Preventing HIV in Developing Countries: Status of Biomedical Interventions

Abstract

Insights have emerged as to ongoing HIV prevention challenges.VaccinesThe "STEP" study of a multivalent adenovirus‐vectored prime with a DNA boost did not prevent HIV; in fact, persons with prior adenovirus (+) status were infected with HIV more often than were adenovirus (‐) persons.MicrobicidesBoth cellulose sulfate and Carraguard failed to prevent HIV.BarriersThe female diaphragm was not successful in preventing HIV in Zimbabwe.Behavior changeA meta‐analysis (Cochrane review) suggested no efficacy of abstinence‐only based behavior change (BMJ 2007).Risk reduction for injection drug useHIV seroincidence has declined substantially where needle exchange programs and drug addiction treatment are available.Male circumcisionRandomized clinical trials in South Africa, Kenya, and Uganda indicated ≈50% reduction in seroincidence among circumcised men.Control of sexually transmitted infectionsThe suppression of HSV‐2 with chronic acyclovir did not reduce HIV seroconversions.Prevention of mother to child transmissionUse of 2‐3 drugs in pregnant women and use of post‐partum prophylaxis in breastfeeding infants can reduce HIV drug resistance and also can increase efficacy (PEPI study). Early therapy of HIV(+) infants is more effective than later therapy (CHER study).Work in progressWe will highlight recent findings in the HIV Prevention Trials Network.