Research ArticleHIV

Postexposure Protection of Macaques from Vaginal SHIV Infection by Topical Integrase Inhibitors

Science Translational Medicine  12 Mar 2014:
Vol. 6, Issue 227, pp. 227ra35
DOI: 10.1126/scitranslmed.3007701

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An After-Sex Gel to Protect Against HIV

Vaginal gels containing antiretroviral (ARV) drugs are important for HIV prevention but are all designed to be applied by women before sex, which can interfere with sex practices and limit their use. A gel that can be applied after sex would be more desirable because it will have more user control and less need for sex anticipation and partner acceptance. However, all ARV-based gels in development contain ARV drugs that block the early steps in virus infection and thus require application before sex. Dobard et al. in their new study reasoned that HIV integrase inhibitors, which belong to a different ARV class that blocks later steps in virus infection, may be more suitable for application after HIV exposure during sex. They first confirmed that HIV integration into cellular DNA begins about 6 hours after virus infection, providing a wide window for dosing with integrase inhibitors after sex. Using a macaque model to assess efficacy, the authors further showed that a vaginal gel containing an integrase inhibitor protected macaques when applied 30 min before or 3 hours after vaginal challenge with simian HIV. The study supports evaluation of topical integrase inhibitors for HIV prevention and the assessment of after-sex use for improved acceptability by women.