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MEDIA CENTER Microbicides Can Save Millions of Lives NEW YORK (7 July 2000) — "Increased funding for microbicide research could cut development time in half, potentially saving millions of lives," says George F. Brown, M.D., vice president of the Population Council's international program division. "Women desperately need an AIDS prevention product that they can control. The world needs both a microbicide and a vaccine to prevent AIDS." Dr. Brown is one of more than a dozen Council researchers who will discuss microbicides and other HIV/AIDS prevention efforts at the 13th International AIDS Conference in Durban, South Africa, from 9-14 July. Although research on an HIV/AIDS vaccine is moving forward, it will be some time before a protective vaccine is available and accessible to everyone at risk. In the meantime, there is an urgent need to identify additional prevention options. Microbicides, a new approach under development at the Population Council and elsewhere, may offer protection against HIV/AIDS and other sexually transmitted infections (STIs). Carraguard™, the Council's lead compound, was found to block HIV infection in vitro, and a trial is underway with women in South Africa and will begin soon in Thailand to determine the method's safety. Other research organizations are testing the potential of different compounds. Despite all the promise, microbicides are a classic example of a product that will not reach the market without public-sector support, notes Dr. Brown, referring to a new publication, "The Case for Microbicides: A Global Priority," produced by the Population Council and the London-based organization International Family Health. According to the report, in 1999 global public expenditure on microbicide research and development was roughly $35 million—a small amount compared to the high costs typically required to develop a drug for marketing. Microbicides are especially promising, researchers say, because of their potential ability to protect women. Designed to be applied vaginally as a gel or cream, the products work by preventing infectious microorganisms from entering the epithelial cells. Microbicidal compounds can be formulated either to permit or prevent pregnancy while protecting against STIs, including AIDS. "The need for a woman-controlled prevention method is especially acute for two reasons," explains Dr. Brown. "Increasingly, HIV is spread by heterosexual intercourse, making women particularly vulnerable." Of the estimated 16,000 new HIV infections per day, 90 percent are in developing countries, and over 40 percent are in women. "Women are more vulnerable than men to HIV and other STIs, yet the only means of protection — abstinence and condom use — are not always within a woman's control," Dr. Brown says. Furthermore, because pregnant women can transmit HIV to their infants during pregnancy and delivery, or through breastfeeding, the need for prevention becomes all the more critical. While the female condom is a good option for some women, the method is not widely available, and its effectiveness in preventing other STIs is unclear. Abstinence also may not be an option for those women who lack educational and employment opportunities and have few alternatives to exchanging sexual favors for economic survival. Carraguard, the Council's lead product, contains a sulfated polysaccharide known as carrageenan, which is derived from seaweed and has been used extensively in the food, pharmaceutical, and cosmetics industries as a lubricant and stabilizing agent. Carrageenan is available commercially and is generally inexpensive, safe, and water-soluble — desirable characteristics for a vaginal formulation. Initial studies show that Carraguard is safe and nonirritating. Research on acceptability suggests there is likely to be demand for the product in both developing and developed countries. Despite a number of promising product leads like Carraguard, only a few are being tested in large-scale effectiveness trials, notes "The Case for Microbicides: A Global Priority." At the current rate, it could be ten years before microbicides are easily available to those who need them most. During that time millions of women and men will become infected with HIV and other STIs. The remaining development challenges are not insurmountable, and the time frame for product availability could be reduced to five years, the report notes. "However, this will require increased investment to accelerate research and development, strategies to address barriers to industry involvement, and planning to ensure future product availability and access." The report's recommendations include:
"The Case for Microbicides: A Global Priority" is available on the Council's Web site in PDF format.
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