Vaginal Ring Brings New Hope For HIV Prevention in Women

In 2016, the ASPIRE study revealed some promising results: a monthly vaginal ring containing 25 mg of  dapivirine, used regularly, could safely and effectively reduce a woman’s risk of acquiring HIV by up to 56 percent.

Now, the final results of the HOPE study, a phase 3 open-label extension trial of ASPIRE, are even more hopeful in regards to use of the ring as HIV prevention. Presented at the 10th IAS Conference on HIV Science (IAS 2019) recently in Mexico City and published Friday on ContagionLive.com, the findings showed lower-than-anticipated HIV incidence among women in southern and eastern Africa.

HOPE, which launched in July 2016 and concluded in August of last year, provided 1,456 HIV-negative women who had participated in the ASPIRE study 12 months of access to the dapivirine vaginal ring at 14 sites in Malawi, South Africa, Uganda, and Zimbabwe. The women used the ring continuously for four weeks (and then swapped it out for a new one) and had a median age of 31 years old.

The women would return used rings at study visits so researchers could test the residual levels of dapivirine. The team also performed HIV-1 serologic testing at each visit and collected archived, frozen plasma samples quarterly to test for HIV with greater precision, stated the Contagion Live article.

Ninety-two percent (1,342) women accepted the dapivirine ring upon the start of the study, with 90 percent, 89 percent, 87 percent, 83 percent, and 79 percent acceptance at months 1, 2, 3, 6, and 9, respectively. Eighty-six percent returned rings displaying residual dapivirine levels consistent with some use in the prior month (>0.9 mg released).

A total of 35 women (about 0.02 percent) aquired HIV during the study, a statistic that fell below the expected incidence rate and included those who did not accept the ring.

These results strongly reinforce that HIV prevention modalities that don’t involve a daily pill burden are needed in places where individuals may not have easy access to health care — and seem an especially popular choice among women. And the HOPE findings support the dapivirine vaginal ring as a potential option.