Skip to main content

Advertisement

Log in

Vaginal Drug Delivery Systems for HIV Prevention

  • Emerging Drug Delivery Technologies
  • Published:
The AAPS Journal Aims and scope Submit manuscript

Abstract

Microbicides have become a principal focus for HIV prevention strategies. The successful design of drug delivery systems for vaginal microbicide drug candidates brings with it a multitude of challenges. It is imperative that the chemical and physical characteristics of the drug candidate and its mechanism of action be clearly understood and considered to successfully deliver and target drug candidates efficiently. In addition, an understanding of the dynamic nature of the vaginal environment, the tissue and innate barriers present, as well as patient preferences are critical considerations in the design of effective microbicide products. Although the majority of drug candidates clinically evaluated to date have been delivered using conventional semisolid aqueous-based gel dosage forms, drug delivery system design has recently been extended to include advanced delivery systems such as vaginal rings, quick-dissolve films, and tablets. Ultimately, it may be necessary to develop multiple dosage platforms for a single active agent to provide users with options that can be used within the constraints of their social environment, personal choice, and environmental conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. AIDS epidemic update. In UNAIDS (ed) (UNAIDS, ed), WHO Library Cataloguing-in-Publication Data, (2007).

  2. S. Krishnan, M. S. Dunbar, A. M. Minnis, C. A. Medlin, C. E. Gerdts, and N. S. Padian. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. Ann. N. Y. Acad. Sci. 1136:101–110 (2008).

    PubMed  Google Scholar 

  3. Will there be an HIV vaccine in the next 10 years? Nat. Med. 13:518–519 (2007).

  4. R. Pauwels, and E. De Clercq. Development of vaginal microbicides for the prevention of heterosexual transmission of HIV. J. Acquir. Immune. Defic. Syndr. Hum. Retrovirol. 11:211–221 (1996).

    PubMed  CAS  Google Scholar 

  5. J. Balzarini, and L. Van Damme. Microbicide drug candidates to prevent HIV infection. Lancet. 369:787–797 (2007).

    PubMed  CAS  Google Scholar 

  6. J. A. Turpin. Considerations and development of topical microbicides to inhibit the sexual transmission of HIV. Expert. Opin. Investig. Drugs. 11:1077–1097 (2002).

    PubMed  CAS  Google Scholar 

  7. I. Sjoberg. The vagina. Morphological, functional and ecological aspects. Acta. Obstet. Gynecol. Scand. 71:84–85 (1992).

    PubMed  CAS  Google Scholar 

  8. J. G. Forsberg. A morphologist’s approach to the vagina. Acta. Obstet. Gynecol. Scand. Suppl. 163:3–10 (1996).

    PubMed  CAS  Google Scholar 

  9. N. J. Alexander, E. Baker, M. Kaptein, U. Karck, L. Miller, and E. Zampaglione. Why consider vaginal drug administration. Fertil. Steril. 82:1–12 (2004).

    PubMed  Google Scholar 

  10. D. C. Walker, B. H. Brown, A. D. Blackett, J. Tidy, and R. H. Smallwood. A study of the morphological parameters of cervical squamous epithelium. Physiol. Meas. 24:121–135 (2003).

    PubMed  CAS  Google Scholar 

  11. A. B. Sassi, C. E. Isaacs, B. J. Moncla, P. Gupta, S. Hillier, and L. C. Rohan. Effects of physiological fluids on physical-chemical characteristics and activity of topical vaginal microbicide products. J. Pharm. Sci. 97:3123–3139 (2007).

    Google Scholar 

  12. M. J. Godley. Quantitation of vaginal discharge in healthy volunteers. Br. J. Obstet. Gynaecol. 92:739–742 (1985).

    PubMed  CAS  Google Scholar 

  13. C. Treves, M. T. Vincenzini, P. Vanni, F. Bardazzi, A. Cattaneo, and E. Ogier. Changes in enzyme levels in human cervical mucus during the menstrual cycle. Int. J. Fertil. 31:59–66 (1986).

    PubMed  CAS  Google Scholar 

  14. E. V. Valore, C. H. Park, S. L. Igreti, and T. Ganz. Antimicrobial components of vaginal fluid. Am. J. Obstet. Gynecol. 187:561–568 (2002).

    PubMed  CAS  Google Scholar 

  15. W. B. Rencher. Vaginal Microbicide Formulations Workshop, Lippincott-Raven, Arlington, VA, 2001.

    Google Scholar 

  16. B. T. Burruano, R. L. Schnaare, and D. Malamud. Synthetic cervical mucus formulation. Contraception. 66:137–140 (2002).

    PubMed  CAS  Google Scholar 

  17. D. F. Katz. Human cervical mucus: research update. Am. J. Obstet. Gynecol. 165:1984–1986 (1991).

    PubMed  CAS  Google Scholar 

  18. P. M. Zavos, and M. R. Cohen. The pH of cervical mucus and the postcoital test. Fertil. Steril. 34:234–238 (1980).

    PubMed  CAS  Google Scholar 

  19. L. Ming, P. Xiaoling, L. Yan, W. Lili, W. Qi, Y. Xiyong, W. Boyao, and H. Ning. Purification of antimicrobial factors from human cervical mucus. Hum. Reprod. 22:1810–1815 (2007).

    PubMed  Google Scholar 

  20. F. Acarturk, Z. I. Parlatan, and O. F. Saracoglu. Comparison of vaginal aminopeptidase enzymatic activities in various animals and in humans. J. Pharm. Pharmacol. 53:1499–1504 (2001).

    PubMed  CAS  Google Scholar 

  21. J. L. Richardson, and L. Illum. Routes of delivery: case studies. The vaginal route of peptide and protein drug delivery. Adv. Drug. Deliv. Rev. 8:341–366 (1992).

    CAS  Google Scholar 

  22. G. F. Schumacher. Biochemistry of cervical mucus. Fertil. Steril. 21:697–705 (1970).

    PubMed  CAS  Google Scholar 

  23. G. F. Schumacher, M. H. Kim, A. H. Hosseinian, and C. Dupon. Immunoglobulins, proteinase inhibitors, albumin, and lysozyme in human cervical mucus. I. Communication: hormonal profiles and cervical mucus changes–methods and results. Am. J. Obstet. Gynecol. 129:629–636 (1977).

    PubMed  CAS  Google Scholar 

  24. L. J. Tang, F. De Seta, F. Odreman, P. Venge, C. Piva, S. Guaschino, and R. C. Garcia. Proteomic analysis of human cervical-vaginal fluids. J. Proteome. Res. 6:2874–2883 (2007).

    PubMed  CAS  Google Scholar 

  25. S. Dasari, L. Pereira, A. P. Reddy, J. E. Michaels, X. Lu, T. Jacob, A. Thomas, M. Rodland, C. T. Roberts Jr., M. G. Gravett, and S. R. Nagalla. Comprehensive proteomic analysis of human cervical-vaginal fluid. J. Proteome. Res. 6:1258–1268 (2007).

    PubMed  CAS  Google Scholar 

  26. J. L. Shaw, C. R. Smith, and E. P. Diamandis. Proteomic analysis of human cervico-vaginal fluid. J. Proteome. Res. 6:2859–2865 (2007).

    PubMed  CAS  Google Scholar 

  27. L. L. Klein, K. R. Jonscher, M. J. Heerwagen, R. S. Gibbs, and J. L. McManaman. Shotgun proteomic analysis of vaginal fluid from women in late pregnancy. Reprod. Sci. 15:263–273 (2008).

    PubMed  CAS  Google Scholar 

  28. M. K. Di Quinzio, K. Oliva, S. J. Holdsworth, M. Ayhan, S. P. Walker, G. E. Rice, H. M. Georgiou, and M. Permezel. Proteomic analysis and characterisation of human cervico-vaginal fluid proteins. Aust. N. Z. J. Obstet. Gynaecol. 47:9–15 (2007).

    PubMed  Google Scholar 

  29. E. L. Johansson, A. Rudin, L. Wassen, and J. Holmgren. Distribution of lymphocytes and adhesion molecules in human cervix and vagina. Immunology. 96:272–277 (1999).

    PubMed  CAS  Google Scholar 

  30. C. S. Dezzutti, P. C. Guenthner, J. E. Cummins Jr., T. Cabrera, J. H. Marshall, A. Dillberger, and R. B. Lal. Cervical and prostate primary epithelial cells are not productively infected but sequester human immunodeficiency virus type 1. J. Infect. Dis. 183:1204–1213 (2001).

    PubMed  CAS  Google Scholar 

  31. K. B. Collins, B. K. Patterson, G. J. Naus, D. V. Landers, and P. Gupta. Development of an in vitro organ culture model to study transmission of HIV-1 in the female genital tract. Nat. Med. 6:475–479 (2000).

    PubMed  CAS  Google Scholar 

  32. M. S. Cohen, J. R. Black, R. A. Proctor, and P. F. Sparling. Host defences and the vaginal mucosa. A re-evaluation. Scand. J. Urol. Nephrol. Suppl. 86:13–22 (1984).

    PubMed  CAS  Google Scholar 

  33. B. K. Patterson, A. Landay, J. Andersson, C. Brown, H. Behbahani, D. Jiyamapa, Z. Burki, D. Stanislawski, M. A. Czerniewski, and P. Garcia. Repertoire of chemokine receptor expression in the female genital tract: implications for human immunodeficiency virus transmission. Am. J. Pathol. 153:481–490 (1998).

    PubMed  CAS  Google Scholar 

  34. J. Pudney, A. J. Quayle, and D. J. Anderson. Immunological microenvironments in the human vagina and cervix: mediators of cellular immunity are concentrated in the cervical transformation zone. Biol. Reprod. 73:1253–1263 (2005).

    PubMed  CAS  Google Scholar 

  35. M. Johansson, and N. Y. Lycke. Immunology of the human genital tract. Curr. Opin. Infect. Dis. 16:43–49 (2003).

    PubMed  CAS  Google Scholar 

  36. C. J. Miller, M. McChesney, and P. F. Moore. Langerhans cells, macrophages and lymphocyte subsets in the cervix and vagina of rhesus macaques. Lab. Invest. 67:628–634 (1992).

    PubMed  CAS  Google Scholar 

  37. T. Kawamura, S. E. Kurtz, A. Blauvelt, and S. Shimada. The role of Langerhans cells in the sexual transmission of HIV. J. Dermatol. Sci. 40:147–155 (2005).

    PubMed  CAS  Google Scholar 

  38. L. de Witte, A. Nabatov, M. Pion, D. Fluitsma, M. A. de Jong, T. de Gruijl, V. Piguet, Y. van Kooyk, and T. B. Geijtenbeek. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells. Nat. Med. 13:367–371 (2007).

    PubMed  Google Scholar 

  39. D. Medaglini, C. M. Rush, P. Sestini, and G. Pozzi. Commensal bacteria as vectors for mucosal vaccines against sexually transmitted diseases: vaginal colonization with recombinant streptococci induces local and systemic antibodies in mice. Vaccine. 15:1330–1337 (1997).

    PubMed  CAS  Google Scholar 

  40. X. Liu, L. A. Lagenaur, D. A. Simpson, K. P. Essenmacher, C. L. Frazier-Parker, Y. Liu, D. Tsai, S. S. Rao, D. H. Hamer, T. P. Parks, P. P. Lee, and Q. Xu. Engineered vaginal lactobacillus strain for mucosal delivery of the human immunodeficiency virus inhibitor cyanovirin-N. Antimicrob. Agents. Chemother. 50:3250–3259 (2006).

    PubMed  CAS  Google Scholar 

  41. N. F. Ho, L. Suhardja, S. Hwang, E. Owada, A. Molokhia, G. L. Flynn, W. I. Higuchi, and J. Y. Park. Systems approach to vaginal delivery of drugs III: Simulation studies interfacing steroid release from silicone matrix and vaginal absorption in rabbits. J. Pharm. Sci. 65:1578–1585 (1976).

    PubMed  CAS  Google Scholar 

  42. S. Hwang, E. Owada, T. Yotsuyanagi, L. Suhardja, N. F. Ho, G. L. Flynn, and W. I. Higuchi. Systems approach to vaginal delivery of drugs II: In situ vaginal absorption of unbranched aliphatic alcohols. J. Pharm. Sci. 65:1574–1578 (1976).

    PubMed  CAS  Google Scholar 

  43. S. Hwang, E. Owada, L. Suhardja, N. F. Ho, G. L. Flynn, and W. I. Higuchi. Systems approach to vaginal delivery of drugs IV: methodology for determination of membrane surface pH. J. Pharm. Sci. 66:778–781 (1977).

    PubMed  CAS  Google Scholar 

  44. S. Hwang, E. Owada, L. Suhardja, N. F. Ho, G. L. Flynn, and W. I. Higuchi. Systems approach to vaginal delivery of drugs V: in situ vaginal absorption of 1-alkanoic acids. J. Pharm. Sci. 66:781–784 (1977).

    PubMed  CAS  Google Scholar 

  45. T. Yotsuyanagi, A. Molokhia, S. Hwang, N. F. Ho, G. L. Flynn, and W. I. Higuchi. Systems approach to vaginal delivery of drugs I: development of in situ vaginal drug absorption procedure. J. Pharm. Sci. 64:71–76 (1975).

    PubMed  CAS  Google Scholar 

  46. A. D. Woolfson, R. K. Malclm, and R. Gallagher. Drug delivery by the intravaginal route. Crit. Rev. Ther. Drug. Carrier. Syst. 17:509–555 (2000).

    PubMed  CAS  Google Scholar 

  47. H. Okada, and A. M. Hillery. Vaginal Drug Delivery, Taylor & Francis, New York, 2001.

    Google Scholar 

  48. V. H. Lee. Enzymatic barriers to peptide and protein absorption. Crit. Rev. Ther. Drug Carr. Syst. 5:69–97 (1988).

    CAS  Google Scholar 

  49. Y. van Herrewege, J. Michiels, J. van Roey, K. Fransen, L. Kestens, J. Balzarini, P. Lewi, G. Vanham, and P. Janssen. In vitro evaluation of nonnucleoside reverse transcriptase inhibitors UC-781 and TMC120-R147681 as human immunodeficiency virus microbicides. Antimicrob. Agents Chemother. 48:337–339 (2004).

    PubMed  Google Scholar 

  50. L. C. Rohan, D. Ratner, K. McCullough, S. L. Hiller, and P. Gupta. Measurement of anti-HIV activity of marketed vaginal products and excipients using a PBMC-based in vitro assay. Sex. Transm. Dis. 31:143–148 (2004).

    PubMed  CAS  Google Scholar 

  51. C. K. Mauck, D. H. Weiner, M. D. Creinen, K. T. Barnhart, M. M. Callahan, and R. Bax. A randomized Phase I vaginal safety study of three concentrations of C31G vs. Extra Strength Gynol II. Contraception. 70:233–240 (2004).

    PubMed  CAS  Google Scholar 

  52. M. M. Lederman, R. S. Veazey, R. Offord, D. E. Mosier, J. Dufour, M. Mefford, M. Piatak Jr., J. D. Lifson, J. R. Salkowitz, B. Rodriguez, A. Blauvelt, and O. Hartley. Prevention of vaginal SHIV transmission in rhesus macaques through inhibition of CCR5. Science. 306:485–487 (2004).

    PubMed  CAS  Google Scholar 

  53. O. J. D’Cruz, P. Samuel, and F. M. Uckun. PHI-443: a novel noncontraceptive broad-spectrum anti-human immunodeficiency virus microbicide. Biol. Reprod. 71:2037–2047 (2004).

    PubMed  Google Scholar 

  54. K. H. Mayer, S. A. Karim, C. Kelly, L. Maslankowski, H. Rees, A. T. Profy, J. Day, J. Welch, and Z. Rosenberg. Safety and tolerability of vaginal PRO 2000 gel in sexually active HIV-uninfected and abstinent HIV-infected women. Aids. 17:321–329 (2003).

    PubMed  CAS  Google Scholar 

  55. P. F. Harrison, Z. Rosenberg, and J. Bowcut. Topical microbicides for disease prevention: status and challenges. Clin. Infect. Dis. 36:1290–1294 (2003).

    PubMed  Google Scholar 

  56. S. Garg, K. Vermani, G. Kohli, R. Kandarapu, K. R. Tambwekar, A. Garg, D. P. Waller, and L. J. Zaneveld. Survey of vaginal formulations available on the Indian market: physicochemical characterization of selected products. Int. J. Pharmaceut. Med. 16:141–152 (2002).

    Google Scholar 

  57. K. Vermani, and S. Garg. The scope and potential of vaginal drug delivery. Pharm. Sci. Technol. Today. 3:359–364 (2000).

    PubMed  CAS  Google Scholar 

  58. C. Coggins, K. Blanchard, F. Alvarez, V. Brache, E. Weisberg, P. H. Kilmarx, M. Lacarra, R. Massai, D. Mishell Jr., A. Salvatierra, P. Witwatwongwana, C. Elias, and C. Ellertson. Preliminary safety and acceptability of a carrageenan gel for possible use as a vaginal microbicide. Sex. Transm. Infect. 76:480–483 (2000).

    PubMed  CAS  Google Scholar 

  59. S. Joshi, N. Joglekar, M. Ghate, J. Unni, A. Risbud, M. Bentley, M. Shepherd, R. Bollinger, and S. Mehendale. Phase I safety & preliminary acceptability of nonoxynol-9 vaginal pessary as a vaginal microbicide in low risk women in Pune, India. Indian J. Med. Res. 117:152–157 (2003).

    PubMed  CAS  Google Scholar 

  60. L. van Damme, A. Wright, K. Depraetere, I. Rosenstein, V. Vandersmissen, L. Poulter, M. McKinlay, E. Van Dyck, J. Weber, A. Profy, M. Laga, and V. Kitchen. A phase I study of a novel potential intravaginal microbicide, PRO 2000, in healthy sexually inactive women. Sex. Transm. Infect. 76:126–130 (2000).

    PubMed  Google Scholar 

  61. E. Hardy, A. L. Jimenez, K. S. de Padua, and L. J. Zaneveld. Women’s preferences for vaginal antimicrobial contraceptives. III. Choice of a formulation, applicator, and packaging. Contraception. 58:245–249 (1998).

    PubMed  CAS  Google Scholar 

  62. J. Romano, R. K. Malcolm, S. Garg, L. Rohan, and P. Kaptur. Microbicide delivery: formulation technologies and strategies. Current. Opinion. in. HIV. & AIDS. 3:558–566 (2008).

    Google Scholar 

  63. S. Garg, K. R. Tambwekar, K. Vermani, R. Kandarapu, A. Garg, D. P. Waller, and L. J. Zaneveld. Development pharmaceutics of microbicide formulations. Part II: formulation, evaluation, and challenges. AIDS. Patient. Care. STDS. 17:377–399 (2003).

    PubMed  Google Scholar 

  64. H. Thormar, G. Bergsson, E. Gunnarsson, G. Georgsson, M. Witvrouw, O. Steingrimsson, E. De Clercq, and T. Kristmundsdottir. Hydrogels containing monocaprin have potent microbicidal activities against sexually transmitted viruses and bacteria in vitro. Sex. Transm. Infect. 75:181–185 (1999).

    PubMed  CAS  Google Scholar 

  65. J. das Neves, and M. F. Bahia. Gels as vaginal drug delivery systems. Int. J. Pharm. 318:1–14 (2006).

    PubMed  CAS  Google Scholar 

  66. J. R. Hwu, W. N. Tseng, J. Gnabre, P. Giza, and R. C. Huang. Antiviral activities of methylated nordihydroguaiaretic acids. 1. Synthesis, structure identification, and inhibition of tat-regulated HIV transactivation. J. Med. Chem. 41:2994–3000 (1998).

    PubMed  CAS  Google Scholar 

  67. H. Chen, L. Teng, J. N. Li, R. Park, D. E. Mold, J. Gnabre, J. R. Hwu, W. N. Tseng, and R. C. Huang. Antiviral activities of methylated nordihydroguaiaretic acids. 2. Targeting herpes simplex virus replication by the mutation insensitive transcription inhibitor tetra-O-methyl-NDGA. J. Med. Chem. 41:3001–3007 (1998).

    PubMed  CAS  Google Scholar 

  68. N. Khanna, R. Dalby, A. Connor, A. Church, J. Stern, and N. Frazer. Phase I clinical trial of repeat dose terameprocol vaginal ointment in healthy female volunteers. Sex. Transm. Dis. 35:577–582 (2008).

    PubMed  CAS  Google Scholar 

  69. N. Khanna, R. Dalby, M. Tan, S. Arnold, J. Stern, and N. Frazer. Phase I/II clinical safety studies of terameprocol vaginal ointment. Gynecol. Oncol. 107:554–562 (2007).

    PubMed  CAS  Google Scholar 

  70. J. E. Darroch, and J. J. Frost. Women’s interest in vaginal microbicides. Fam. Plann. Perspect. 31:16–23 (1999).

    PubMed  CAS  Google Scholar 

  71. B. Y. Holt, V. G. Morwitz, L. Ngo, P. F. Harrison, K. J. Whaley, A. Pettifor, and A. H. Nguyen. Microbicide preference among young women in California. J. Womens. Health. (Larchmt). 15:281–294 (2006).

    Google Scholar 

  72. S. Braunstein, and J. van de Wijgert. Preferences and practices related to vaginal lubrication: implications for microbicide acceptability and clinical testing. J. Womens Health (Larchmt). 14:424–233 (2005).

    Google Scholar 

  73. J. A. Cohen, M. S. Steele, F. I. Urena, and M. E. Beksinska. Microbicide applicators: understanding design preferences among women in the dominican republic and South Africa. Sex. Transm. Dis. 34:15–19 (2007).

    PubMed  Google Scholar 

  74. M. Rader, G. Marks, G. Mansergh, N. Crepaz, L. C. Miller, P. R. Appleby, and S. Murphy. Preferences about the characteristics of future HIV prevention products among men who have sex with men. AIDS Educ. Prev. 13:149–159 (2001).

    PubMed  CAS  Google Scholar 

  75. B. A. Auslander, M. M. Perfect, D. M. Breitkopf, P. A. Succop, and S. L. Rosenthal. Microbicides: information, beliefs, and preferences for insertion. J. Womens Health (Larchmt). 16:1458–1467 (2007).

    Google Scholar 

  76. S. Garg, R. A. Anderson, C. J. Chany 2nd, D. P. Waller, X. H. Diao, K. Vermani, and L. J. Zaneveld. Properties of a new acid-buffering bioadhesive vaginal formulation (ACIDFORM). Contraception. 64:67–75 (2001).

    PubMed  CAS  Google Scholar 

  77. D. Tien, R. L. Schnaare, F. Kang, G. Cohl, T. J. McCormick, T. R. Moench, G. Doncel, K. Watson, R. W. Buckheit, M. G. Lewis, J. Schwartz, K. Douville, and J. W. Romano. In vitro and in vivo characterization of a potential universal placebo designed for use in vaginal microbicide clinical trials. AIDS Res. Hum. Retroviruses. 21:845–853 (2005).

    PubMed  CAS  Google Scholar 

  78. F. M. Behets, A. N. Turner, K. Van Damme, N. L. Rabenja, N. Ravelomanana, T. A. Swezey, A. J. Bell, D. R. Newman, D. L. Williams, and D. J. Jamieson. Vaginal Microbicide and Diaphragm Use for Sexually Transmitted Infection Prevention: A Randomized Acceptability and Feasibility Study Among High-Risk Women in Madagascar. Sex. Transm. Dis. 35:818–826 (2008).

    PubMed  Google Scholar 

  79. K. H. Mayer, J. Peipert, T. Fleming, A. Fullem, T. Moench, S. Cu-Uvin, M. Bentley, M. Chesney, and Z. Rosenberg. Safety and tolerability of BufferGel, a novel vaginal microbicide, in women in the United States. Clin. Infect. Dis. 32:476–482 (2001).

    PubMed  CAS  Google Scholar 

  80. S. A. Ballagh, V. Brache, C. Mauck, M. M. Callahan, L. Cochon, A. Wheeless, and T. R. Moench. A Phase I study of the functional performance, safety and acceptability of the BufferGel Duet. Contraception. 77:130–137 (2008).

    PubMed  CAS  Google Scholar 

  81. R. A. Maguire, V. R. Zacharopoulos, and D. M. Phillips. Carrageenan-based nonoxynol-9 spermicides for prevention of sexually transmitted infections. Sex. Transm. Dis. 25:494–500 (1998).

    PubMed  CAS  Google Scholar 

  82. R. Pearce-Pratt, and D. M. Phillips. Sulfated polysaccharides inhibit lymphocyte-to-epithelial transmission of human immunodeficiency virus-1. Biol. Reprod. 54:173–182 (1996).

    PubMed  CAS  Google Scholar 

  83. J. E. Cummins Jr., J. Guarner, L. Flowers, P. C. Guenthner, J. Bartlett, T. Morken, L. A. Grohskopf, L. Paxton, and C. S. Dezzutti. Preclinical testing of candidate topical microbicides for anti-human immunodeficiency virus type 1 activity and tissue toxicity in a human cervical explant culture. Antimicrob. Agents. Chemother. 51:1770–1779 (2007).

    PubMed  CAS  Google Scholar 

  84. J. H. van de Wijgert, S. L. Braunstein, N. S. Morar, H. E. Jones, L. Madurai, T. T. Strickfaden, M. Moodley, J. Aboobaker, G. Ndlovu, T. M. Ferguson, B. A. Friedland, C. E. Hart, and G. Ramjee. Carraguard Vaginal Gel Safety in HIV-Positive Women and Men in South Africa. J. Acquir. Immune. Defic. Syndr. 46:538–546 (2007).

    PubMed  Google Scholar 

  85. P. H. Kilmarx, K. Blanchard, S. Chaikummao, B. A. Friedland, N. Srivirojana, C. Connolly, P. Witwatwongwana, S. Supawitkul, P. A. Mock, T. Chaowanachan, and J. Tappero. A randomized, placebo-controlled trial to assess the safety and acceptability of use of carraguard vaginal gel by heterosexual couples in Thailand. Sex. Transm. Dis. 35:226–232 (2008).

    PubMed  CAS  Google Scholar 

  86. R. A. Anderson, K. A. Feathergill, X. H. Diao, M. D. Cooper, R. Kirkpatrick, B. C. Herold, G. F. Doncel, C. J. Chany, D. P. Waller, W. F. Rencher, and L. J. Zaneveld. Preclinical evaluation of sodium cellulose sulfate (Ushercell) as a contraceptive antimicrobial agent. J. Androl. 23:426–438 (2002).

    PubMed  CAS  Google Scholar 

  87. R. A. Anderson, K. Feathergill, X. H. Diao, C. Chany 2nd, W. F. Rencher, L. J. Zaneveld, and D. P. Waller. Contraception by Ushercell (cellulose sulfate) in formulation: duration of effect and dose effectiveness. Contraception. 70:415–422 (2004).

    PubMed  CAS  Google Scholar 

  88. W. M. El-Sadr, K. H. Mayer, L. Maslankowski, C. Hoesley, J. Justman, F. Gai, C. Mauck, J. Absalon, K. Morrow, B. Masse, L. Soto-Torres, and A. Kwiecien. Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women. Aids. 20:1109–1116 (2006).

    PubMed  CAS  Google Scholar 

  89. L. van Damme, R. Govinden, F. M. Mirembe, F. Guedou, S. Solomon, M. L. Becker, B. S. Pradeep, A. K. Krishnan, M. Alary, B. Pande, G. Ramjee, J. Deese, T. Crucitti, and D. Taylor. Lack of effectiveness of cellulose sulfate gel for the prevention of vaginal HIV transmission. N. Engl. J. Med. 359:463–472 (2008).

    PubMed  Google Scholar 

  90. W. Tao, C. Richards, and D. Hamer. Enhancement of HIV infection by cellulose sulfate. AIDS. Res. Hum. Retroviruses. 24:925–929 (2008).

    PubMed  Google Scholar 

  91. N. Bolognesi. AIDS gel’s failure calls prevention approach into question. Nat. Med. 13:230 (2007).

    PubMed  CAS  Google Scholar 

  92. V. A. Jespers, J. M. Van Roey, G. I. Beets, and A. M. Buve. Dose-ranging phase 1 study of TMC120, a promising vaginal microbicide, in HIV-negative and HIV-positive female volunteers. J. Acquir. Immune. Defic. Syndr. 44:154–158 (2007).

    PubMed  CAS  Google Scholar 

  93. N. Bourne, D. I. Bernstein, J. Ireland, A. J. Sonderfan, A. T. Profy, and L. R. Stanberry. The topical microbicide PRO 2000 protects against genital herpes infection in a mouse model. J. Infect. Dis. 180:203–205 (1999).

    PubMed  CAS  Google Scholar 

  94. L. Van Damme, A. Wright, K. Depraetere, I. Rosenstein, V. Vandersmissen, L. Poulter, M. McKinlay, E. Van Dyck, J. Weber, A. Profy, M. Laga, and V. Kitchen. A phase I study of a novel potential intravaginal microbicide, PRO 2000, in healthy sexually inactive women. Sex. Transm. Infect. 76:126–130 (2000).

    PubMed  Google Scholar 

  95. P. S. Fletcher, and R. J. Shattock. PRO-2000, an antimicrobial gel for the potential prevention of HIV infection. Curr Opin Investig Drugs. 9:189–200 (2008).

    PubMed  CAS  Google Scholar 

  96. K. H. Mayer, L. A. Maslankowski, F. Gai, W. M. El-Sadr, J. Justman, A. Kwiecien, B. Masse, S. H. Eshleman, C. Hendrix, K. Morrow, J. F. Rooney, and L. Soto-Torres. Safety and tolerability of tenofovir vaginal gel in abstinent and sexually active HIV-infected and uninfected women. Aids. 20:543–551 (2006).

    PubMed  CAS  Google Scholar 

  97. R. K. Rosen, K. M. Morrow, A. Carballo-Dieguez, J. E. Mantell, S. Hoffman, F. Gai, L. Maslankowski, W. M. El-Sadr, and K. H. Mayer. Acceptability of tenofovir gel as a vaginal microbicide among women in a phase I trial: a mixed-methods study. J. Womens. Health. (Larchmt). 17:383–392 (2008).

    Article  Google Scholar 

  98. D. L. Patton, Y. T. Cosgrove Sweeney, J. E. Balkus, L. C. Rohan, B. J. Moncla, M. A. Parniak, and S. L. Hillier. Preclinical Safety Assessments of UC781 Anti-HIV Topical Microbicide Formulations. Antimicrob. Agents. Chemother. 51:1608–1615 (2007).

    PubMed  CAS  Google Scholar 

  99. J. L. Schwartz, G. Kovalevsky, J. J. Lai, S. A. Ballagh, T. McCormick, K. Douville, C. K. Mauck, and M. M. Callahan. A randomized six-day safety study of an antiretroviral microbicide candidate UC781, a non-nucleoside reverse transcriptase inhibitor. Sex. Transm. Dis. 35:414–419 (2008).

    PubMed  CAS  Google Scholar 

  100. I. M. Malonza, F. Mirembe, C. Nakabiito, L. O. Odusoga, O. A. Osinupebi, K. Hazari, S. Chitlange, M. M. Ali, M. Callahan, and L. Van Damme. Expanded Phase I safety and acceptability study of 6% cellulose sulfate vaginal gel. Aids. 19:2157–2163 (2005).

    PubMed  CAS  Google Scholar 

  101. J. L. Schwartz, C. Mauck, J. J. Lai, M. D. Creinin, V. Brache, S. A. Ballagh, D. H. Weiner, S. L. Hillier, R. N. Fichorova, and M. Callahan. Fourteen-day safety and acceptability study of 6% cellulose sulfate gel: a randomized double-blind Phase I safety study. Contraception. 74:133–140 (2006).

    PubMed  CAS  Google Scholar 

  102. C. Mauck, D. H. Weiner, S. Ballagh, M. Creinin, D. F. Archer, J. Schwartz, H. Pymar, J. J. Lai, and M. Callahan. Single and multiple exposure tolerance study of cellulose sulfate gel: a Phase I safety and colposcopy study. Contraception. 64:383–391 (2001).

    PubMed  CAS  Google Scholar 

  103. M. E. Bentley, A. M. Fullem, E. E. Tolley, C. W. Kelly, N. Jogelkar, N. Srirak, L. Mwafulirwa, G. Khumalo-Sakutukwa, and D. D. Celentano. Acceptability of a microbicide among women and their partners in a 4-country phase I trial. Am. J. Public. Health. 94:1159–1164 (2004).

    PubMed  Google Scholar 

  104. K. Morrow, R. Rosen, L. Richter, A. Emans, A. Forbes, J. Day, N. Morar, L. Maslankowski, A. T. Profy, C. Kelly, S. S. Abdool Karim, and K. H. Mayer. The acceptability of an investigational vaginal microbicide, PRO 2000 Gel, among women in a phase I clinical trial. J. Womens. Health. (Larchmt). 12:655–666 (2003).

    Google Scholar 

  105. S. A. Ballagh, J. M. Baker, D. M. Henry, and D. F. Archer. Safety of single daily use for one week of C31G HEC gel in women. Contraception. 66:369–375 (2002).

    PubMed  CAS  Google Scholar 

  106. C. K. Mauck, D. H. Weiner, S. A. Ballagh, M. D. Creinin, D. F. Archer, J. L. Schwartz, H. C. Pymar, J. J. Lai, W. F. Rencher, and M. M. Callahan. Single and multiple exposure tolerance study of polystyrene sulfonate gel: a phase I safety and colposcopy study. Contraception. 70:77–83 (2004).

    PubMed  CAS  Google Scholar 

  107. N. Coetzee, K. Blanchard, C. Ellertson, A. A. Hoosen, and B. Friedland. Acceptability and feasibility of Micralax applicators and of methyl cellulose gel placebo for large-scale clinical trials of vaginal microbicides. Aids. 15:1837–1842 (2001).

    PubMed  CAS  Google Scholar 

  108. M. E. Bentley, K. M. Morrow, A. Fullem, M. A. Chesney, S. D. Horton, Z. Rosenberg, and K. H. Mayer. Acceptability of a novel vaginal microbicide during a safety trial among low-risk women. Fam. Plann. Perspect. 32:184–148 (2000).

    PubMed  CAS  Google Scholar 

  109. A. D. Woolfson, R. K. Malcolm, R. J. Morrow, C. F. Toner, and S. D. McCullagh. Intravaginal ring delivery of the reverse transcriptase inhibitor TMC 120 as an HIV microbicide. Int. J. Pharm. 325:82–89 (2006).

    PubMed  CAS  Google Scholar 

  110. K. M. Gupta, S. M. Pearce, A. E. Poursaid, H. A. Aliyar, P. A. Tresco, M. A. Mitchnik, and P. F. Kiser. Polyurethane intravaginal ring for controlled delivery of dapivirine, a nonnucleoside reverse transcriptase inhibitor of HIV-1. J. Pharm. Sci. 97(10):4228–4239 (2008).

    PubMed  CAS  Google Scholar 

  111. C. Elias, and C. Coggins. Acceptability research on female-controlled barrier methods to prevent heterosexual transmission of HIV: Where have we been? Where are we going. J. Womens. Health. Gend. Based. Med. 10:163–173 (2001).

    PubMed  CAS  Google Scholar 

  112. A. Dinge, and M. Nagarsenker. Formulation and evaluation of fast dissolving films for delivery of triclosan to the oral cavity. AAPS. PharmSciTech. 9:349–356 (2008).

    PubMed  Google Scholar 

  113. S. Singh, S. Jain, M. S. Muthu, S. Tiwari, and R. Tilak. Preparation and evaluation of buccal bioadhesive films containing clotrimazole. AAPS. PharmSciTech. 9:660–667 (2008).

    PubMed  CAS  Google Scholar 

  114. B. Vondrak, and S. Barnhart. Dissolvable films: dissolvable films for flexible product format in drug delivery. Pharm. Tech. (2008).

  115. M. H. Pan, Y. C. Liang, S. Y. Lin-Shiau, N. Q. Zhu, C. T. Ho, and J. K. Lin. Induction of apoptosis by the oolong tea polyphenol theasinensin A through cytochrome c release and activation of caspase-9 and caspase-3 in human U937 cells. J. Agric. Food Chem. 48:6337–6346 (2000).

    PubMed  CAS  Google Scholar 

  116. S. Garg, K. Vermani, A. Garg, R. A. Anderson, W. B. Rencher, and L. J. Zaneveld. Development and characterization of bioadhesive vaginal films of sodium polystyrene sulfonate (PSS), a novel contraceptive antimicrobial agent. Pharm. Res. 22:584–595 (2005).

    PubMed  CAS  Google Scholar 

  117. C. K. Mauck, J. M. Baker, S. P. Barr, T. J. Abercrombie, and D. F. Archer. A phase I comparative study of contraceptive vaginal films containing benzalkonium chloride and nonoxynol-9. Postcoital testing and colposcopy. Contraception. 56:89–96 (1997).

    PubMed  CAS  Google Scholar 

  118. R. E. Roddy, L. Zekeng, K. A. Ryan, U. Tamoufe, S. S. Weir, and E. L. Wong. A controlled trial of nonoxynol 9 film to reduce male-to-female transmission of sexually transmitted diseases. N. Engl. J. Med. 339:504–510 (1998).

    PubMed  CAS  Google Scholar 

  119. H. Lu, Q. Zhao, G. Wallace, S. Liu, Y. He, R. Shattock, A. R. Neurath, and B. S. Jiang. Cellulose acetate 1,2-benzenedicarboxylate inhibits infection by cell-free and cell-associated primary HIV-1 isolates. AIDS Res. Hum. Retroviruses. 22:411–418 (2006).

    PubMed  CAS  Google Scholar 

  120. T. Gyotoku, L. Aurelian, and A. R. Neurath. Cellulose acetate phthalate (CAP): an ‘inactive’ pharmaceutical excipient with antiviral activity in the mouse model of genital herpesvirus infection. Antivir. Chem. Chemother. 10:327–332 (1999).

    PubMed  CAS  Google Scholar 

  121. A. R. Neurath, N. Strick, Y. Y. Li, and A. K. Debnath. Cellulose acetate phthalate, a common pharmaceutical excipient, inactivates HIV-1 and blocks the coreceptor binding site on the virus envelope glycoprotein gp120. BMC. Infect. Dis. 1:17 (2001).

    PubMed  CAS  Google Scholar 

  122. A. R. Neurath, N. Strick, and Y. Y. Li. Water dispersible microbicidal cellulose acetate phthalate film. BMC. Infect. Dis. 3:27 (2003).

    PubMed  Google Scholar 

  123. P. Raghuvanshi, R. Bagga, D. Malhotra, S. Gopalan, and G. P. Talwar. Spermicidal & contraceptive properties of Praneem polyherbal pessary. Indian. J. Med. Res. 113:135–141 (2001).

    PubMed  CAS  Google Scholar 

  124. R. Bagga, P. Raghuvanshi, S. Gopalan, S. K. Das, R. Baweja, S. Suri, D. Malhotra, S. Khare, and G. P. Talwar. A polyherbal vaginal pessary with spermicidal and antimicrobial action: evaluation of its safety. Trans. R. Soc. Trop. Med. Hyg. 100:1164–1167 (2006).

    PubMed  CAS  Google Scholar 

  125. S. Joshi, S. Dutta, B. K. Kumar, U. Katti, S. Kulkarni, A. Risbud, and S. Mehendale. Expanded Safety Study of Praneem Polyherbal vaginal tablet among HIV un-infected women in Pune, India: A Phase II clinical trial report. Sex Transm Infect. 84:343–347 (2008).

    PubMed  CAS  Google Scholar 

  126. N. S. Joglekar, S. N. Joshi, S. N. Navlakha, U. R. Katti, and S. M. Mehendale. Acceptability of Praneem polyherbal vaginal tablet among HIV uninfected women & their male partners in Pune, India–Phase I study. Indian. J. Med. Res. 123:547–552 (2006).

    PubMed  CAS  Google Scholar 

  127. A. Ham, M. Cost, A. Sassi, C. Dezzutti, and L. Rohan. Targeted Delivery of PSC-RANTES for HIV-1 Prevention using Biodegradable Nanoparticles. Pharm. Res. (2008). In press.

  128. S. McCormack, R. Hayes, C. J. Lacey, and A. M. Johnson. Microbicides in HIV prevention. British. Medical. Journal. 322:410–413 (2001).

    PubMed  CAS  Google Scholar 

  129. J. A. Turpin, M. L. Schito, L. M. Jenkins, J. K. Inman, and E. Appella. Topical microbicides: a promising approach for controlling the AIDS pandemic via retroviral zinc finger inhibitors. Adv. Pharmacol. 56:229–256 (2008).

    PubMed  CAS  Google Scholar 

  130. S. L. Lard-Whiteford, D. Matecka, J. J. O’Rear, I. S. Yuen, C. Litterst, and P. Reichelderfer. Recommendations for the nonclinical development of topical microbicides for prevention of HIV transmission: an update. J. Acquir. Immune. Defic. Syndr. 36:541–552 (2004).

    PubMed  Google Scholar 

  131. J. G. Clarke, J. F. Peipert, S. L. Hillier, W. Heber, L. Boardman, T. R. Moench, and K. Mayer. Microflora changes with the use of a vaginal microbicide. Sex. Transm. Dis. 29:288–293 (2002).

    PubMed  Google Scholar 

  132. B. J. Moncla, and S. L. Hillier. Why nonoxynol-9 may have failed to prevent acquisition of Neisseria gonorrhoeae in clinical trials. Sex. Transm. Dis. 32:491–494 (2005).

    PubMed  CAS  Google Scholar 

  133. B. J. Moncla, K. Pryke, and C. E. Isaacs. Killing of Neisseria gonorrhoeae, Streptococcus agalactiae (group B streptococcus), Haemophilus ducreyi, and vaginal Lactobacillus by 3-O-octyl-sn-glycerol. Antimicrob. Agents. Chemother. 52:1577–1579 (2008).

    PubMed  CAS  Google Scholar 

  134. C. A. Schreiber, L. A. Meyn, M. D. Creinin, K. T. Barnhart, and S. L. Hillier. Effects of long-term use of nonoxynol-9 on vaginal flora. Obstet. Gynecol. 107:136–143 (2006).

    PubMed  CAS  Google Scholar 

  135. Q1A(R2): Stability Testing of New Drug Substances and Products (Second Revision), ICH Harmonised Tripartite Guideline, 2003.

Download references

Acknowledgment

The author’s research was supported in part by the National Institute of Allergy and Infectious Diseases (NIAID). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIAID.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lisa Cencia Rohan.

Additional information

Guest Editor: Dexi Liu

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rohan, L.C., Sassi, A.B. Vaginal Drug Delivery Systems for HIV Prevention. AAPS J 11, 78–87 (2009). https://doi.org/10.1208/s12248-009-9082-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1208/s12248-009-9082-7

Key words

Navigation