New York Times examines questions left unanswered by microbicide trial

The New York Times examines a set of questions raised by news out of the International AIDS Conference-AIDS 2010 last week that a microbicide gel containing the antiretroviral (ARV) tenofovir used by women before and after sex helped reduce their risk of HIV infection by 39 percent.

"After more than a dozen microbicide failures, [the news of the trial] was a huge relief …," the newspaper writes, before noting researchers' questions regarding the amount of testing needed before the drug could win approval from regulators, the cost of the drug for poor countries and the potential for tenofovir-resistance from using the microbicide gel.

According to the newspaper, "The price of a dose could fall below that of a condom because the applicators are just molded plastic and, without patents restrictions, 'the Chinese could make them for half a penny,' [Principal investigator Salim Abdool Karim, professor of epidemiology at the University of KwaZulu-Natal in South Africa and Columbia University] said." Other questions, such as how to improve drug efficacy, would be dependent on what researchers find in future clinical trials. "A complex multination trial of several methods, including microbicide, is due to end in 2013, but a rapid new one may be designed as quickly as possible. … Globally, more than a million women a year die of AIDS, so speed is important," the newspaper writes.

The article explores still more questions raised by the trial - such as the viability of the microbicide gel offering protection against HIV transmission for gay men - and includes comments by Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; Kevin Fenton, director of the AIDS division of the CDC; Catherine Hankins, chief scientific adviser for UNAIDS; as well as a microbicide researcher and HIV/AIDS advocate (McNeil, 7/26).

Goosby Discusses Efforts To Drive Down Costs While Also Expanding PEPFAR's Reach Worldwide

In related news, IRIN/PlusNews interviewed Ambassador Eric Goosby, U.S. global AIDS coordinator, "about how lower funding levels are likely to impact HIV programmes" and how the program plans to increase efficiency as a means of expanding its reach.

"[W]e do not expect any major drop in accrual of patients on treatment over the next couple of years because we have enough fat in the system to redirect resources and get smarter at delivering services," Goosby said, pointing to examples of how the costs to treat patients has been reduced since PEPFAR was first launched. Through cost-savings, Goosby noted, "we are able to redirect … resources towards treatment expansion."

Goosby also comments on the need for generic second-line antiretroviral drugs and the need for PEPFAR partner countries to take responsibility for funding their own HIV/AIDS programs. He also describes the rationale behind PEPFAR's stance on funding programs that target sex workers (7/26).