Dohadwala Sarah, Politch Joseph A, Barmine Jessica H, Anderson Deborah J
Department of Virology, Immunology and Microbiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Open Access J Contracept. 2023 Jun 13;14:83-94. doi: 10.2147/OAJC.S375634. eCollection 2023.
The high incidence of HIV and other sexually transmitted infections (STIs), and an unmet need for modern contraception resulting in a high unintended pregnancy rate, are major problems in reproductive health. The concept of multipurpose prevention technology (MPT) was introduced following the failure of several leading microbicide candidates to prevent human immunodeficiency virus type 1 (HIV-1) transmission in large clinical trials in the early 2000s. MPTs are defined as products designed to simultaneously prevent at least two of the following conditions: unintended pregnancy, HIV-1, or other major STIs. The goal of contraceptive MPT products (cMPTs) is to provide contraception and protection against one or more major STI pathogen (eg, HIV-1, herpes simplex virus (HSV) type 2, (gonorrhea), syphilis (Chlamydia). This new field has great potential and will benefit from lessons learned from the early microbicide trials. The cMPT field includes candidates representing various categories with different mechanisms of action including pH modifiers, polyions, microbicidal peptides, monoclonal antibodies, and other peptides that target specific reproductive and infectious processes. More preclinical research is being conducted to ensure minimal side effects and maximum efficacy in vivo. Effective proven and novel candidates are being combined to maximize efficacy, minimize side effects, and avoid drug resistance. More attention is being paid to acceptability and new delivery systems. cMPTs have a very promising future if adequate resources can be mobilized to sustain the effort from preclinical research to clinical trials to bring effective, acceptable, and affordable products to market.
艾滋病毒和其他性传播感染（STIs）的高发病率，以及现代避孕措施未得到满足的需求导致意外怀孕率居高不下，是生殖健康领域的主要问题。在21世纪初，几种主要的杀微生物剂候选药物在大型临床试验中未能预防1型人类免疫缺陷病毒（HIV-1）传播之后，多用途预防技术（MPT）的概念被提出。MPT被定义为旨在同时预防以下至少两种情况的产品：意外怀孕、HIV-1或其他主要性传播感染。避孕用MPT产品（cMPT）的目标是提供避孕措施并预防一种或多种主要性传播感染病原体（例如，HIV-1、2型单纯疱疹病毒（HSV）、淋病、梅毒、衣原体）。这个新领域具有巨大潜力，将从早期杀微生物剂试验中吸取的经验教训中受益。cMPT领域包括代表不同作用机制类别的候选药物，包括pH调节剂、聚离子、杀微生物肽、单克隆抗体以及其他针对特定生殖和感染过程的肽。正在进行更多的临床前研究，以确保体内副作用最小化和疗效最大化。已证实有效的候选药物和新型候选药物正在联合使用，以实现疗效最大化、副作用最小化并避免耐药性。人们越来越关注可接受性和新的给药系统。如果能够调动足够的资源来维持从临床前研究到临床试验的工作，以便将有效、可接受且价格合理的产品推向市场，cMPT将拥有非常光明的未来。
