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Risk Reduction Options in DevelopmentMicrobicides
Over the past 10 years, there has been significant progress in microbicide research and development. A number of promising new products are currently in different stages of development, and the results of marketing and acceptability research have been encouraging. Nonetheless, it is likely to be another decade before safe, effective, and affordable microbicides are readily available. In general, scientists are using two approaches to the development of microbicides: developing and testing new substances, and researching the potential microbicidal activity of existing spermicidal products. Today, approximately 38 small biotechnology firms, 28 nonprofit research institutes, and six public-sector agencies are working on microbicides. In 2000, about 60 product leads were in development, of which seven were in later-stage clinical trials. Almost 36 potential products remain in some stage of Phase I testing. VaccinesCurrently, an effective preventive vaccine exists for hepatitis B only. No other preventive vaccines are available for HIV or other STIs. The hepatitis B vaccine has been available since 1982 and is given in a series of three shots. It provides protection against hepatitis B in 90 to 95% of those vaccinated. However, this vaccine is not widely available in developing countries. Vaccines for other STIs are in various stages of development. Research is currently being conducted on a variety of potential HIV vaccines. Only one potential vaccine has entered Phase III human efficacy trials, and one is in Phase II trials. There are more than 60 Phase I trials with approximately 30 candidate vaccines. Although there is promise, it is not likely that a highly effective vaccine will be available in the near future. It is worth noting that once a vaccine is developed, it may be only partially effective, and may only stop or delay progression of the disease, or reduce infectiousness among people already infected rather than prevent primary transmission. (The Making It Work section provides a link to the IAVI Web site for details about phases in vaccine development. Click on the “vaccine science” icon.)
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Research is currently being
conducted into the development of microbicides, products
that can be used vaginally and potentially rectally to prevent transmission
of HIV, and potentially other STIs by blocking transmission or killing
the pathogen. 