Common spermicide found to increase HIV risk

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Frequent Nonoxonyl-9 Use May Boost HIV Risk: Study

September 27, 2002 10:21 AM ET

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NEW YORK (Reuters Health) - Female prostitutes who use sexual lubricants containing the spermicide nonoxonyl-9 many times a day appear to have nearly double the risk of contracting HIV compared to those using lubricants without nonoxynol-9, new study findings suggest.

Nonoxynol-9 is a common ingredient in sexual lubricants, condoms and contraceptive products designed exclusively for vaginal use such as diaphragm jelly, contraceptive foams and creams.

While early studies suggested that nonoxynol-9 may thwart HIV transmission, new findings indicate that, in some cases, the opposite may be true.

In the current study, lead author Dr. Lut Van Damme and colleagues evaluated nonoxynol-9's ability to protect female prostitutes from HIV infection. The women worked as prostitutes in four different countries: South Africa, Ivory Coast, Benin and Thailand.

The researchers provided 376 female prostitutes lubricant containing nonoxynol-9 and 389 other female prostitutes sexual lubricant without the spermicide, according to the report published in September 28th issue of The Lancet. All of the women were also instructed to use condoms for every sexual act.

Overall, the team found that 59 of the women in the nonoxynol-9 group contracted HIV compared with 104 in the group having sex without it.

However, Van Damme, who is with the Institute of Tropical Medicine in Antwerp, Belgium, and colleagues found that women who reported using nonoxynol-9-containing lubricant about 3.5 times a day were nearly twice as likely to be infected with HIV than the women who used the lubricant without spermicide.

The investigators believe that overuse of the spermicide caused the women to develop lesions in their vaginas that left them more vulnerable to infection with HIV.

This study did not show a protective effect of lubricant containing nonoxynol-9 on HIV transmission in high-risk women, the authors conclude.

"Multiple use of nonoxynol-9 could cause toxic effects enhancing HIV infection," Van Damme and colleagues add.

Commenting on the findings in an accompanying editorial, David Wilkinson of the University of South Australia writes: "It is vitally important that the global effort to develop an effective vaginal microbicide that reduces the risk of acquisition of HIV (and preferably other sexually acquired infections) among women does not lose any momentum as a result of the negative results of the Van Damme trial and the systematic review."

On Thursday, the Global Campaign for Microbicides issued a warning that rectal use of nonoxynol-9 may also boost HIV infection risk. The World Health Organization and the US Centers for Disease Control and Prevention also recently advised that the spermicide should not be used to prevent HIV or other sexually transmitted diseases, because it is ineffective for this purpose.

SOURCE: The Lancet 2002;360:971-977, 962-963.