Infectious Diseases Research Centre and Faculty of Medicine, Université Laval, Centre Hospitalier de l'Université Laval, CHUQ, 2705 Boulevard Laurier, RC-709, Québec, QC, Canada, G1 V 4G2.
Int J Infect Dis. 2011 Oct;15(10):e656-60. doi: 10.1016/j.ijid.2011.05.001. Epub 2011 Jun 25.
There is an urgent need to develop vaginal microbicides to empower women to better control their own sexual life and to protect themselves against HIV and other sexually transmitted infections (STIs). Prevention of STIs with its 330 million cases a year would have a great global health impact. Because of their anatomy, women are up to 8 times more susceptible than men to STIs including HIV. Women who can't negotiate condom use with their male partners have no means of protecting themselves from these infections. In the last few years, especially after the recent failures of several microbicides in Phase III trials, there was increasing pressure from those favoring the use of a more targeted approach to introduce marketed antiretroviral drugs (ARVs) into microbicides. This Pre-Exposure Prophylaxis (PrEP) concept which targets only HIV using specific ARVs contrasts with the primary approach of broad spectrum microbicides which aimed at offering universal protection against several sexually transmitted pathogens. However, before using ARVs as PrEP for HIV prevention, there are still many important issues to consider. In this article, we compare both strategies, while reviewing the last 15 years of microbicide research and its future.
目前迫切需要开发阴道杀微生物剂，以使妇女能够更好地控制自己的性生活，并预防艾滋病毒和其他性传播感染（STIs）。预防每年 3.3 亿例性传播感染将对全球健康产生重大影响。由于解剖结构的原因，女性感染性传播感染（包括艾滋病毒）的几率比男性高 8 倍。无法与性伴侣协商使用避孕套的女性无法保护自己免受这些感染。在过去几年中，尤其是在最近几项杀微生物剂 III 期临床试验失败后，越来越多的人赞成采用更有针对性的方法，将已上市的抗逆转录病毒药物（ARV）引入杀微生物剂。这种针对艾滋病毒的暴露前预防（PrEP）概念仅使用特定的 ARV 药物，与广谱杀微生物剂的主要方法形成对比，广谱杀微生物剂旨在提供针对几种性传播病原体的普遍保护。然而，在将 ARV 用作预防艾滋病毒的 PrEP 之前，仍有许多重要问题需要考虑。本文比较了这两种策略，同时回顾了过去 15 年的杀微生物剂研究及其未来。
