Vaginal Gel Cuts Women's HIV Risk

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Scientists are hailing a new vaginal gel as a breakthrough in the fight against HIV infection. Use of the gel cut in half a woman's risk of being infected by a sex partner. The gel contains the drug tenofovir. This drug also is used to treat AIDS, the disease caused by HIV. The study included 889 heterosexual women in South Africa. They did not have HIV infection when the study started. Half of them were given the gel and told how to use it before and after sex. The other women received the same instructions, but a different gel. This gel was a placebo. It had no medicine in it. The researchers did not know which women got which gel. Neither did the women. After one year, the HIV infection rate in those who got the real drug was reduced by 50%, compared with women who got the placebo. After 21⁄2 years, the rate was reduced by 39%. The journal Science published the study online July 19.

What Is the Doctor's Reaction?

It's not often that you hear the word "breakthrough" when talking about HIV research. But that's exactly how a study about an anti-HIV vaginal gel is being described.

I think it's too soon to know. But if the findings can be confirmed by others, this news is important.

The study included 889 heterosexual women. Half were provided a newly developed vaginal gel that contains tenofovir. This is the same drug found in the anti-HIV pill Viread. The other half of the women received a placebo gel that contained no medicine. Neither the women nor the researchers knew who had the real drug.

After 21⁄2 years, 60 women in the placebo group became infected with HIV. Only 38 women who used the tenofovir gel were infected. This is a risk reduction of nearly 40%. It's the first time that a treatment applied in this way has been shown to reduce the risk of becoming infected with HIV.

There was more good news in this study, too:

• The true effectiveness of the gel was even higher because many women did not use the gel every time they had sex. For those with the highest use, the risk reduction was closer to 50%.


• Women using the gel also were less likely to become infected with herpes.


• Nearly all of the women using the gel (97%) found it acceptable. About 98% said they'd use it regularly if it prevented HIV infection.


• Side effects were rare and mild.


• The gel is not expensive.

Still, you might be thinking, "What's the big deal? Condoms are much more effective than this new gel. And they are already widely available."

It is a big deal! A reduction in HIV risk of 40% to 50% could translate to thousands of infections prevented and lives saved. And this type of treatment is completely under the control of the woman. Sometimes a man will refuse or forget to use a condom. If that happens, the benefit of the gel found in this new research is far better than nothing.

What Changes Can I Make Now?

Until we have a vaccine or other highly effective measures to prevent HIV, do what you can to avoid infection. You can take these steps to reduce your risk:

• Avoid unprotected sexual intercourse with an infected person. That means practicing abstinence or safe sex. Limit the number of sexual partners you have.


• Avoid transfusions unless absolutely necessary. The blood supply in the United States is quite safe, but it may not be safe everywhere in the world.


• Never share needles if you use intravenous drugs.


• Take precautions to avoid needle sticks or other exposure to body fluids if you are a health care professional.


• Seek medical care right away if you may have been exposed to HIV. If you have had an accidental needle stick or high-risk sexual encounter, get immediate treatment (within 72 hours). This can reduce the chances you'll be infected.

Get tested for HIV and encourage your partner to do the same. Many people who have HIV do not know it yet. Testing is especially important if you're thinking of becoming pregnant. Treatment during pregnancy can dramatically reduce the chances of passing the virus along to your unborn child.

If you have already been infected with HIV, seek treatment right away. You can take several medicines, vaccinations and precautions to slow down the disease. Treatment can limit your illness from HIV, prolong your life and reduce spread of the infection. See your doctor regularly. Be sure you understand all of your treatment recommendations.

What Can I Expect Looking to the Future?

The enthusiasm level for this new vaginal gel has been running high. But it must be tempered by the following questions:

• Will other researchers be able to confirm these findings?


• Will women reliably use this new gel? The women in this study only used it as recommended 60% of the time.


• Can a similar treatment reduce HIV transmission between homosexual men as well?

Research on these questions is beginning. The National Institute of Allergy and Infectious Diseases is planning a study of the gel in 5,000 women. This and other future research will determine whether the new anti-HIV gel is truly a breakthrough or a promising idea that will soon be forgotten.