Biomedical Approaches to HIV Prevention in Women

Female Genital Tract Infections (J Sobel, Section Editor)
  • 1 Downloads
Part of the following topical collections:
  1. Topical Collection on Female Genital Tract Infections

Abstract

Purpose of Review

Effective HIV prevention techniques for women are of critical importance, as nearly half of all HIV infections globally are in women. This article reviews the recent literature on biomedical approaches to HIV prevention in women.

Recent Findings

In trials in which women were adherent to oral pre-exposure prophylaxis (PrEP), PrEP was equally efficacious in men and women. However, in studies of oral PrEP exclusively in women, adherence was low, and it was not efficacious. In trials of topical PrEP, including vaginal tenofovir gel and the monthly dapivirine ring, efficacy was also dependent upon adherence. Treatment as prevention (TasP) is a very effective HIV prevention strategy, though limited in that it is not controlled by the HIV-uninfected partner.

Summary

Adherence is an important factor in the efficacy of biomedical interventions for HIV prevention in women; continued research is needed to identify the most efficacious and acceptable agents for women. Oral PrEP is currently recommended for the following groups of HIV-negative women: heterosexual women in ongoing sexual relationships with a partner infected with or at substantial risk of HIV infection and women who inject drugs and share injection or drug preparation equipment.

Keywords

Women HIV prevention Pre-exposure prophylaxis (PrEP) Post-exposure prophylaxis (PEP) Treatment as prevention (TasP) 

Notes

Compliance with Ethical Standards

Conflict of Interest

Christine Heumann declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
  2. 2.
    Women|Gender|HIV by Group|HIV/AIDS| CDC. 2017. https://www.cdc.gov/hiv/group/gender/women/index.html.
  3. 3.
    Boily M-C, Baggaley RF, Wang L, Masse B, White RG, Hayes R, et al. Heterosexual risk of HIV-1 infection per sexual act: a systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009;9(2):118–29.  https://doi.org/10.1016/S1473-3099(09)70021-0.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol. 2004;2(1):33–42.  https://doi.org/10.1038/nrmicro794.CrossRefPubMedGoogle Scholar
  5. 5.
    Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA, O'Campo P. HIV/AIDS and intimate partner violence: intersecting women’s health issues in the United States. Trauma Violence Abuse. 2007;8(2):178–98.  https://doi.org/10.1177/1524838007301476.CrossRefPubMedGoogle Scholar
  6. 6.
    Li Y, Marshall CM, Rees HC, Nunez A, Ezeanolue EE, Ehiri JE. Intimate partner violence and HIV infection among women: a systematic review and meta-analysis. J Int AIDS Soc. 2014;17:18845.  https://doi.org/10.7448/ias.17.1.18845.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Intersection of Intimate Partner Violence and HIV in Women | National Prevention Information Network. Centers for Disease Control and Prevention, National Center for HIV Viral Hepatitis STD and TB Prevention. 2014. https://npin.cdc.gov/publication/intersection-intimate-partner-violence-and-hiv-women.
  8. 8.
    Economically Disadvantaged|HIV by Group|HIV/AIDS|CDC. 2017. https://www.cdc.gov/hiv/group/poverty.html.
  9. 9.
    Mabala R. From HIV prevention to HIV protection: addressing the vulnerability of girls and young women in urban areas. Environ Urban. 2006;18(2):407–32.  https://doi.org/10.1177/0956247806069624.CrossRefGoogle Scholar
  10. 10.
    Injection Drug Use|HIV Risk and Prevention|HIV/AIDS|CDC. 2017. https://www.cdc.gov/hiv/risk/idu.html.
  11. 11.
    Crime UNOoDa. HIV/AIDS Prevention and Care for Female Injection Drug Users. 2006. http://www.unodc.org/pdf/HIV-AIDS_femaleIDUs_Aug06.pdf.
  12. 12.
    Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission. The Cochrane database of systematic reviews. 2002(1):Cd003255. doi: https://doi.org/10.1002/14651858.cd003255.
  13. 13.
    Valappil T, Kelaghan J, Macaluso M, Artz L, Austin H, Fleenor ME, et al. Female condom and male condom failure among women at high risk of sexually transmitted diseases. Sex Transm Dis. 2005;32(1):35–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Act Against AIDS | Basics|HIV Prevention|Can using lubricant help reduce my HIV risk?|Center for Disease Control and Prevention. 2018. https://www.cdc.gov/actagainstaids/basics/prevention.html.
  15. 15.
    Kennedy CE, Bernard LJ, Muessig KE, Konda KA, Akl EA, Lo YR, et al. Serosorting and HIV/STI infection among HIV-negative MSM and transgender people: a systematic review and meta-analysis to inform WHO guidelines. J Sex Transm Dis. 2013;2013:583627.  https://doi.org/10.1155/2013/583627.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Effective HIV Prevention Strategies| HIV Risk and Prevention Estimates|HIV Risk and Prevention|HIV/AIDS| CDC. 2017. https://www.cdc.gov/hiv/risk/estimates/preventionstrategies.html.
  17. 17.
    Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, et al. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav. 2013;17(9):2878–92.  https://doi.org/10.1007/s10461-013-0593-y.CrossRefPubMedGoogle Scholar
  18. 18.
    CDC. HIV and injection drug use—vital signs. @CDCgov. 2016. https://www.cdc.gov/vitalsigns/hiv-drug-use/index.html.
  19. 19.
    Sciences G. Truvada Access (Gilead Sciences, Inc): FDA Package Insert. 2016. http://medlibrary.org/lib/rx/meds/truvada-access-1/.
  20. 20.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.  https://doi.org/10.1056/NEJMoa1108524.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Murnane PM, Celum C, Mugo N, Campbell JD, Donnell D, Bukusi E, et al. Efficacy of preexposure prophylaxis for HIV-1 prevention among high-risk heterosexuals: subgroup analyses from a randomized trial. AIDS (London, England). 2013;27(13):2155–60.  https://doi.org/10.1097/QAD.0b013e3283629037. CrossRefGoogle Scholar
  22. 22.
    Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.  https://doi.org/10.1056/NEJMoa1110711.CrossRefPubMedGoogle Scholar
  23. 23.
    Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Supplementary appendix to: antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.  https://doi.org/10.1056/NEJMoa1110711. CrossRefPubMedGoogle Scholar
  24. 24.
    • Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.  https://doi.org/10.1056/NEJMoa1202614. In this study of oral PrEP in heterosexual women (FEM-PrEP), participants were randomized to TDF or placebo. Unfortunately, there was no reduction in HIV acquistion, and the study was stopped early because of a lack of efficacy. It was speculated that adherence was a major factor in these result. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    •• Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18.  https://doi.org/10.1056/NEJMoa1402269. In this study of PrEP in heterosexual women (VOICE), participants were randomized to TDF, TDF-FTC, 1% tenfovir gel, or placebo. There was no significant reduction in the HIV infection rate with any of the interventions. Adherence was a major issue in this study. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet (London, England). 2013;381(9883):2083–90.  https://doi.org/10.1016/s0140-6736(13)61127-7.CrossRefGoogle Scholar
  27. 27.
    Mayer KH, Maslankowski LA, Gai F, El-Sadr WM, Justman J, Kwiecien A, et al. Safety and tolerability of tenofovir vaginal gel in abstinent and sexually active HIV-infected and uninfected women. AIDS (London, England). 2006;20(4):543–51.  https://doi.org/10.1097/01.aids.0000210608.70762.c3. CrossRefGoogle Scholar
  28. 28.
    Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science (New York, NY). 2010;329(5996):1168–74.  https://doi.org/10.1126/science.1193748.CrossRefGoogle Scholar
  29. 29.
    Rees HD-M, Sinead A, Lombard C, Baron D, Panchia R, Myer L, et al. FACTS 001 phase III trial of pericoital tenofovir 1% gel for HIV prevention in women. Seattle: CROI; 2015.Google Scholar
  30. 30.
    Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–32.  https://doi.org/10.1056/NEJMoa1506110.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Nel A, van Niekerk N, Kapiga S, Bekker LG, Gama C, Gill K, et al. Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med. 2016;375(22):2133–43.  https://doi.org/10.1056/NEJMoa1602046.CrossRefPubMedGoogle Scholar
  32. 32.
    Announcement. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV—United States, 2016. MMWR Morbidity and mortality weekly report. 2016;65(17):458. doi: https://doi.org/10.15585/mmwr.mm6517a5.
  33. 33.
    Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337(21):1485–90.  https://doi.org/10.1056/nejm199711203372101. CrossRefPubMedGoogle Scholar
  34. 34.
    Griffith WF, Ackerman GE, Zoellner CL, Sheffield JS. Sexual assault: a report on human immunodeficiency virus postexposure prophylaxis. Obstet Gynecol Int. 2010;2010:1–6.  https://doi.org/10.1155/2010/196963.CrossRefGoogle Scholar
  35. 35.
    Linden JA, Oldeg P, Mehta SD, McCabe KK, LaBelle C. HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Acad Emerg Med. 2005;12(7):640–6.  https://doi.org/10.1197/j.aem.2005.01.015.CrossRefPubMedGoogle Scholar
  36. 36.
    Olshen E, Hsu K, Woods ER, Harper M, Harnisch B, Samples CL. Use of human immunodeficiency virus postexposure prophylaxis in adolescent sexual assault victims. Arch Pediatr Adolesc Med. 2006;160(7):674–80.  https://doi.org/10.1001/archpedi.160.7.674.CrossRefPubMedGoogle Scholar
  37. 37.
    • Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.  https://doi.org/10.1056/NEJMoa1105243. In this study (HPTN052), treatment as prevention was found to be an extremely effective HIV prevention strategy. Couples were randomized to either early or delayed initiation of antiretroviral therapy, and HIV transmission was decreased by 96% in the early initiation group. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    van der Straten A, Stadler J, Montgomery E, Hartmann M, Magazi B, Mathebula F, et al. Women’s experiences with oral and vaginal pre-exposure prophylaxis: the VOICE-C qualitative study in Johannesburg, South Africa. PLoS One. 2014;9(2):e89118.  https://doi.org/10.1371/journal.pone.0089118.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Cottrell ML, Yang KH, Prince HM, Sykes C, White N, Malone S, et al. A translational pharmacology approach to predicting outcomes of preexposure prophylaxis against HIV in men and women using tenofovir disoproxil fumarate with or without emtricitabine. J Infect Dis. 2016;214(1):55–64.  https://doi.org/10.1093/infdis/jiw077. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Hendrix CW, Chen BA, Guddera V, Hoesley C, Justman J, Nakabiito C, et al. MTN-001: randomized pharmacokinetic cross-over study comparing tenofovir vaginal gel and oral tablets in vaginal tissue and other compartments. PLoS One. 2013;8(1):e55013.  https://doi.org/10.1371/journal.pone.0055013.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Klatt NR, Cheu R, Birse K, Zevin AS, Perner M, Noël-Romas L, et al. Vaginal bacteria modify HIV tenofovir microbicide efficacy in African women. Science (New York, NY). 2017;356(6341):938–45.  https://doi.org/10.1126/science.aai9383. CrossRefGoogle Scholar
  42. 42.
    Heffron R, McClelland RS, Balkus JE, Celum C, Cohen CR, Mugo N, et al. Efficacy of oral pre-exposure prophylaxis (PrEP) for HIV among women with abnormal vaginal microbiota: a post-hoc analysis of the randomised, placebo-controlled Partners PrEP Study. Lancet HIV. 2017;4(10):e449–e56.  https://doi.org/10.1016/s2352-3018(17)30110-8. CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Jackson AG, Else LJ, Mesquita PM, Egan D, Back DJ, Karolia Z, et al. A compartmental pharmacokinetic evaluation of long-acting rilpivirine in HIV-negative volunteers for pre-exposure prophylaxis. Clin Pharmacol Ther. 2014;96(3):314–23.  https://doi.org/10.1038/clpt.2014.118.CrossRefPubMedGoogle Scholar
  44. 44.
    Markowitz M, Frank I, Grant RM, Mayer KH, Elion R, Goldstein D, et al. Safety and tolerability of long-acting cabotegravir injections in HIV-uninfected men (ECLAIR): a multicentre, double-blind, randomised, placebo-controlled, phase 2a trial. Lancet HIV. 2017;4(8):e331–e40.  https://doi.org/10.1016/s2352-3018(17)30068-1. CrossRefPubMedGoogle Scholar
  45. 45.
    Woodsong C, Musara P, Chandipwisa A, Montgomery E, Alleman P, Chirenje M, et al. Interest in multipurpose prevention of HIV and pregnancy: perspectives of women, men, health professionals and community stakeholders in two vaginal gel studies in southern Africa. BJOG. 2014;121(Suppl 5):45–52.  https://doi.org/10.1111/1471-0528.12875. CrossRefPubMedGoogle Scholar
  46. 46.
    US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014. A clinical practice guideline. https://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Wayne State University School of MedicineDetroitUSA
  2. 2.Detroit Public Health STD ClinicDetroitUSA

Personalised recommendations