HIV infection is caused by the human immunodeficiency virus. Without treatment, the virus will get worse over time and damage your immune system. To prevent that, here’s a new tool that lowers HIV infection rates.
photo credit: andrew loxley
This potential new tool for fighting HIV infections reduced infection rates by about a third for African women in two major clinical trials. To effectively deliver antiretroviral drugs to women, this vaginal ring has been shown for the first time. But the reactions from researchers and advocates were mixed as this highly anticipated fights presented at a conference in Boston.
Some celebrated the potential arrival of much-needed prevention tool while others were disappointed the vaginal ring fell short of expectations, particularly to those who received minimal to no protection. Researchers are preparing to seek regulatory approval.
Dr. Mark Wainberg, director of an AIDS centre with McGill University and the Jewish General Hospital, said that they would’ve hoped that the level of protection would actually have been larger than what they observed. He’s not involved with the studies, but added that this finding is really good news. It’s a step in the right direction, but hoping for better.
The number of people who are currently living with HIV is 37 million and more than half of them are women. Majority of those women living with this condition are residing in sub-Saharan Africa which has some of the world’s highest infection rates. The non-profit International Partnership for Microbicides (IPM) has been developoing a vaginal ring that can protect at-risk women from HIV infection for the past decade. The device releases an anti-HIV drug called dapivirine, which prevents the virus from replicating and it’s similar to vaginal ring used as contraceptives.
Researchers are excited about this ring because it offers invisible protection. It’s a huge benefit to women who are vulnerable to rape or lack control in their sexual reproductive health.
Better yet, it only needs to be replaced once a month. It offers a lower-maintenance option than alternative HIV prevention methods, like prophylactic pills or microbicidal gels. African women have shown low adherence which means they have struggled to follow the products’ requirements.
In 2012, two large clinical trials of the vaginal ring began with 4,588 women enrolled across sites in Uganda, South Africa, Malawi and Zimbabwe.
As a result, both studies suggested that the vaginal ring was the most protective for adult women. In one study dubbed ASPIRE, led by the U.S. National Institutes of Health, the HIV infection rate was reduced by 61 percent for women over 25 and 56 percent for those over 21. These results were published in the New England Journal of Medicine on Monday. The other, called the Ring Study, led by IPM and resulted in reductions by 37 percent for women over 21.
Dr. Annalene Nel, IPM’s chief medical officer who led the study said that the ring is the first long-acting HIV prevention method designed specifically for women and two large studies have confirmed the ring’s efficacy with statistical significance. And, the results give every women who suffer from HIV hope that researchers must and can do better.
However, the vaginal ring showed little to no protection for women under the age of 21 in both studies. The ring reduced infections by only 15 percent for women between 18 and 21 in the Ring Study. The added protection for these women was zero in ASPIRE.
Dr. Jared Baeten, a University of Washington professor with the ASPIRE team thinks that they know from lots of settings from HIV treatment, from contraception that women who are younger often have problems with adherence. He added that more work is needed to unpack why the vaginal ring performed poorly in younger women.
In spite of that, the researchers believe their findings are promising enough to stop giving placebos to women in the South African control group of the Ring Study and start giving them the microbicidal versions. The ASPIRE study has already ended.
By 2017, the IPM also hopes to license the vaginal ring. It is exploring development of a different version that doubles as a contraceptive. They also plan to produce a vaginal ring that can last for three months instead of one.
Paula Donovan, co-director of the international advocacy organization AIDS-Free World, expressed her opinion saying that she considers Monday’s trial results to be a ‘completely good news story’, though she emphasized that she’s not a scientist. She thinks that the vaginal ring is a promising intermediate step and the beginning of what everybody’s hoping will be the perfect prevention method.
According to her, there’s just been nothing to date that’s held out any hope for women of reproductive age who don’t necessarily have autonomy over their sexual lives. She added that to have something like this, that can be used by women with or without the knowledge of their sexual partners and that’s just incredibly welcome.