Vaginal Ring Provides Some HIV Protection for Women

A clinical trial finds the dapivirine ring, which releases an anti-retroviral drug in the vagina provides women with a moderate level of protection against HIV infection.

The ASPIRE study, also known as MTN-020, enrolled more than 2,600 women between the ages of 18 and 45 years, who were not infected with HIV but were at high risk for the infection. Participants were assigned at random to receive either the experimental dapivirine ring or a placebo ring, with no one associated with the study knowing which ring patients received until the end of the trial. All participants received a package of HIV prevention services at each visit throughout the study, which began in 2012. These services included HIV risk-reduction counseling, partner HIV testing, treatment of sexually transmitted infections in participants and their partners, and free condoms.
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The dapivirine ring reduced the risk of acquiring HIV by 27% among all participants in the trial, according to the researchers. The ring reduced the risk by 37% when the researchers excluded data from 2 sites where many women were not returning for regular study visits or using the ring on a consistent basis. The authors also determined that this figure rose to 61% among participants age 25 and older, but provided no statistically notable protection in those under the age of 25.

In performing analyses that were not originally planned, the researchers found the ring cut down on the risk of HIV infection by 56% in women older than 21, but offered no protection for those between the ages of 18 and 21. The authors note that more research is needed to determine what factors may be responsible for this finding.

Overall, the results offer encouragement that “effective prevention approaches can be developed for women; [approaches] that work within women’s lives,” says Jared Baeten, MD, PhD, a professor of global health, medicine, and epidemiology at the University of Washington, and a co-lead author of the study.

Oral daily emtricitabine/tenofovir (Truvada) is currently the only approved HIV prevention medication available to primary care practitioners in the United States, says Baeten, who urges primary care providers to discuss this option with both male and female patients at risk for HIV.

—Mark McGraw

Reference:

Baeten J, Palanee-Phillips T, et al. Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women. NEJM. 2016.