High Use and Adherence Seen With Dapivirine Vaginal Ring for HIV Prevention

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Of 1407 enrollees, 92% accepted the dapivirine vaginal ring and 89% of returned rings had residual dapivirine levels consistent with some use during the prior month.
Of 1407 enrollees, 92% accepted the dapivirine vaginal ring and 89% of returned rings had residual dapivirine levels consistent with some use during the prior month.

A silicon, vaginal ring infused with the anti-HIV drug dapivirine has been used "at least some of the time" in 89% of women who were given the option in a follow-up trial. The results were announced as part of preliminary findings from the phase 3b HOPE trial at CROI 2018, held March 4-7 in Boston, Massachusetts.1

The HOPE trial is a follow-up to the ASPIRE trial (ClinicalTrials.gov identifier: NCT01617096), which demonstrated that usage of the dapivirine-containing vaginal ring reduced the risk of HIV infection by 27%.2 An exploratory analysis of ASPIRE found that the ring reduced the risk of HIV infection by at least 56% in those women who used it "most or all of the time." The HOPE trial aims to further investigate the protection conferred by the ring in relation to patient adherence. 

Over 1400 women who participated in ASPIRE enrolled in HOPE; study patients were sexually active, HIV-negative women aged 20 to 49 years. They are being offered the dapivirine ring for a month at a time for up to 12 consecutive months. During the first 3 months, the women attend monthly study visits where they may obtain a new ring. They then attend quarterly visits where they may receive 3 rings at a time. 

Through this, researchers are able to measure patient acceptance, patient satisfaction, and factors affecting adherence and nonadherence. Residual levels of dapivirine in returned rings and blood levels of dapivirine are being assessed to quantify adherence.

As of October 2017 — the cut off date for interim analysis — 89% of the rings returned had residual dapivirine levels consistent with some use in the prior month. This level of some use in the prior month was ~16% greater than that seen in the ASPIRE trial. Moreover, the rate of study participants developing a new HIV infection was 1.9 per 100 person-years of follow-up. For ASPIRE participants receiving placebo, a mathematical model showed an average HIV incidence of 4.1 new infections per 100 person-years —  approximately twice the rate seen in the new HOPE interim analysis.

"Interim data from the HOPE open-label extension study appear to be sending a positive signal about the desirability of the anti-HIV vaginal ring in a setting more like the real world than previous trials," said Carl W. Dieffenbach, PhD, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases.3

References

  1. Baeten JM, Palanee-Phillips T, Mgodi N, et al. High uptake and reduced HIV-1 incidence in an open-label trial of the dapivirine vaginal ring. Presented at: CROI 2018. Boston, MA; March 4-7, 2018. Abstract 143LB.
  2. Baeten JM, Palanee-Phillips T, Brown ER, et al; MTN-020–ASPIRE Study Team. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375:2121-2132.
  3. High uptake and use of vaginal ring for HIV prevention observed in open-label study [news release]. Bethesda, MD: National Institute of Allergy and Infectious Diseases. Published March 6, 2018. Accessed March 8, 2018.
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