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Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis

BACKGROUND: Each year more than two million people are newly infected with HIV worldwide, a majority of them through unprotected vaginal sex. More than half of new infections in adults occur in women. Male condoms and male circumcision reduce the risk of HIV acquisition; but the uptake of these meth...

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Autores principales: Obiero, Jael, Mwethera, Peter G, Hussey, Gregory D, Wiysonge, Charles S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531270/
https://www.ncbi.nlm.nih.gov/pubmed/23130761
http://dx.doi.org/10.1186/1471-2334-12-289
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author Obiero, Jael
Mwethera, Peter G
Hussey, Gregory D
Wiysonge, Charles S
author_facet Obiero, Jael
Mwethera, Peter G
Hussey, Gregory D
Wiysonge, Charles S
author_sort Obiero, Jael
collection PubMed
description BACKGROUND: Each year more than two million people are newly infected with HIV worldwide, a majority of them through unprotected vaginal sex. More than half of new infections in adults occur in women. Male condoms and male circumcision reduce the risk of HIV acquisition; but the uptake of these methods is out of the control of women. We therefore aimed to determine the effectiveness of vaginal microbicides (a potential female-controlled method) for prevention of sexual acquisition of HIV in women. METHODS: We conducted a comprehensive search of peer-reviewed and grey literature for publications of randomised controlled trials available by September 2012. We screened search outputs, selected studies, assessed risk of bias, and extracted data in duplicate; resolving differences by discussion and consensus. RESULTS: We identified 13 eligible trials that compared vaginal microbicides to placebo. These studies enrolled 35,905 sexually active HIV-negative women between 1996 and 2011; in Benin, Cameroon, Cote d’Ivoire, Ghana, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, Zimbabwe, India, Thailand, and the United States of America. A small trial of 889 women found that tenofovir (a nucleotide reverse transcriptase inhibitor) significantly reduces the risk of HIV acquisition (risk ratio [RR] 0.63, 95% confidence intervals [CI] 0.43 to 0.93). Effectiveness data are not yet available from follow-up tenofovir trials being conducted in South Africa, Uganda, and Zimbabwe (1 trial) and multiple sites in South Africa (1 trial). We found no evidence of a significant effect for nonoxynol-9 (5 trials), cellulose sulphate (2 trials), SAVVY (2 trials), Carraguard (1 trial), PRO 2000 (2 trials), and BufferGel (1 trial) microbicides. The pooled RR for the effect of current experimental vaginal microbicides on HIV acquisition in women was 0.97, 95%CI 0.87 to 1.08. Although study results were homogeneous across the different drug classes (heterogeneity P = 0.17, I(2) = 27%), the overall intervention effect was not statistically significant. Nonoxynol-9 significantly increased the risk of having adverse genital lesions but no other microbicide led to significant increases in adverse events. CONCLUSIONS: There is not enough evidence at present to recommend vaginal microbicides for HIV prevention. Further high-quality research is needed to confirm the beneficial effects of tenofovir as well as continue the development and testing of new microbicides.
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spelling pubmed-35312702013-01-03 Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis Obiero, Jael Mwethera, Peter G Hussey, Gregory D Wiysonge, Charles S BMC Infect Dis Research Article BACKGROUND: Each year more than two million people are newly infected with HIV worldwide, a majority of them through unprotected vaginal sex. More than half of new infections in adults occur in women. Male condoms and male circumcision reduce the risk of HIV acquisition; but the uptake of these methods is out of the control of women. We therefore aimed to determine the effectiveness of vaginal microbicides (a potential female-controlled method) for prevention of sexual acquisition of HIV in women. METHODS: We conducted a comprehensive search of peer-reviewed and grey literature for publications of randomised controlled trials available by September 2012. We screened search outputs, selected studies, assessed risk of bias, and extracted data in duplicate; resolving differences by discussion and consensus. RESULTS: We identified 13 eligible trials that compared vaginal microbicides to placebo. These studies enrolled 35,905 sexually active HIV-negative women between 1996 and 2011; in Benin, Cameroon, Cote d’Ivoire, Ghana, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, Zimbabwe, India, Thailand, and the United States of America. A small trial of 889 women found that tenofovir (a nucleotide reverse transcriptase inhibitor) significantly reduces the risk of HIV acquisition (risk ratio [RR] 0.63, 95% confidence intervals [CI] 0.43 to 0.93). Effectiveness data are not yet available from follow-up tenofovir trials being conducted in South Africa, Uganda, and Zimbabwe (1 trial) and multiple sites in South Africa (1 trial). We found no evidence of a significant effect for nonoxynol-9 (5 trials), cellulose sulphate (2 trials), SAVVY (2 trials), Carraguard (1 trial), PRO 2000 (2 trials), and BufferGel (1 trial) microbicides. The pooled RR for the effect of current experimental vaginal microbicides on HIV acquisition in women was 0.97, 95%CI 0.87 to 1.08. Although study results were homogeneous across the different drug classes (heterogeneity P = 0.17, I(2) = 27%), the overall intervention effect was not statistically significant. Nonoxynol-9 significantly increased the risk of having adverse genital lesions but no other microbicide led to significant increases in adverse events. CONCLUSIONS: There is not enough evidence at present to recommend vaginal microbicides for HIV prevention. Further high-quality research is needed to confirm the beneficial effects of tenofovir as well as continue the development and testing of new microbicides. BioMed Central 2012-11-06 /pmc/articles/PMC3531270/ /pubmed/23130761 http://dx.doi.org/10.1186/1471-2334-12-289 Text en Copyright ©2012 Obiero et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Obiero, Jael
Mwethera, Peter G
Hussey, Gregory D
Wiysonge, Charles S
Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis
title Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis
title_full Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis
title_fullStr Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis
title_full_unstemmed Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis
title_short Vaginal microbicides for reducing the risk of sexual acquisition of HIV infection in women: systematic review and meta-analysis
title_sort vaginal microbicides for reducing the risk of sexual acquisition of hiv infection in women: systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531270/
https://www.ncbi.nlm.nih.gov/pubmed/23130761
http://dx.doi.org/10.1186/1471-2334-12-289
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