Microbicide & Safe Sex (8)

HIV/Aids
Persons initially infected with HIV may develop an "acute retroviral syndrome" characterized by fever, lymph node enlargement, and flu-like symptoms. If symptoms are present, they clear spontaneously, but all infected persons, both with and without symptoms, remain infected and infectious to others indefinitely. The incubation period is highly variable, averaging about a decade, but ranging from a few months or years to possibly longer than two decades. When sufficient damage to the immune system has been sustained, measured either by laboratory cell counts of the Thelper cells or by onset of opportunistic infections, the patient is said to have AIDS. Common manifestations of HIV infection include tiredness, lymph node enlargement, fever, weight loss, and yeast infections of the mouth and vagina.

HIV infection is diagnosed by laboratory detection of evidence of infection, usually identification of HIV-specific antibodies in a blood, oral fluid, or urine specimen. AIDS can be diagnosed in HIV-infected persons in several ways, based on either laboratory evidence of immunodeficiency (lowered levels of CD4+ cells), or clinically by onset of any one or more of a specific list of opportunistic diseases. Opportunistic diseases are those that occur only, or most severely, in patients whose immune systems are impaired. The most common opportunistic diseases in AIDS patients are Pneumocystis carinii pneumonia, Kaposi's sarcoma, toxoplasmosis of the brain, tuberculosis and other mycobacterial infections, and severe herpes, cytomegalo virus, and yeast infections.

How the AIDS Virus Works?
The AIDS virus weakens the immune system (“immune deficiency”), allowing other infections to ravage the body. These infections are called “opportunistic” because they take advantage of the opportunity to live where the body’s immune system would normally destroy them. It’s when these opportunistic infections strike that the person is said to have AIDS.

Microbicide Q & A (3)

How would an HIV microbicide function?
An HIV microbicide could work in 5 different ways:
- Eliminating or inactivating pathogens.
A microbicide could inhibit HIV infection by breaking down the surface of the virus or pathogen.
- Create physical barriers. Gels or creams could offer a physical barrier between pathogens or viruses, and susceptible cells in the epithelium (cell wall) of the vagina or rectum.
- Strengthening the body's natural protection.
The body has numerous naturally sourced defense system that a microbicide might be able to supplement or enhance. For example, lactobacillus is a naturally occurring, "good" bacteria that helps protect the vagina by keeping its acidic environment. This natural acidity helps foster an inhospitable environment for a lot of pathogens, including HIV. A microbicide that supports the lactobacilli in carrying out this function might inhibit infection by HIV or STDs.
- Inhibiting viral entry.
A microbicide could inhibit viral or bacterial infection by interfering with the binding of viral proteins to cellular receptors. For example, infection with the HIV virus happens through binding of gp120 (on the outside of the virus) to receptors on a cell's membrane. A potential microbicide might interrupt this process by binding to receptors ahead of time, thus blocking the sites and preventing HIV attachment to the cell.
- Suppressing viral replication. Designed as gels or creams, anti-HIV medications that are already FDA-approved and available might be able to reduce replication of HIV in the vagina or rectum during sexual intercourse.

Microbicide Q & A (2)

Who is working on microbicide research and development?
Virtually all microbicides research to date has been conducted by non-profit and academic institutions or small biotech companies. Research is financed by charitable foundations along with government grants. These public funds also support basic science, social and behavioural research, and clinical study infrastructure that contribute to microbicides research and development. Large pharmaceutical companies have not invested significantly in this area, this is mostly because their income would be minimal.

Why do we need microbicides if we will finally have an HIV-vaccine?
No method or technology will "solve" the AIDS pandemic. We must implement all existing prevention methods --such as behavior change, voluntary counselling and testing, STI diagnosis and treatment, extensive access to male and female condoms, and anti-retroviral interventions-- as well as extend our collection of resources and technologies. Microbicides will probably be accessible and available sooner than an HIV-vaccine. Even after a safe and effective vaccine is discovered, vaccines and microbicides will have different, complementary roles to play in an integrated, multi-faceted global HIV prevention strategy.

Would a microbicide also protect the male partners of HIV positive women?
Lots of candidate microbicides currently being examined are widely anti-microbial and may provide protection against a variety of sexually transmitted infections, including HIV.  By neutralising pathogens in both semen and vaginal secretions, these products will give bi-directional protection; that is, will help protect men and partners. This will give HIV positive people a way of minimizing their partner's risk of HIV exposure during intercourse --as well a way of reducing their own risk of re-infection.
Microbicides will also provide valuable back-up protection to couples who use them with condoms. If the condom slips or breaks, the microbicides can provide both partners added protection from possible infection.

Why would a man want to use a microbicide instead of a condom?
Lots of men dislike using male condoms, regardless that they are excellent barriers against infection and unintended pregnancy. Objections include perceived decrease in pleasure, difficult maintaining an erection, interruption of spontaneity and decrease of the intimacy associated with skin to skin contact. Even before the spread of HIV/AIDS resulted in higher concern about STIs, these factors influenced men's attitude towards condoms. Largely, they account for the popularity of non-condom methods of contraception.
However, non-condom methods of STIs prevention do not yet {exist|be found}. Even when microbicides reach the market, it is unlikely that they will meet the efficacy of male and female condoms for HIV prevention. Logically, it is advisable to keep a virus from coming into contact with one's body than it is to try to eliminate it once it is there.
But, for men and women who don't use condoms regularly, microbicides will offer an essential risk reduction option. Using even a partially effective microbicide will provide significantly more protection than using nothing at all.

Microbicide Q & A (1)

What is a microbicide?
A microbicide is a compound that eliminates micro-organisms.

What does a microbicide do?
Topical microbicides, applied to lining of body cavities, work as chemical barriers to avoid the spread of Sexually Transmitted Diseases (STDs).
An HIV microbicide provides the potential for a protection choice that both women and men could effortlessly control, with or without the consent or knowledge of their sexual partner.

What forms can a microbicide come in?
A microbicide could be produced in various forms including gels, creams, suppositories, films, or in combination with a sexual lubricant.

Will different HIV microbicides be necessary for vaginal and rectal use?
Probably.
Different microbicides will be necessary for the vagina and for the rectum because of differences in their physical structure and properties.
An effective rectal microbicide must take into consideration that HIV is more easily transmitted during anal rather than vaginal intercourse.

Will a microbicide cure AIDS?
No, a microbicide is not a remedy for those already infected with HIV.
Instead, it would be an HIV prevention option, impeding (or halting) the transmission of HIV.