HIV microbicides: where are we now?

Area of Science:

• Virology
• Immunology
• Public Health

Background:

• Sexual contact is the primary route of human immunodeficiency virus (HIV) transmission, typically across mucosal epithelia.
• Current HIV prevention relies on behavioral interventions, structural measures, and pre-exposure prophylaxis (PrEP) using antiretroviral drugs.
• Antiretroviral drugs, administered orally or topically, are key components of pre-exposure prophylaxis (PrEP) strategies.

Discussion:

• The CAPRISA 004 and iPreX trials demonstrated the potential of tenofovir-based microbicides and oral TRUVADA® for HIV prevention.
• Recent trial failures (FEMPreP, VOICE) highlight the need for improved efficacy and safety in current pre-exposure prophylaxis (PrEP) regimens.
• Developing novel, potent, and safe strategies is crucial to effectively block sexual HIV transmission.

Key Insights:

• Pre-exposure prophylaxis (PrEP) offers a viable biomedical approach to prevent HIV infection.
• Successes in early trials validate the concept of reverse transcription inhibitor (RTI)-based prevention.
• Mixed results from recent trials underscore the complexity of HIV prevention and the need for optimization.

Outlook:

• Future studies are essential for developing next-generation HIV prevention methods.
• Continued research aims to enhance the potency and safety profile of antiretroviral pre-exposure prophylaxis (PrEP).
• The ultimate goal is to significantly reduce the global burden of HIV transmission through improved strategies.