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AIDS meeting spotlights pills to prevent infection

© 2006 Nature Publishing Group http://www.nature.com/naturemedicine

Gels, creams and pills that can prevent HIV think about it, what is more female-controlled
infection are the most promising new tools in the than taking a pill in the morning that can 38.6 million Number
fight against HIV/AIDS: that was the recurring protect you from getting infected?” infected with HIV worldwide
theme at the 16th international AIDS conference
in Toronto in August. Trials and tribulations
4.1 million Number of new
Faced with growing numbers of HIV The concept of using antiretroviral drugs is
infections in 2005
infections and the dim prospects of a vaccine to not new. Drugs such as AZT and nevirapine 1.65 million Number of
prevent them, researchers are pinning their hopes have been used in HIV-positive pregnant individuals on antiretroviral
on circumcision, microbicides and antiretroviral women to prevent transmission of the virus therapy
drugs taken to thwart HIV infection. to their children. Members of some high-risk
Trials of 16 microbicides, championed by the groups, such as men who have sex with men,
8,000 Number of deaths
Bill & Melinda Gates Foundation and others, are already thought to take AIDS drugs as
each day from AIDS-related
are under way in Africa and India. Five of those prevention.
illnesses
are in advanced trials and results are expected If rigorous trials back the use of these pills 9% Proportion of adults at
next year. One large trial last year showed that for preventing infections, several questions risk with access to condoms
circumcision can reduce HIV infections by up follow: who would pay to provide the pills,
to 60% (Nat. Med. 11, 1261; 2005). and to whom? What about the potential for
33% Proportion of US
But antiretroviral drugs are only just beginning misuse and for resistance to the drug? Is it
funds for prevention set
to get attention as a means of prevention. safe to give these potentially toxic medicines
aside for abstinence
In his keynote speech, Bill Gates said his to otherwise healthy individuals?
foundation would dedicate funds for drugs that A few concerns arose even before the trials
prevent HIV infection. “Oral prevention has began. Activists asked whether the drug would be Against abstinence
not gone as fast as it should,” he said. “We blame available to participants after the trial ended and Solutions to the many other ethical concerns are
ourselves for not pushing that more.” whether those who become infected during the starting to emerge. Tenofovir is long-lasting and
An early trial, funded by the foundation and trial would be cared for long term. The intense safe. Other antiretroviral drugs, such as 3TC,
led by the nonprofit Family Health International, media scrutiny that followed shut down studies have been available longer and are known to be
has shown that the antiretroviral drug tenofovir in Cambodia and Cameroon. safe even after long-term use.
(Viread) is safe when given to healthy people. Trials since then have taken these concerns To combat the potential problems with
Because too few people became infected during into account, says Peterson. For instance, she resistance, ideally some companies would reserve
the trial, however, it is not yet clear whether the says, researchers negotiated to provide treatment specific drugs for prevention, says Lange. Despite
drug can protect against HIV, says Leigh Peterson, for at least 15 years to trial participants in Ghana all the hurdles that remain, he says, “I still think
lead investigator of the trial. who became infected. it’s far easier in the end to do this than to put 30
Other trials of the approach are million people on therapy.”
under way in Thailand, Botswana, Peru Researchers at the meeting also
and the US, testing either tenofovir or discussed the use of cervical barriers,
Truvada, a combination of tenofovir and such as diaphragms, and suppressing
emtricitabine. Results from the Thai trial, herpesvirus infections, which increase
expected next year, should clarify whether HIV risk by up to three times.
the approach works. For the first time, world leaders also
These studies are testing the method in loudly criticized the US government’s
sex workers, men who have sex with men emphasis on abstinence. President
Jorge Uzon/Agence France Presse

and drug users—high-risk groups for Bush’s $15 billion AIDS program
whom the drugs are likely to be the most earmarks 33% of its prevention funds
effective. Oral drugs would also allow for abstinence-based programs.
women to protect themselves without the “On balance, this program has
knowledge or cooperation of their partners, done a lot more good than harm,” said
notes Joep Lange, an AIDS specialist at the former President Bill Clinton. But “an
University of Amsterdam. abstinence-only program is going to
“There’s an enormous need for female- Safety first: New tools for prevention and the US policy on fail.”
abstinence were hot topics at the AIDS meeting in Toronto.
controlled methods,” Lange says. “If you Apoorva Mandavilli, Toronto

NATURE MEDICINE VOLUME 12 | NUMBER 9 | SEPTEMBER 2006 981