Topical microbicides: the time has come

Area of Science:

• * Infectious Diseases
• * Public Health
• * Pharmacology

Background:

• * Microbicides are topical agents applied vaginally or rectally to prevent sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV).
• * Numerous microbicide candidates are currently undergoing preclinical and clinical evaluation.
• * Existing research provides a proof-of-concept for microbicide efficacy, but large-scale trials are essential for definitive proof.

Purpose of the Study:

• * To review the current status of microbicide development for STI prevention.
• * To highlight the potential of combination microbicide strategies.
• * To discuss the implications for both HIV prevention in uninfected individuals and transmission reduction in infected populations.

Main Methods:

• * Review of preclinical data (in vitro, animal models).
• * Analysis of in vivo investigations.
• * Consideration of ongoing and planned large-scale clinical trials.

Main Results:

• * Preclinical and early-stage in vivo data support the concept that microbicides can inhibit HIV and other pathogens.
• * Approximately 30 microbicide products are in various stages of development.
• * The ultimate efficacy of microbicides will be determined by large-scale clinical trials.

Conclusions:

• * Microbicides represent a promising biomedical approach to HIV and STI prevention.
• * Synergistic combinations of microbicides are likely to provide superior protection due to multiple HIV targets in the genital tract.
• * Combination microbicides may reduce HIV transmission risk for both uninfected and infected individuals.