Which and When?

One of the best talks of the conference was an attempt to synthesize much of the progress of the field. You might ask, "How complicated could this be?" The answer is -- "Pretty darn complicated." Let me give you a flavor.

There are at least six different classes of microbicides. Some of them, like Carraguard (the Council's candidate), are fusion inhibitors, which seek to physically block the virus from attaching to the woman's body. Others include using anti-retroviral therapy drugs (the drugs used to treat HIV at the moment). Still others are CCR5 Antagonists (which are also potential drugs to treat HIV), which basically block the entry of the disease at the cellular level (CCR5 is a co-receptor for the virus). There are several other areas being looked at, like cervical barriers, vaginal rings, and even using live bacteria.

Choosing the "right" microbicide will be like choosing a job from about 20 different offers. It will depend on your criteria, and -- by the way -- all of the offers will not come at the same time. Would you rather have a good job now, or the potential for a great job in two years? Switching jobs can be messy and expensive.

There are 5 microbicides in Phase III clinical trials right now, including Carraguard. But even we have 2nd generation microbicides being developed and tested for safety. If the first round produces three partially effective candidates (and we don't know how effective they will be, but they will likely not be 100% effective used on their own), which one would you choose? And would you invest in the development and production of one of them, or wait a year or two for something that might be more potent?