The Pharmaceutical Journal
Vol 269 No 7218 p474
5 October 2002

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The Lancet (www.thelancet.com)

Frequent use of spermicide could increase risk of HIV in prostitutes

An over-the-counter spermicidal gel, previously suggested as a preventive agent against HIV, has been shown to increase the risk of infection in a randomised trial (Lancet 2002;360:971).

Dutch researchers found that women who used nonoxynol-9-based spermicide gel more than three-and-a-half times a day on average ran twice the risk of HIV-1 infection compared with women who used a placebo gel (P=0.03). The results contradict in vitro studies, which have shown that nonoxynol-9-based spermicide has anti-HIV-1 activity.

The study involved 765 HIV-negative prostitutes from South Africa, the Ivory Coast, Benin and Thailand. Approximately half the women were given nonoxynol-9-based spermicide gel, the other half placebo. The researchers found that 16 per cent of nonoxynol-9 users contracted HIV-1, compared with 12 per cent of women using placebo gel (P=0.047). A third of the women used more than three-and-a-half applications of spermicide per day. But among those who used it less frequently, the risk of HIV-1 infection did not differ between those using nonoxynol-9-based gel and those using placebo. There was also no difference in the risk of gonorrhoea or chlamydia infection between the two groups.

The researchers conclude that nonoxynol-9 has an adverse effect on vaginal integrity when used frequently, which increasing a woman's susceptibility to HIV-1 infection.

Dr Lut Van Damme, from the Institute of Tropical Medicine in Antwerp, Brussels, commented: "Nonoxynol-9 no longer has a part to play in HIV-1 prevention. Our data show that low frequency use of nonoxynol-9 causes neither harm nor benefit, but that frequent use increases a woman's risk of HIV-1 infection by causing lesions."