New Frontiers in HIV Prevention: The Microbicide Trials Network

by Jessica Collins

Women in sub-Saharan Africa, adolescents, pregnant and breastfeeding women, and men who have sex with men (MSM) are at an elevated risk for contracting HIV. Despite the continued worldwide prevalence of this disease, there are only five global HIV/AIDS clinical trials. The University of Pittsburgh, in partnership with Magee-Women’s Research Institute, is home to one of these organizations: the Microbicide Trials Network (MTN).

The MTN was established in 2006 to develop and assess HIV microbicides, gels or films that are applied to the vagina or rectum to prevent the contraction and spread of HIV. Microbicides are traditionally used to prevent the spread of sexually transmitted infections or to prevent pregnancy. The MTN designs, manufactures, tests and enhances microbicide products with the goal of creating an easy, affordable and effective product.

With an extensive network of over 25 clinical research sites across Africa, Asia, South America and the U.S., the MTN focuses on establishing prevention measures for high-risk third-world populations.

Two of MTN’s most promising trials are the ASPIRE and MTN-017. ASPIRE (A Study to Prevent Infection with a Ring for Extended Use) is a trial testing a vaginal ring—which contains an antiretroviral drug—for safety and efficacy in preventing transmission of HIV. Women in sub-Saharan Africa are the primary targets of this product although widespread use is certainly feasible and encouraged. A vaginal ring is an important protective agent against HIV infection, because it is female-controlled.

Dr. Ian McGowan, co-principal investigator of MTN, is a supporter of these new protective measures. “We’re optimistic about this option,” commented Dr. McGowan. “What we’re trying to do here is circumvent the problems related to adherence by using sustained delivery products.” Results from this trial are expected between 2014 and 2015.

MTN-017 is MTN’s second clinical trial. MTN-017 is evaluating the safety, efficacy and acceptability of a rectal microbicide that can be used as a lubricant but also contains an anti-retroviral component. This product is targeted towards men who have sex with men, although women can also use it. HIV-negative men who have sex with men and transgender women from Peru, South Africa, Thailand, and the U.S. are currently enrolled in the study. Results are expected in 2016 for this trial.

One major issue encountered during the trials is the social stigma associated with HIV/AIDS. Women and men enrolled in these trials often will not use treatments as prescribed or will avoid being tested for fear of being seen at the testing site. Others refuse treatment altogether, fearing what would happen if their partner found out. One way that researchers at the MTN are working to solve this issue is to disguise the HIV microbicide in less stigmatized products that are commonly used by sexually active adults: lubricants and contraceptive pills.

“We are trying to provide a multipurpose technology that will provide additional benefits to women in Sub-Saharan Africa” said Dr. Charlene Dezzutti, Network Laboratory Principal Investigator of the MTN.

The overarching goal of these trials is to find a simple, safe and effective prevention system to protect all high-risk groups from contracting HIV through sexual intercourse. In 2013, the MTN was awarded 70 million dollars to continue manufacturing and testing a multitude of HIV prevention products. With this funding the MTN will be able to continue research of prevention measures through the year 2021.