Topical microbicides are self-administered products for prevention of HIV transmission, and they present one of the most promising strategies for combating the HIV-AIDS epidemic. The development of microbicides is a long and complicated process, with many hurdles that are unique to this class of product, including challenges in product design, in the conduct and design of clinical trials, and in obtaining licensure of a new class of products intended for use almost exclusively in developing countries. Once they have been registered, there are additional challenges to the marketing and distribution of microbicides. This article, focussing on vaginally applied microbicides, provides an overview of the types of microbicide currently in development (membrane disruptive agents, entry inhibitors and reverse transcriptase inhibitors) and how they work, and a summary of the issues and the approaches being taken to address them. It is argued that close collaboration is required between all parties involved in the development and introduction of microbicides and in health and development issues more generally.
Infectious Disease Clinics of North America (2007) 21 (1) pp. 219-239 (issue on ‘HIV/AIDS’, edited by K.H. Mayer).