Sustainable HIV prevention possibilities present choices, challenges

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When he looks at what biomedical science can do in the next decade to prevent HIV transmission, Jim Turpin of the National Institutes of Health said, he thinks of the lyrics of a Timbuk3 song: “The future’s so bright I gotta wear shades.”

By, which, actually, he means — don’t get blinded by the light; the search for answers will require focus.

“The challenge is not the lack of options,” he said, “but prioritizing the best options.”

Turpin, program officer and branch chief in the Prevention Sciences Program in the Division of AIDS at NIH”s  National Institute of Allergy and Infection Disease spoke this morning in webinar titled “The HIV Prevention Pipeline: A Future of Possibilities.” The webinar was sponsored by the International Rectal Microbicide Advocates (IRMA) and AVAC Global Advocacy for HIV Prevention.

After a series of disappointments in the quest for a vaccine or microbicide to prevent HIV transmission, the last two years offered hope, in strategies using antiretroviral medicine to prevent acquiring HIV, organizers point out. But, with a diversity of prevention needs and challenges among women and men worldwide still demanding answers, is that all there is?

Or, as Turpin put it, “Do we currently have what it takes to create a sustainable prevention pipeline?”

The answer, was yes, Turpin said, looking at current clinical trials of vaginal gels, rectal gels, silicone rings, pills, and injectable non vaccine biomedical prevention methods, using antiretroviral drugs. Then he offered a glimpse of the future — films — potentially for rectal or vaginal use, rings that can dispense different drugs at different times, quick dissolve tablets being developed now, before moving to what could be next:  a world where nano-technology could facilitate the cost-effective, time-released delivery of combinations of drugs. The potential candidates for effective drugs is growing now, as well, he said.

But the choices those all can offer demand a close look at reality, he said. That will include looking at the practicalities not only of distribution, but of disposal (how do you get rid of a gel applicator? does a ring continue to carry traces of drugs that could have unwanted effects depending on where it is disposed of?), ease of use, messiness (does it leak, stain?) and desirability (does it interfere with pleasure? comfort?).

“I think one thing we’ve learned in clinical trials,” he said, “It’s not an ‘if we make it they will come’ situation.”

All of this, Turpin said, calls for bringing in the behavioral scientists to determine what physical properties are going to make a difference in how acceptable a product ultimately is to the women and men who will be expected to use it.

Finally, the question of funding — for development, manufacture, distribution is an inescapable part of the whole equation.

“I love science fiction, but I’m grounded in reality,” Turpin said.

Slides from the webinar can be found on the IRMA Web site, here, where a recording of the event also will soon be available.




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