23 February 2016

Vaginal ring offers partial HIV protection

A vaginal ring that slowly oozes an experimental HIV virus-blocking drug named dapivirine into the surrounding vaginal tissue is being tested in Africa.


Women who inserted a vaginal ring coated with an anti-Aids drug once a month were partially protected against HIV infection, researchers said Monday as they released long-awaited results from two large studies in Africa.

Results promising enough

The ring proved safe although the protection was modest, reducing overall HIV infection by less than a third. Surprisingly, the ring worked far better in women 25 and older, leaving researchers wondering if the youngest women, who got little to no benefit, simply didn't use the device properly.

Women make up more than half of the nearly 37 million people worldwide living with HIV, most of them in hard-hit Africa, and scientists have long sought tools to help them protect themselves when their partners won't use a condom.

Despite questions the studies raise, the non-profit International Partnership for Microbicides said it considered the results promising enough to seek appropriate regulatory approval for wider use in parts of Africa.

Read: Antiretroviral treatment

"You can't just say, 'Until something is perfect, we're going to wait,'" said Dr Zeda Rosenberg, founding chief executive officer of IPM. "We have to give women options."

"For a woman to have a prevention tool that she can control is an incredibly important goal," added Dr Jared Baeten of the University of Washington, who led a National Institutes of Health-funded study of the ring. "I want rings, pills and other strategies to be on the shelf for women so they can make choices for what's going to work for them."

Aside from condoms, HIV prevention tools include taking a daily anti-Aids pill. That so-called "pre-exposure prophylaxis" isn't widely available in poor countries, and other attempts at HIV-blocking vaginal gels haven't yet panned out.

Experimental virus-blocking drug

But the age disparity found in the vaginal ring studies is so puzzling that the NIH plans to consult with outside experts on next research steps.

Read: HIV drugs more effective when taken right after diagnosis

While women need a discreet form of HIV prevention, "it's going to be absolutely critical" to determine if the younger women really didn't follow instructions, or if there was some biological difference, cautioned Dr Anthony Fauci, director of NIH's National Institute for Allergy and Infectious Diseases.

Vaginal rings are sold in the U.S. for birth control, but the anti-Aids version tested in Africa contained no contraception. Instead, it slowly oozes an experimental virus-blocking drug named dapivirine into the surrounding vaginal tissue. Women would replace the ring once a month, when it was time for another dose.

Two studies involving more than 4,500 women in Africa are being presented at the Retrovirus Conference in Boston, comparing women who used the dapivirine ring with those given an identical-looking but drug-free version. It offered modest protection, reducing by 27 percent to 31 percent the participants' overall risk of HIV.

Read: HIV medication side effects

But closer inspection of the large NIH-funded ASPIRE study in Malawi, South Africa, Uganda and Zimbabwe turned up something odd. Ring users who were 25 and older were 61 percent less likely to be infected while those ages 18 to 21 essentially got no benefit, Baeten said.

Ring must be used consistently

While the ring is designed to stay in place for an entire month before being replaced, there are signs the younger women didn't use it as regularly, said Baeten, whose results also were published online in the New England Journal of Medicine.

Read: Basic management and monitoring of HIV infection

He said women had to get comfortable with the how to use a device they'd never seen before, but those who used the ring continuously saw protection that continued throughout the 2½-year study.

"The ring must be used consistently to achieve protection," the IPM's Annalene Nel told reporters Monday as she discussed the second study, called the Ring Study. Conducted in South Africa and Uganda, that study likewise showed a trend toward greater protection for women over 21, she said.

While that study isn't completed yet, the IPM said South African regulators asked researchers to switch all the remaining study participants to the dapivirine-coated ring rather than the placebo version. 

Read more: 

What is HIV/Aids? 

Symptoms of HIV/Aids 

Prevention of HIV infection


Ask the Expert

HIV/Aids expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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