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Where next in PrEP and microbicides? Europeans discuss research pipeline
Gus Cairns, 2015-07-07 08:50:00
Thursday 18 June saw the final research meeting in Brussels of CHAARM (Combined Highly Active Anti-Retroviral Microbicides), the EU-supported research consortium which for the last five and a half years has been researching and developing possible new biomedical methods of preventing HIV.
With the success last year of the European PrEP trials PROUD and Ipergay as well as the overwhelming evidence of the potential efficacy of simply putting as many people on treatment as possible – reinforced last month by the results from the START trial – it might be asked why there needs to be further research in this field.
However while we now have PrEP’s proof of concept in gay men, the evidence that PrEP may be options women can use is much less firm, with only two trials – Partners PrEP and the Caprisa 004 vaginal gel trial - reporting statistically significant positive results for women. With suggestions that hormonal contraception could impact on vulnerability to HIV, we need something that protects against both HIV and pregnancy. With fears that PrEP in gay men could lead to mass migration from condoms and a rise in STIs, we need substances that can work against other viruses. We have no proof of concept for PrEP in adolescents or specifically in female sex workers. We need to broaden the range of drugs that can be used for prevention, especially into classes not used for treatment, because of the possibility of drug resistance. And with models implying that PrEP might only be cost-effective for very restricted groups, we need simpler molecules that can be cheaply manufactured.
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