D U R B A N, South Africa, July 12, 2000 -- The widely used spermicidenonoxynol-9, long recommended as a way to stop the spread of AIDS,may actually increase the risk of catching the virus, at leastamong women who use it frequently, according to the surprisingfindings of a large study.
As a result, health officials said condoms used solely toprevent disease should not be coated with nonoxynol-9, although acondom with the spermicide is certainly safer than no condom atall. And they said the spermicide should also not be used for birthcontrol by anyone at high risk of catching HIV.
Nonoxynol-9 is widely used around the world for contraception,and about one-third of lubricated condoms sold in the United Statesare covered with it. Nonoxynol-9 is a detergent formulated to killsperm, but in the test tube it also wipes out HIV, and many havelong assumed it helps protect people from the virus.
However, a study on prostitutes released today at the 13thInternational AIDS Conference showed just the opposite: Women usinga nonoxynol-9 gel increased their risk of contracting HIV ratherthan lowering it.
“It is an understatement to say that we were extremelydisappointed,” said Dr. Lut Van Damme of the Institute of TropicalMedicine in Antwerp, the study’s director.
The researchers now assume that nonoxynol-9, or N-9, increasesthe risk by irritating the vaginal lining, causing tears that givethe virus a way to enter the body.
The prostitutes in the study applied N-9 up to 20 times a day,and there is no evidence that women who use it once or twice a dayincrease their risk of HIV. Nevertheless, Van Damme recommendedthat N-9’s long-term safety as a contraceptive be re-evaluated.
Study Used Almost 1,000 Prostitutes
The study began in 1996 on 990 prostitutes in South Africa,Benin, Thailand and Ivory Coast. They were randomly given either anN-9 gel called Advantage-S or a similar-looking but inactivevaginal moisturizer. The women were also urged to use condoms andgiven a free supply.
The study ended May 31, and the researchers were surprised bythe results. Fifteen percent of the women using the N-9 gel hadbecome infected with HIV, compared with 10 percent in thecomparison group.
“This convincingly shows this product is not a good idea in ahigh-risk population,” said Dr. Joseph Perriens, who headsmicrobicide research at UNAIDS. “If you use nonoxynol-9, you arewasting your money, and you may be wasting your life.”
Dr. Ann Duerr, HIV chief in the reproductive health division atthe U.S. Centers for Disease Control and Prevention, said theeffects of the low amounts of N-9 on condoms are unclear. But givena choice, people who want to protect themselves from HIV shouldselect those without the spermicide, even though condoms with thespermicide are safer than avoiding condoms entirely.
“For sexually transmitted disease prevention, ourrecommendation has been to use condoms with or withoutnonoxynol-9,” Duerr said. “Now it’s clear that N-9 does not addprotection and may be harmful.”
Advantage-S spermicide is sold in the United States and Chinaand manufactured by Columbia Laboratories of Miami. Howard Levine,its research director, said the company’s work shows the product issafe when applied up to four times a day. He attributed the study’sresults to the prostitutes’ high use.
Despite the widely held assumption that N-9 stops HIV, earlierresearch raised doubts. The most recent, a study of 1,170prostitutes in Cameroon, found a spermicide film did not preventinfection, although it offered no hint that it increased the risk,either. An earlier study found a higher infection rate in Kenyanprostitutes using an N-9 sponge, but the increase was notstatistically meaningful.
Van Damme said two other large studies involving an N-9 gelcalled Conceptrol, being done on non-prostitutes in Africa, mayhave to be stopped. The CDC said today it had halted a studyinvolving N-9 in Miami and Los Angeles.
Finding an HIV-killing lotion is a major goal of AIDS research,since it would offer an alternative to condoms. Several novelproducts are in early-stage human testing. Among these are PC-515and Pro2000, both derived from seaweed.
The Bill & Melinda Gates Foundation, started by the Microsoftfounder, said today it would donate $25 million to develop andtest products to prevent the spread of AIDS and other sexuallytransmitted diseases.