Dapivirine Vaginal Ring for HIV-1 Prevention

Abstract

To the Editor: The Microbicide Trials Network 020–A Study to Prevent Infection with a Ring for Extended use (MTN-020–ASPIRE) reported by Baeten et al. (Dec. 1 issue)1 does not take into consideration the possible effect of vaginal microbicides on the normal cervicovaginal mucus. It is now accepted that normal cervicovaginal mucus that is rich in hydrogen peroxide–producing lactobacilli, especially Lactobacillus crispatus, is capable of biochemically disabling the human immunodeficiency virus (HIV) and other sexually transmitted pathogens and preventing their access to the cervicovaginal epithelium. This property would be lost if the lactobacillus population was effectively eliminated by the microbicides used . . .