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Dozens in development: anti-HIV microbicides probably a decade away.(Gynecology)
SAN FRANCISCO -- More than 20 years into the HIV epidemic, advances in understanding the disease have enlivened the quest for an effective microbicide, but it will be another decade or so before one becomes available, Dr. Robin J. Shattock said at the 11th Conference on Retroviruses and Opportunistic Infections.
Understanding of the mechanisms of HIV transmission has progressed at a much more rapid pace in recent years, and some of the newer therapeutic drugs are being incorporated into experimental microbicides. These two factors have led to a wide range of new products in the microbicide development pipeline that target different stages in the HIV life cycle, said Dr. Shattock of St. George's Hospital Medical School, London.
At least five microbicides will be in advanced clinical trials in 2004. "It's almost shameful that it's taken us 15-18 years to get these products into phase III clinical trials," he said at the meeting, sponsored by the Foundation for Retrovirology and Human Health.
Another 7 microbicides will enter phase I-II studies in 2004, and more than 40 third-generation candidates are in clinical development. In addition, some compounds are crossing over from oral antiretroviral therapeutics into experimental microbicides.
In a pessimistic scenario of development, if all of the first five products to reach advanced clinical trials fail, but second-tier products show 60% efficacy in preventing HIV infection, an effective microbicide might not reach the market until 2016 if first- and second-generation products are tested sequentially, he said. In an optimistic scenario, if one of the first five products shows 60% efficacy and the second- and third-generation products are tested at the same time, a microbicide could be available by 2010.
Realistically, a combination of the two scenarios suggests that an effective microbicide could be available by 2013, he said.
Initial trials of virucidal microbicides, such as nonoxynol-9 ...
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