Findings that a vaginal ring could prevent the transmission of HIV in some women elicited cheers and cautious sighs of relief in the global health community. Two separate studies of the dapivirine ring found that it cut HIV cases by 30 percent among women who used it as opposed to those using a placebo.
It joins the drug Truvada as a pre-exposure prophylaxis that helps prevent the spread of HIV. A decade of development led to a ring that slowly releases the antiretroviral drug dapivirine into a woman’s body. Champions of the ring were optimistic about the findings.
“These findings give new hope to many women at high risk who need more and different options to effectively protect themselves from HIV,” said Dr. Zeda Rosenberg, CEO of the nonprofit International Partnership for Microbicides, a group involved in the ring’s development, in a statement.
There appears to be widespread agreement that the trial results are good news. However, some are taking a more cautious view of the findings. First, protecting roughly one-third of women is good, but not nearly enough. Truvada, when taken correctly, prevents more than 90 percent of infections. Speaking of taking it correctly, the study found some serious problems with adherence, particularly among young women.
“The dapivirine vaginal ring might become an additional option as additional questions are answered and regulatory agencies consider these results,” said Mitchell Warren, head of anti-AIDS advocacy group AVAC, in a statement. “In the meantime, the incredibly high HIV infection rates among women in these trials tell us that we need to make oral PrEP more widely accessible and available with urgency.”
One trial conducted over two years in Malawi, South Africa, Uganda, Zimbabwe found that women using the ring had a 27 percent protection rate, as compared to those who did not. Women between 18 and 21 years old did not benefit. Full results were published in the New England Journal of Medicine, this week. The other trial, which is yet to be officially published, saw a protection rate of 31 percent among ring users, and also did not see benefits for women younger than 21.
The studies were done at the same time in the hopes of speeding up the medical approval process. But concerns linger about the usage of the rings. The lack of protection for younger women is likely due to improper use. Women must wear the ring for 28 days at a time, before exchanging for a new ring. The drug will offer little to no protection if that is not followed, as is the case with Truvada.
Trials will continue to both refine the rings and improve usage. The international Partnership for Microbicides is working on forms with different dosage levels and ones that could last for up to three months. All efforts are aimed at making it easier for women and increasing protection against HIV. The current rings will retail for about $5 and are set to apply for regulatory approval in about one year.
It is thought the ring will be used with other forms of protection, from the condom to Truvada, to protect the spread of HIV. And that is what makes the study findings good news. Amid the caveats and concerns, there will soon be a tool available that can help prevent women from contracting HIV from their partners.