AIDS Experts Cite Common Spermicide

Wednesday, July 12th 2000, 12:00 am
By: News On 6

DURBAN, South Africa (AP) — A landmark study released Wednesday offers surprising data about the widely used spermicide nonoxynol-9: It may increase the risk of women catching HIV rather than lower it, as many had assumed.

Nonoxynol-9 is often used as a coating for condoms. Test-tube studies have suggested that it can kill HIV, and many believed it helps prevent the spread of the virus.

However, the new study found that women who use it often actually have a higher risk of AIDS than those who do not.

``It is an understatement to say that we were extremely disappointed,'' said Dr. Lut Van Damme of the Institute of Tropical Medicine in Antwerp, Belgium. Van Damme, the study's director, presented the findings at the 13th International AIDS Conference in Durban.

The study was conducted on 990 prostitutes in Africa and Asia. Fifteen percent of those using a nonoxynol-9 cream became infected with HIV, compared with 10 percent of a comparison group using a vaginal moisturizer.

Scientists theorized that the increased risk could be related to vaginal irritation caused by the spermicide. Experts said the long-term safety of nonoxynol-9 as a contraceptive should also be re-evaluated.

In another report Wednesday, researchers said scattered successes around the world show that government prevention programs can slow and reverse the AIDS epidemic, even in the poorest areas.

The explosive spread of AIDS, especially in sub-Saharan Africa, has surprised even those who warned several years ago about the continent's vulnerability to HIV. However, Peter R. Lamptey, an official at Family Health International in Washington, said examples of declining AIDS incidence in several countries in Africa and Asia show the situation is not hopeless.

Many of these prevention programs are underfunded and small, and there is no way to accurately monitor their impact. Still, he said, ``I have no doubt that many of them are saving lives and that the epidemic would have been far worse without them.''

Lamptey, who is from Ghana, noted that Thailand and Uganda have already reversed broad epidemics, and Senegal is the only sub-Saharan African country to prevent one from occurring. He said there are encouraging signs that the epidemic may be stabilizing in Cambodia, Zambia and the Democratic Republic of the Congo.

Lamptey said money spent on these programs is still relatively small. In 1990, developing countries spent about $600 million on both AIDS prevention and care. By comparison, the United States spent $800 million on domestic HIV prevention and $7 billion on AIDS care and assistance programs.

Key ways of preventing AIDS spread include education programs that promote condom use, treatment of other sexually spread diseases and treatment to prevent mother-to-child transmission.

``We know that HIV prevention can work,'' Lamptey said. ``How many more people must die before we find the will and the resources needed to make prevention and care work for everyone?''

In presentations at the meeting Tuesday, doctors described a new approach to treatment — taking patients off their AIDS drugs for a few weeks at a time to see if breaks in therapy are safe and perhaps even more effective than giving the grueling treatment continuously. The new approach departs from the commonly held dogma that even a brief interruption in drug treatment will allow the AIDS virus to come roaring back in a mutant form that is impossible to control.

Intentionally interrupted therapy is still considered experimental. But doctors say it potentially has several important advantages, including lower cost, fewer side effects and temporary relief from a demanding pill schedule. It could make AIDS therapy more practical and affordable in poor parts of the world, where the sophisticated combinations of medicines are simply beyond the reach of most people with HIV.

Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, described promising but still early results with the approach.

``Patients are absolutely delighted at the prospect of spending half of their lives off therapy,'' Fauci said of those taking part in his experiments.

However, Fauci noted at least a dozen teams around the world are studying the approach — which he calls structured intermittent therapy — and it will be at least a year before doctors know whether it is safe.