Comparative efficacy of topical microbicides in the prevention of HIV transmission – results from a systematic review and network meta-analysis

Abstract

Introduction and aim. Preventing new HIV infections is crucial, particularly for women and girls at high risk. Vaginal microbi cides offer a female-controlled HIV prevention method. This systematic review evaluated the comparative efficacy of topical microbicides in preventing HIV transmission. Material and methods. Electronic databases were searched up to May 2024 for randomized controlled trials (RCTs) comparing topical microbicides versus placebo/no treatment in sexually active women. The primary outcome was the incidence of HIV. A random effects network meta-analysis (NMA) was employed. Relative ranking was assessed using surface under the cumula tive ranking curve (SUCRA) probabilities. Analysis of literature. Thirteen RCTs were included in the review comparing the dapivirine ring, the tenofovir gel, BufferGel, PRO 2000, Carraguard, cellulose sulfate, or SAVVY against placebos. Compared to placebo, only dapivirine significantly reduced HIV incidence (risk ratio (RR) 0.71 [95% CI 0.56 to 0.91]). Dapivirine was superior to BufferGel (RR 0.61 [95% CI 0.39 to 0.94]) and SAVVY (RR 0.52 [95% CI 0.28 to 0.97]). Dapivirine ranked highest in efficacy (SUCRA=0.93), followed by tenofovir (SUCRA=0.76). In general, consistent network results with some small study effects. Conclusion. This study supports the use of the vaginal dapivirine ring for HIV prevention over SAVVY or BufferGel. More high-quality trials are needed to validate the efficacy of tenofovir gel.