SPERMICIDE WORSENS HIV RISK, STUDY FINDS

By Maggie Fox

Reuters 12 July 2000

South Africa -- Researchers hoping to find a way for women to protect themselves from AIDS have said they were dismayed to find that a product they thought may prevent infection actually increased the risk.

The product, a spermicide called nonoxynol-9, did not protect prostitutes in Benin, Ivory Coast, Thailand and South Africa from infection with HIV, a team of U.N.-sponsored researchers said.

"We were dismayed to find out that the group using the N-9 gel had a higher rate of HIV infection than the group using a placebo,'' Dr Joseph Perriens, who heads the UNAIDS microbicide effort, told an AIDS conference Wednesday.

They tested nearly 1,000 women and found 59 of those who used the spermicide became infected with HIV, compared to 41 of those who used a dummy gel.

"We were extremely disappointed,'' Lut van Damme, a researcher at the Institute of Tropical Medicine in Antwerp who led the study, told a news conference.

She said researchers may be forced to suspend other trials involving the product, marketed under the trade name Advantage S by U.S.-based Columbia Laboratories Inc.

"The long-term safety of nonoxynol-9 as a family planning method may have to be re-evaluated,'' she said.

Activists and researchers have been clamoring for the development of a microbicide -- a gel or cream sometimes described as an "invisible condom'' -- that women and men could use to protect themselves not only from HIV, but from other sexually transmitted diseases such as syphilis and gonorrhea.

"I think this may be the end of nonoxynol-9 as a potential microbicide,'' Van Damme said, although she said the trials did show that women -- in this case prostitutes at high risk of HIV infection -- would use a microbicide if one was available.

CDC Expresses Concern

The Centers for Disease Control and Prevention (CDC) said it was concerned by the findings because some groups advise people to use nonoxynol-9 to protect themselves from HIV if they cannot use a condom.

"I think it's pretty clear we have to tell men who have sex with men not to use it,'' Dr. Lynn Paxton, a microbicides expert at the CDC, said in an interview.

"I think they are most at risk and I know they are using it.'' She said it was less clear whether women who use nonoxynol-9 as a contraceptive -- women who are not at risk of getting HIV -- should avoid it.

One possible reason for the findings was that the women who used the spermicide had more lesions than the women who did not, Van Damme said.

"If you use nonoxynol-9 (to protect from HIV), you are probably wasting your money. You may possibly be wasting your life,'' Perriens said. But, he added: "There is nothing in this trial to suggest you should stop using it as a spermicide.''

UNAIDS said it was pressing for the development of other products.

"We know that there are more products to come,'' Perriens said. "This shouldn't be the end of the field... One of the things holding up development, increasingly, is a lack of private sector interest in this area.''

The Bill and Melinda Gates Foundation said it would try to help with a $25 million grant for microbicide research.