United Press International - Sunday, 9 July 2000
Ed Susman, UPI Science News

At the XIII International AIDS Conference in Durban, South Africa, Dr. Mark Wainberg, director of the McGill AIDS Centre in Montreal, said that reformulation of drugs used in treating HIV infection might be useful in preventing transmission of disease during sex.

In a press briefing dealing with women's issues that have arisen during the AIDS epidemic, researchers said women often are unable to protect themselves against infection because they face physical and mental abuse from male sexual partners if the use of condoms is suggested.

Doctors also said that recent trials with other microbicides have not proven effective in defeating AIDS infection.

But Wainberg said using antiretroviral drugs -- such as efavirenz or other drugs used to treat AIDS -- as a vaginal microbicide might provide the protection women need to prevent infection. "I lament that there are no clinical trials using these drugs for this purpose," Wainberg said.

Almost all the drugs used in treatment of HIV infection were tested in laboratory before they went into clinical trials, so researchers would know which of the items are candidates for use as a microbial, Wainberg said.

In addition, he said pharmaceutical companies might be able to dust off some old compounds that failed to make it as an oral antiretroviral medication.

Lori Heise, director of the Microbicide Development Fund in Washington, D.C., concurred with Wainberg.

"The very likely scenario," Heise said, "is that there may be some candidate drugs that were not well-absorbed or were too toxic to be taken internally but they could be applied topically. These drugs could stop the virus in its tracks."

But, Dr. Helen Rees, chair of the Medicines Control Council, South Africa's equivalent to the Food and Drug Administration in the US, said, "There isn't a big investment in this now. We need to get the pharmaceutical industry interested in this."

Rees said there are trials moving forward in antiviral microbicides, but there is no work using the antiretrovirals that were designed to fight AIDS. Antiviral drugs attack virus, but antiretrovirals attack a certain type of virus, typical of the organism that causes AIDS.

Wainberg said the use of the antiretrovirals as a topical treatment to prevent infection would unlikely cause problems with drug resistance. The women using these microbials would not be infected and would therefore drug resistance would not come into play, he said.

"I am convinced that we have the scientific knowledge to develop these products," Wainberg said. "Costs should be modest."

Rees suggested that pharmaceutical companies have a moral obligation to develop the topical antiretrovirals.
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