Marcia Frellick

March 04, 2014

BOSTON — Without a cure or vaccine for HIV, some researchers are focusing on prevention.

In all the excitement about new drugs and treatments, "it's important to remember that 5 people are infected for every 3 people who come onto treatment," said Sharon Hillier, PhD, director of the Center of Excellence in Women's Health at the Magee-Women's Hospital of the University of Pittsburgh Medical Center.

She discussed progress and challenges in HIV prevention here at 2014 Conference on Retroviruses and Opportunistic Infections.

Because not all people who are infected seek treatment, the HIV epidemic is of particular concern to receptive sexual partners, who are often least able to control condom use when participating in vaginal or anal sex, she explained.

For women, a vaginally inserted ring that releases the antiretroviral drug dapivirine helps prevent HIV. It is a discreet, easy-to-use method of protection, and is active for a full month, eliminating adherence issues. It is considered safe for long-term use.

The ring is currently being tested in 2 phase 3 trials: ASPIRE, being conducted by the Microbicide Trials Network; and The Ring Study, being conducted by the International Partnership for Microbicides.

These studies involve more than 5000 women volunteers from multiple sites in Africa.

It's important to remember that 5 people are infected for every 3 people who come onto treatment.

"To date, most women say that their partners cannot feel the ring during sex, and most find it completely acceptable," Dr. Hillier told Medscape Medical News. She said the ring results will be available in late 2015 or early 2016.

Several companies are starting to test rings that combine contraceptives and antiretrovirals, she added.

The ring has substantial promise, said Susan Buchbinder, MD, director of Bridge HIV, an HIV prevention research unit in the San Francisco Department of Public Health.

"If it proves to be successful and can be coformulated with contraception, that would be a really nice option for women," she said.

She noted that one of the most promising prevention advances is pre-exposure prophylaxis. Uninfected people take a daily pill or apply a medication topically that acts as a shield against HIV.

'What we're trying to find out now is how best to deliver it to people who may benefit from it most," Dr. Buchbinder said.

Dr. Hillier said she would like to see more effort put into making pre-exposure prophylaxis as available and prominent as hand sanitizers, which are ubiquitous in airports and public gathering spots.

Another positive prevention measure is the increase in the number of circumcisions. In the decade since large trials showed a substantial reduction in HIV infection in circumcised men, that reduction has been sustained, Dr. Hillier reported. "This is a one-off procedure that actually gives a lifelong benefit."

Dr. Hillier reports being a Merck board member and receiving payments from Clinical Care Options for development of educational presentations. Dr. Buchbinder has disclosed no relevant financial relationships.

2014 Conference on Retroviruses and Opportunistic Infections (CROI). Presented March 3, 2014.


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