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Expanding the pipeline for multipurpose prevention technologies: compounds with potential activity to prevent or treat HIV and other STIs
  1. Bethany Young Holt1,
  2. Anke Hemmerling2,
  3. Susanna Moore1,
  4. Katherine Yang3
  1. 1 CAMI Health, Public Health Institute, Oakland, California, USA
  2. 2 Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, USA
  3. 3 Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
  1. Correspondence to Dr Katherine Yang; katherine.yang2{at}


Background Continued high incidence of HIV and other STIs, paired with rising antibiotic resistance to a number of existing treatments, warrants the development of new pharmaceutical approaches for STI prevention. Multipurpose prevention technologies (MPTs) offer an innovative approach for expanding HIV/STI prevention. The majority of MPT product candidates currently in development include HIV prevention, while only half include compounds active against non-HIV STIs.

Methods This narrative review focuses on compounds in preclinical development (in vitro and in vivo) through phase 3 clinical trials with activity against one or more of the following infections: HIV, HSV-1, HSV-2, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and Trichomonas vaginalis. Bacterial vaginosis is included due to its association with increased risk of STIs. The focus is on compounds with novel mechanisms of action and prophylactic and/or therapeutic potential. Articles published in PubMed between 2011 and 2021, NIH RePorter and conference abstracts and proceedings between 2020 and 2021 were searched. Excluded from the review are compounds that are already being used in MPT product candidates.

Main results There is a growing pipeline of compounds targeting viral STIs, many of which have successfully transitioned from preclinical to clinical stages of development. However, the product development pipeline remains limited for compounds that target bacterial STIs.

Conclusions The paucity of new pharmaceutical approaches for STI prevention, particularly non-HIV STIs, remains a public health gap. Future funding priorities should include STI prevention research. Despite limited attention to STI prevention in the development of MPTs, many research institutions worldwide are working on discoveries of new compounds, exploring new indications for existing drugs or on innovative drug delivery mechanisms. Our findings can be used to connect researchers across the globe to advance the development of compounds that have potential as active pharmaceutical ingredients in future MPTs.

  • HIV
  • AIDS
  • Chalmydia Trachomatis
  • Gonorrhea

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  • Handling editor Ming Jie Lee

  • Twitter @bethany young holt

  • Contributors BYH conceived the idea for this paper as it was identified as a priority action area identified in manuscript by AH and BYH. KY was lead in framing the search criteria implemented by coauthors. All authors contributed to the search/review, writing of the manuscript and discussion of reviewer feedback.

  • Funding This work was made possible by the generous support of the National Institutes of Health (NIH) through contract #75N94021P00910. The contents of this manuscript are the sole responsibility of the IMPT, CAMI Health, PHI and its partners and do not necessarily reflect the views of NIH or the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.