have a mirobicide that seems to work in preventing both HIV and Herpes Simplex Virus – 2.

CAPRISA was the big news coming out of the 2010 International AIDS Conference held in July – you could hear the word everywhere. It has made headlines around the world. The research team received standing ovations and accolades. The word was heard in the hallways (except in the “Condomize Zone,” where description of various condom options wafted through the air). The day the announcement was made, the atmosphere crackled with anticipation.

In and of itself, the results of the CAPRISA trial are great news, with an apparent reduction in transmission of 41% for HIV (more than 50% for those who strictly adhered to the protocol) and 54% for HSV. Yet, the results are not definitive – they need to be verified in different populations, additional and larger studies are needed, and we are years away from a product that women can use. These are the next chapters in the story.

The researcher in me is cautious but optimistic. The most promising advances in the past few years — a vaccine with limited efficacy, a somewhat complex male circumcision intervention, and now a potentially useful microbicide — have not been as clear cut or as successful as we might have hoped. “Combination prevention” was the other refrain heard at the AIDS conference. It will likely be a familiar refrain heard over the coming months and years.

Still, the non-researcher side of me is jumping up and down. After several false starts, we now have hope that there will be a product that will offer women some measure of control over their risk of HIV infection. This product could be used without negotiating with men about using condoms. Control is the true groundbreaking aspect of the CAPRISA trial – more important than the exact numbers – it is the idea that, for many women around the world, life could change for the better.

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