A vaginal gel reduced
HIV infection in South African women by more than half, the
first hint of success in the long hunt for protection women
can use against the virus, according to a study released
Monday in Science Express magazine.
"I think it's a
landmark paper," said Dave O'Connor, an HIV researcher at
the University of Wisconsin-Madison School of Medicine and
Public Health, who was not involved in the study. "It
opens up the possibility that we'll have an intervention that
women can use discreetly — that works."
Women who used an
anti-retroviral gel faithfully before and after sex cut their
chances of getting HIV by 54 percent, while those who had
typical use cut their chances by 38 percent, according to the
study. The findings were also presented at the International
AIDS Conference in Vienna on Tuesday.
If follow-up studies
show the same result, the gel could potentially save millions
of lives and allow women to protect themselves from HIV —
even when their partners refuse to wear condoms, said
Quarraisha Abdool Karim, lead author of the study and
infectious disease epidemiologist at Columbia University's
Mailman School of Public Health, in a news conference Monday.
Researchers have long
sought a drug that could allow women to stop HIV transmission,
but six potential microbicides over the last 15 years failed
to curb infection — and one actually increased transmission
rates.
Worldwide, 33 million
people have HIV, and in South Africa, about one in every three
women is infected, said Barbara Jasny, the deputy editor of
Science, in a Monday news conference about the trial.
Giving women the
power to protect themselves is especially important in
Sub-Saharan Africa, where many of the women who are infected
cannot get their partners to use condoms, O'Connor said.
The study enrolled
889 rural and city-dwelling women, ranging in age from 18 to
40, who were not using condoms in KwaZulu-Natal, South Africa.
Half of the group used a placebo gel, and half received a gel
that contained tenofovir, an anti-retroviral drug that
prevents the virus from replicating inside cells.
Both groups of women
in the study applied the gel once up to 12 hours before sex,
and again within 12 hours after sex. Researchers measured how
faithfully they applied the gel by counting the number of used
and unused gel applicators the women brought back at monthly
check-ups.
In the 2 1/2-year
study, 38 women using tenofovir were infected with HIV,
compared with 60 women in the placebo group, said Salim Abdool
Karim, pro-vice chancellor of research at the University of
KwaZulu-Natal, who led the study along with wife Quarraisha
Abdool Karim.
The findings still
need to be confirmed by larger trials and clear regulatory
hurdles before it can be marketed, the scientists said. But
"they suggest that we could soon have a new method to
help reduce the heavy toll of HIV among women around the
world," said Kevin Fenton, the director of the National
Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
in an e-mail statement.
The gel also slashed
rates of herpes type 2 by 51 percent in the group that used
it, although the researchers aren't sure why that worked.
The researchers don't
know why this vaginal gel worked after the long string of
failures that preceded it.
But Salim Abdool
Karim, who conducted research on several of those failed
drugs, said tenofovir works by a different mechanism.
Tenofovir enters the cells that HIV targets and prevents the
virus from replicating, while past candidates mostly tried to
prevent HIV from getting into cells in the first place, he
said.
In addition, the
findings raise hopes that optimizing the dose could make the
microbicide even more effective. In an ongoing trial, women
are using tenofovir in combination with another
anti-retroviral in a microbicide, O'Connor said.
"The impact of
this could be felt worldwide," he said.