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Safety and effectiveness of BufferGel and 0.5% PRO2000 gel for the prevention of HIV infection in women

Abdool Karim, Salim Sa,b; Richardson, Barbra Ac; Ramjee, Gitad; Hoffman, Irving Fe; Chirenje, Zvavahera Mf; Taha, Tahag; Kapina, Muzalah; Maslankowski, Lisai; Coletti, Annej; Profy, Albertk; Moench, Thomas Rl; Piwowar-Manning, Estellem; Mâsse, Benoîtn; Hillier, Sharon Lo; Soto-Torres, Lydiap; on behalf of the HIV Prevention Trials Network (HPTN) 035 Study Team

doi: 10.1097/QAD.0b013e32834541d9
Epidemiology and Social

Objective: To determine the safety and effectiveness of BufferGel and 0.5% PRO2000 microbicide gels for the prevention of male-to-female HIV transmission.

Design: Phase II/IIb, randomized, placebo-controlled trial with three double-blinded gel arms and an open-label no gel arm.

Methods: Study participants from Malawi, South Africa, Zambia, Zimbabwe, and the USA were instructed to apply study gel up to 1 h before each sex act and safety, sexual behavior, pregnancy, gel adherence, acceptability, and HIV serostatus were assessed during follow-up.

Results: The 3101 enrolled women were followed for an average of 20.4 months with 93.6% retention and 81.1% self-reported gel adherence. Adverse event rates were similar in all study arms. HIV incidence rates in the 0.5% PRO2000 gel, BufferGel, placebo gel, and no gel arms were 2.70, 4.14, 3.91, and 4.02 per 100 women-years, respectively. HIV incidence in the 0.5% PRO2000 gel arm was lower than the placebo gel arm (hazard ratio = 0.7, P = 0.10) and the no gel arm (hazard ratio = 0.67, P = 0.06). HIV incidence rates were similar in the BufferGel and both placebo gel (hazard ratio = 1.10, P = 0.63) and no gel control arms (hazard ratio = 1.05, P = 0.78). HIV incidence was similar in the placebo gel and no gel arms (hazard ratio = 0.97, P = 0.89).

Conclusion: The 0.5% PRO2000 gel demonstrated a modest 30% reduction in HIV acquisition in women. However, these results were not statistically significant and subsequent findings from the Microbicide Development Programme (MDP) 301 trial have confirmed that 0.5% PRO2000 gel has little or no protective effect. BufferGel did not alter the risk of HIV infection. Both products were well tolerated.

aCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa

bDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA

cDepartment of Biostatistics, University of Washington, Seattle, Washington, USA

dHIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa

eDivision of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA

fDepartment of Obstetrics and Gynecology College of Health Science, University of Zimbabwe, Harare, Zimbabwe

gBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

hCentre for Infectious Disease Research in Zambia, Lusaka, Zambia

iUniversity of Pennsylvania, Philadelphia, Pennsylvania, USA

jFamily Health International, Durham, North Carolina, USA

kPreclinical and Pharmaceutical Sciences, Endo Pharmaceuticals Solutions Inc., Lexington, Massachusetts, USA

lReProtect Inc., Baltimore, USA

mJohns Hopkins University, Baltimore, Maryland, USA

nUniversity of Montreal, Montreal, Quebec, Canada

oUniversity of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

pNational Institutes of Health, Bethesda, Maryland, USA.

Received 2 December, 2010

Revised 20 January, 2011

Accepted 1 February, 2011

Correspondence to Salim S. Abdool Karim, Centre for the AIDS Program of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella 4013, South Africa. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.