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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Update on Microbicides [J Stephenson. JAMA 2000;283:1811]: The author reviews the current state-of-the-art for microbicides. Currently, there are at least 36 products in preclinical development, four are ready for safety studies, and four are ready for large-scale clinical trials. The major approaches to this issue are diverse and summarized below:

  • Surfactants: These are detergent-like chemicals including nonoxynol-9 and benzalkonium chloride. The problem with N-9 is irritation effect of the mucosa, which may actually increase susceptibility and may account for variable results in clinical trials for prevention of HIV. These effects may be dose-related, so lower dose formulations are currently being tested.
  • Acid-buffering agents: The goal here is to retain the acid pH and H202, which have antimicrobial activities including activity versus HIV.
  • Attachment inhibitors: The goal is to prevent HIV and other STD pathogens from attaching to mucosal surfaces using charged polymers such as dextran sulfate.
  • Monoclonal antibodies: These antibodies target HIV and other STD pathogens.
  • Fusion inhibitors: The goal here is to interfere with fusion of HIV and target cells on the mucosa as with cyanovirin-N which has potent anti-HIV properties.
  • Antiretroviral agents: The goal here is for topical application of the same agents that have established merit for systemic application.
In conclusion, Mark Wainberg, President of IAS, comments on the difficult economic issues surrounding the use of these agents noting that the greatest need exists in areas with the fewest resources. Thus, international efforts to deal effectively with HIV in the developing world need to adopt microbicides as a major component of their mission.posted 6/6/2000







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