The report of a microbicide gel that actually protects against HIV infection made waves earlier this week. Now comes news that the same product — which is based on the antiretroviral drug tenofovir — also reduces a woman’s risk of contracting herpes simplex virus-2 (HSV-2).

In a paper published online in Science on Monday, Quarraisha and Salim Abdool Karim, along with their colleagues, reported that the vaginal gel cut HIV infection by 39% compared to placebo. And yesterday, the husband-and-wife team behind the 889-women South African trial announced at the International AIDS Conference in Vienna that, among the 426 women who were HSV-2-negative before the trial began, half as many participants using the gel became infected with herpes compared with those in the placebo arm of the study.

A precursor compound to tenofovir called adefovir currently exists to treat HSV-2 infection. But tenofovir, which blocks viral replication, is only approved for the treatment of HIV. Both drugs are marketed by Foster City, California-based Gilead Sciences.

Robert Grant, a clinical virologist at the University of California–San Francisco, applauded the study authors for thinking to check both HIV and HSV-2 infection levels in their study. “It goes to show that sometimes you learn unexpected things from well-designed science projects," he told ScienceNOW. “It’s a nice example of how prevention interventions can synergize with each other.”

When the AIDS epidemic first roared to life in the 1980s, the slow initial response of world governments to address the outbreak can, in part, be attributed to the stigma of its association with homosexuality. But now what was once derisively termed the “gay plague” is looking more and more like the “drug user plague”.

Outside of sub-Saharan Africa, where the AIDS virus is largely spread through heterosexual intercourse, one in every three new cases of HIV is contracted through the use of injectable drugs. In Central Asia and Eastern Europe, where the virus is spreading fastest, it’s estimated that drug users account for 80% of all HIV cases. And now, just as then, the stigma associated with its victims’ habits is costing lives.

To that end, the organizers of this year’s International AIDS Conference have made the reformation of global drug policy a major theme of discussion. The Vienna Declaration calls for governments and international organizations to decriminalize drug users, conduct aggressive reviews of the effectiveness of their drug policies, and offer more treatment options for this marginalized population.

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There’s an emerging consensus among AIDS experts that treating HIV earlier reduces mortality, slows the progression of AIDS and may even reduce transmission of the virus. But just how early that treatment should start depends on who you ask.

At the International AIDS Conference in Vienna today, the World Health Organization released new guidelines saying that antiretroviral therapy should be initiated when a patient’s CD4 cell count drops below 350 cells per microliter. The previous WHO standard, adopted in 2006, advised starting therapy when CD4 levels dropped below 200 cells per microliter. Earlier treatment, the WHO says, could reduce AIDS-related deaths by about 20% over the next five years.

The new guidelines, if adopted, would expand the number of people needing treatment to 15 million worldwide. The WHO estimates this increase will push costs for HIV treatment up to $9 billion in 2010. But the added expenditure could be offset by a decrease in hospital costs, since delaying treatment means patients will eventually require more expensive drugs as they become sicker.

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