Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"2 for 1: Developing intra-vaginal microbicidal/contraceptive rings"
Meredith Paddock

Issues
Combination microbicidal/contraceptive products are under development to address the current feminization of HIV and unwanted pregnancies. Given the high demand for a safe, effective, female-initiated, and coitally independent product, intra-vaginal rings represent a new drug-delivery system that may provide dual protection.

Description
This review discusses the development of a dual-action microbicidal/contraceptive intra-vaginal ring as an alternative to first-generation dual-action microbicidal gels. Intra-vaginal rings are a promising alternative to gels, as rings do not affect natural lubrication and can safely remain in place for extended periods of time (one month to one year), during which the active drugs are released from the ring. Product adherence and acceptability is expected to be greater with a ring than with a coitally dependent gel, which risks partner consent and/or awareness.

Lessons learned
Previous clinical trials of dual-action gel products such as nonoxynol-9, SAVVY, and BufferGel have all been ineffective in preventing HIV transmission. The review revealed that no microbicidal/contraceptive ring currently exists, but preclinical and clinical studies show the efficacy of hormonal vaginal rings, and the safety of microbicidal rings. For example, the approved contraceptive NuvaRing shows strong data in efficacy, stability, and user acceptability. Furthermore, early clinical trials of dapivirine (an NNRTI in a vaginal ring) show that the microbicidal product appropriately and safely delivers drug to the genital tract and is acceptable to women. Future studies will investigate combination rings consisting of HIV treatment drugs (antiretrovirals) and hormonal contraceptives.

Next steps
Preclinical and clinical studies with behavioral interview components will continue to determine which materials and drugs will work best for the efficacy, adherence, and acceptability of a dual-action ring. A successful and widely available product would significantly impact women's health and autonomy by reducing HIV infections and preventing unwanted pregnancies worldwide.

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