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We want the ring...

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Shobha Shukla, CNS (Citizen News Service)


Female initiated methods are vital to prevent unintended pregnancies, STIs, HIV
(Image by CNS (Citizen News Service citizen-news.org))
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That seemed to be the resonating refrain of women at the HIV Research for Prevention Conference (HIVR4P2018) held recently in Madrid, Spain. And no, they were not talking about the engagement ring. Their focus of interest was the intra-vaginal dapivirine vaginal ring - a long acting female-initiated, self-administered product that has been found to be highly effective in reducing the risk of HIV infection.

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Dr Zeda Rosenberg, founder and CEO of the International Partnership for Microbicides (IPM), told CNS (Citizen News Service) in an exclusive interview, "IPM developed this monthly dapivirine ring - the first long-acting microbicide product clinically shown to reduce HIV risk. It is a flexible silicon ring that slowly releases the drug dapivirine, which is an HIV prevention drug. More importantly, its use is under the control of women who can use it discreetly, if they want to, without their partner's knowledge. Any HIV negative woman, who is at risk of acquiring the infection, can herself put the ring in her vagina, leave it in place for 1 month and then replace it by herself. The drug is slowly released into the target cells and substantially reduces the risk of her HIV infection."

The ring is similar to vaginal rings commonly used by women for contraception except that it contains dapivirine, which belongs to a class of antiretrovirals (ARVs) called non-nucleoside reverse transcriptase inhibitors (NNRTIs) that prevent HIV from replicating itself. The long-acting ring sits high inside the vagina, where it slowly releases the drug directly at the site of potential infection, with low systemic absorption, over the course of one month the ring is worn. Women can insert and replace the ring themselves once every month.

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Why the ring?

Key features of the dapivirine ring include:

- Low systemic drug absorption, no interaction with contraception, no related resistance;

- Easy to use and comfortable, woman-initiated and controlled, does not interrupt her daily activities; and

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- Low manufacturing cost, stored at room temperature, and hence scalable.

Dr Rosenberg further said that, "We know that women like choices. It is not just one product that all women may want to or can use. We already have a highly effective HIV prevention option - the male and the female condom - that can protect against unintended pregnancy as well as HIV. But its uptake is not very high. We also have the daily oral HIV prevention or PrEP (pre exposure prophylaxis) pill - Truvada - which is highly effective in preventing HIV infection in women if used consistently. But we know that there are women who cannot adhere to taking a pill everyday and/or fear the stigma of taking PrEP as prevention and being misperceived as being HIV infected rather than uninfected. Yet others may not want the HIV drug to be circulating in their body. So for all these women, a ring that provides a high dose of drug locally where the infection occurs (and hardly any systemic drug in the blood stream) might be a perfect option."

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Citizen News Service (CNS) specializes in in-depth and rights-based, health and science journalism. For more information, please contact: www.citizen-news.org or @cns_health or www.facebook.com/cns.page

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