Using Drugs to Prevent HIV Transmission

The search for a vaccine against HIV has been ongoing for two decades but has yet to yield any viable candidates. The latest setback came in September 2007, when a vaccine being developed by Merck, which had advanced to the clinical trial stage, was declared a failure.

In the meantime, the HIV epidemic has continued to spread. By the end of 2007, an estimated 33.2 million people worldwide were living with HIV.

“If a vaccine is to be developed, it’s probably ten, fifteen years down the road,” Kashuba says. “Well, ten to fifteen years down the road, we’re going to have a whole lot more people infected with HIV.

“What we do have now are drugs, and we have generic drugs in developing countries that are cheap and available and becoming more available, so one of the research interests on campus is to use drugs to prevent the transmission of HIV.”

There are two ways to prevent transmission with drugs—giving drugs orally before and after high-risk behavior or applying drugs topically as a microbicide. Kashuba, who has a particular interest in women’s health, is studying both approaches. She is researching how quickly orally administered drugs get into the genital tract and how high the concentration is. Kashuba also is examining applying drugs topically to the genital tract to prevent the HIV virus from entering the body. That data will give groups such as the World Health Organization and the Centers for Disease Control and Prevention a pharmacologic basis for determining which antiretroviral drugs to move forward in clinical studies of HIV prevention.

“The reality is that we’re probably going to need a number of ways,” Kashuba says. “I don’t know if a pill is going to be more or less effective versus something applied topically. We need a menu of options women can choose from depending on what their situation is.”

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