Prevention Revolution. 11/10/11

The world is at the “hot edge” of developing groundbreaking HIV prevention interventions and on many fronts South Africa is in the thick of things


By Anso Thom
11 October 2011

The world is at the “hot edge” of developing groundbreaking HIV prevention interventions and on many fronts South Africa is in the thick of things, according to a leading clinical researcher.

“We are truly seeing a prevention revolution,” Professor Linda-Gail Bekker, principal investigator at the Desmond Tutu HIV Centre at the University of Cape Town told a media gathering in Cape Town yesterday (Monday).

Considered one of the world’s foremost HIV and tuberculosis researchers, Bekker said there was a “nice range of armaments (against HIV infection) coming through”.

Results from a range of large studies looking at among others microbicides for women, rectal gels primarily for men who have sex with men, as well as the use of oral antiretrovirals as a prevention prophylaxis were expected from next year.

Statistics are varied, but the international numbers indicate that a staggering 7 400 new HIV infections occur daily, making targeted prevention interventions even more critical. “We need to close the tap,” said Bekker.

She said there was a need to target the “at risk” groups which include pregnant women, young women, men who have sex with men (MSM), intravenous drug users, commercial sex workers, prisoners, migrant workers and orphans and vulnerable children.

She said that in terms of the prevention of HIV transmission from mother to child “we need to move in and shut it down”.

“We have just got to go and do it,” she said, adding that 60 000 babies were infected with HIV every year in South Africa, while it was possible to eliminate paediatric HIV and remove the burden of caring for HIV positive patients for a lifetime.

It is widely believed that a critical intervention is a prevention method placed in the hands of women. Microbicides are vaginal and rectal products containing antiretroviral drugs already used to treat HIV/AIDS and which are now being tested as a method to prevent HIV infection.

Last year, one clinical study in South Africa (Caprisa 004) showed that a vaginal microbicide gel containing the ARV Tenofovir can offer women a 38% protection from heterosexual transmission of HIV, and that it also reduces transmission of genital herpes.

Although it was a major scientific breakthrough which provided hope and encouragement, the sample size was small and is now being confirmed in a much bigger trial (FACTS 001) involving over 3 000 participants.

A number of clinical studies testing microbicide products are currently underway or about to begin in South Africa and a few other African countries.

In addition, other formulations of vaginal microbicides, rectal microbicides and antiretroviral drugs taken orally are also being tested as prevention options for men and for discordant couples (those where one partner is infected with HIV and the other is not).

Bekker said they were hoping that the VOICE study and its four-arm HIV prevention trial in women would provide even more answers.

Two arms of the trial involve taking a placebo and compared to one arm taking a daily oral dose of tenofovir and FTC and another arm using a daily 1% tenofovir vaginal gel.

The trial is scheduled to conclude in 2012 with data available early in 2013.

A rectal microbicide containing Tenofovir will undergo safety tests in South Africa, Peru, Thailand and the United States early next year.

A vaginal ring containing an antiretroviral Dapirivine, not currently used in treatment of HIV/AIDS, is also in the development pipeline.

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