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The rectal microbicide pipeline and how to proceed.
As the first phase II rectal microbicide study, MTN 017, wraps up, the prevention field is poised to consider what’s next. Some key considerations are: As highly effective oral PrEP becomes available, how will a rectal microbicide fit into combination prevention? And what might be the best rectal microbicide candidate?
The lead rectal tenofovir-based candidate is not the most potent against HIV in the test-tube. Other compounds look better in these “in vitro” analyses, giving researchers hope that they might also provide protection in humans. But clinical trials are needed to get real answers. Previous studies have shown that vaginal tenofovir gel can lower HSV-2 risk in women but other compounds in early research, such as Griffithsin, are active against HIV, HSV-2 and HCV. There are also questions about what types of delivery systems are most desirable and effective—gel, enema, nanofiber, quick-dissolving tablet, etc.
IRMA and AVAC convened a stakeholder consultation at the South African AIDS Conference in Durban, in June, to grapple with these very issues. South African advocates, clinicians and researchers weighed in, declaring the desire for more prevention options and helping to shape an agenda in support of the development of safe, effective, acceptable and accessible rectal microbicides for men, women and transgender individuals. The consultation was held in collaboration with the Desmond Tutu HIV Foundation (DTHF) and the Microbicide Trials Network.
IRMA and AVAC are pleased to share with you the six detailed PowerPoints presented by Ian McGowan and Ross Cranston of the Microbicide Trials Network, José Romero of the Population Council, Brian Kanyemba of the Desmond Tutu HIV Foundation, and Jim Pickett of IRMA. DTHF researcher Linda Gail Bekker co-chaired the event with Pickett.
Check them out here: rectalmicrobicides.org/community.php and below.
- An introduction to rectal microbicide development: Ian McGowan, Microbicide Trials Network
- An overview of MTN-017 and an introduction to MTN-026: Ross Cranston, Microbicide Trials Network
- Beyond HIV: Rectal microbicides to prevent HIV and other STIs: José Romero, Population Council
- Moving the rectal microbicide agenda forward; results from a scientific, ethical, and community consultative process: Ian McGowan
- Community Perspectives on Rectal Microbicides; Forward, Ever Forward: Brian Kanyemba, Desmond Tutu HIV Foundation and Jim Pickett, IRMA