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Vaginal Ring Provides Partial HIV Protection

N Engl J Med; ePub 2016 Feb 22; Baeten, et al

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The risk of HIV-1 infection was modestly reduced among African women with a monthly vaginal ring containing dapivirine, and this protective effect was strongest in women aged >25 years. This according to a phase 3, double-blind, placebo-controlled trial involving 2,629 women ages 18 to 45 years. Researchers found:

• 168 HIV-1 infections occurred; 71 in the dapivirine group and 97 in the placebo group.

• The incidence of HIV-1 infection in the dapivirine group was lower by 27% vs the placebo group; by 37% in an analysis that excluded data from 2 sites that had reduced rates of retention and adherence.

• Higher rates of HIV-1 protection were observed among women aged >21 years but not among those aged ≤21 years in a post hoc analysis.

• The rates of adverse medical events and antiretroviral resistance among women who acquired HIV-1 infection were similar in the 2 groups.

Citation: Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. [Published online ahead of print February 22, 2016]. N Engl J Med. doi:10.1056/NEJMoa1506110.

Commentary: Daily preexposure prophylaxis (PrEP) is effective at decreasing the rate of acquisition of HIV in individuals at high-risk for HIV infection.1 In addition, the use of PrEP on an as-needed basis, to be administered before and after a high-risk sexual episode, has recently been shown to be effective.2 Taking medications as prescribed is difficult for many women in third world nations and the use of devices with sustained delivery of medications, like the vaginal ring, are potentially useful forms of therapy that may facilitate adherence to effective preventive therapy. —Neil Skolnik, MD

1. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012; 367:399.

2. Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373:2237-2246. doi:10.1056/NEJMoa1506273

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