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Meta-Analysis
. 2002;2002(4):CD003936.
doi: 10.1002/14651858.CD003936.

Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men

D Wilkinson  1 , G Ramjee, M Tholandi, G Rutherford
Affiliations
Meta-Analysis

Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men

D Wilkinson et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: There is a need for female-controlled methods of HIV prevention. Vaginal microbicides, substances inserted into the vagina to prevent women acquiring HIV and sexually transmitted infections (STIs) from men, could be useful in this regard. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9).

Objectives: To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of HIV infection by women from men.

Search strategy: Extensive searches of electronic databases, conference abstracts, reference lists of relevant studies and contact with experts and funders.

Selection criteria: Randomised controlled trials meeting pre-determined quality criteria with HIV infection as the outcome.

Data collection and analysis: Data were extracted by one reviewer and checked by the another. Any discrepancies were adjudicated by a third reviewer.

Main results: Five trials were included in the review and four contributed to a meta-analysis. Overall, the risk of HIV infection was not statistically significantly different among women receiving N-9 (relative risk [RR] 1.12, 95% CI 0.88-1.42; p=0.4). The risk of genital lesions was statistically significantly greater among women receiving N-9 (RR 1.18, 95%CI 1.02-1.36; p=0.02).

Reviewer's conclusions: There is no evidence that nonoxynol-9 protects against vaginal acquisition of HIV infection by women from men. There is evidence that it may do harm by increasing the frequency of genital lesions.

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Conflict of interest statement

Gita Ramjee was an investigator in one of the cited trials.

Figures

1.1
1.1. Analysis
Comparison 1 N‐9 vs placebo, Outcome 1 HIV infection.
1.2
1.2. Analysis
Comparison 1 N‐9 vs placebo, Outcome 2 Genital lesion.
See this image and copyright information in PMC

References

References to studies included in this review

Kreiss 1992 {published data only}
    1. Kreiss J, Ngugi E, Holmes KK, Ndinya‐Achola J, Waiyaki P, Roberts PL, Ruminjo I, Sajabi R, Kimata J, Fleming TR, Anzala A, Holton D, Plummer F. Efficacy of nonoxynol‐9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. JAMA 1992;268(4):477‐482. - PubMed
Roddy 1998 {published data only}
    1. Roddy RE, Zekeng L, Ryan KA, Tamoufe U, Weir SS, Wong EL. A controlled trial of nonoxynol‐9 film to reduce male to female transmission of sexualy transmitted diseases. New England Journal of Medicine 1998;339(8):504‐510. - PubMed
Roddy 2001 {published data only}
    1. Roddy RE, Zekeng L, Ryan KA, Tamoufe U, Tweedy KG. Nonoxynol‐9 provides no prophylaxis for urogenital gonorrhoea and chlamydial infection: randomised controlled trial. - PubMed
Van Damme 2001 {published data only}
    1. Van Damme. Effectiveness on HIV‐1 transmission of COL‐1492, a nonoxynol‐9 vaginal gel, among female sex workers.

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