30 November 2016

New vaginal ring for slow release ARV

Trials of a new vaginal ring that slowly releases antiretroviral medicine found that it offered women between 27 and 31 percent protection against HIV infection.

A new HIV prevention product for women in the form of a vaginal ring that slowly releases antiretroviral medicine, may soon become available commercially.

New ring every month

Two trials found that the ring offered up to 31 percent protection for the woman and also did not interfere with their sexual activity, as most of their partners did not notice the ring.

The two large trials involved over 5 000 women, including a number of South Africans. The women inserted a new ring every month and it slowly released an ARV called dapivirine. They were monitored for two years.

The trials of the ring – one run by the International Partnership for Microbicides called ASPIRE and the other, the Microbicide Trial Network (MTN) Ring study – found that the ring offered the women between 27 and 31 percent protection against HIV infection. 

Read: Vaginal gel no HIV protection

The results of the MTN Ring trial are due to be published in the New England Journal of Medicine on World Aids Day, although the results were announced a few months ago.

In that trial, some women received rings with dapivirine while others received rings without, and no one knew who had the ARV rings. The trial found that the women using the dapivirine rings were 31 percent less likely to get HIV.

However, age played an important role with the ring only offering a 15 percent protection rate to women under the age of 21 and 37 percent protection to women over the age of 21.

Sex largely unaffected

This is similar to the results of the ASPIRE trial, which found that the ring offered no protection to women aged 18 to 21 and 56 percent protection to those over 21. 

There is speculation that this could be related to the fact that the younger women’s genital tracts were not that well developed.

Most of the women who used the experimental vaginal ring reported that sex was largely unaffected by the product, which is inserted every month. This is according to the researchers, who reported back on their findings at the recent HIV Research for Prevention Conference held in Chicago in October.

The majority of the women who took part in the MTN trial did not feel the ring at all, according to Dr Sharon Hillier, principal investigator of the clinical trial. 

“Some women said you can dance while you have it in the vagina, and you can have sex. Some men said it makes sex better,” said Hillier, adding that most men did not even know their female partner was wearing the ring inside her vagina because they could not feel it during sex.

Read: Vaginal ring contraceptive may help migraines

But about five percent of women participants in Johannesburg experienced violence after their partners discovered the ring.

Violence against women

“Women who were beaten up by their boyfriends or husbands had a hard time using the product, because they would argue about using it,” Hillier said, explaining that violence was an issue for many young women.

According to Dr Thesla Palanee-Phillips, director of network trials at the Wits Reproductive Health and HIV Institute and protocol co-chair of the MTN020 study, violence against women is a significant problem globally, particularly in the communities where the ring study was conducted.

Hillier added that while the product had not yet been licensed, it was at point where women who participated in the study were being called back and offered another chance to use the ring. 

Ntando Yola, community engagement officer at the Desmond Tutu HIV Foundation, told Health-e News that if the vaginal ring is licensed for public use, it will encourage people to know their HIV status because HIV testing was key to ring use.

Read: Home HIV testing gets the green light

“We hope that, if approved, the long-acting dapivirine ring could join daily pre-exposure prophylaxis in expanding new self-initiated options for women as part of a comprehensive HIV prevention package that includes male and female condoms, Treatment as Prevention and other strategies,” he said. – Health-e News.

Read more:

A monthly vaginal ring for HIV prevention?

Churches are a good place for HIV testing and treatment in Africa

HIV-prevention pill appears to be working