[pronut-hiv] Why women should NOT use Lemon or Lime Juice as a microbicide

["ProNut-HIV" <pronut-hiv@healthnet.org>]

[PMTCTforum] Why women should NOT use Lemon or Lime Juice as a
microbicide 

 Some people say that women can use lime or lemon juice to protect
themselves from HIV. Is that true?

  No. Women in many cultures have used lemon or 
lime juice for contraception and vaginal hygiene
  purposes for centuries. Studies in Nigeria and 
elsewhere show that some women also believe that 
lemon
  and lime juice might help protect them from HIV 
infection. New research findings, however, 
demonstrate
  that rather than helping, these juices can 
cause damage that could make it easier for HIV to 
enter the
  body. Washing out the vagina with either 100% 
or diluted lime or lemon juice may increase a 
woman's
  risk of getting infected with HIV if her 
partner is HIV positive.
   
What research shows that lime or lemon juice in the vagina could
increase HIV risk?

  Three studies have shown this.
  Dr. Christine Mauck of CONRAD did a study 
enrolling 48 sexually abstinent women volunteers. She
  divided the women into four groups: those using 
100% lime juice ("neat" juice with no water), 50% 
(half
  water, half juice), 25% (one part water, three 
parts juice) and one group using plain water. 
Each group
  inserted their assigned test fluid twice daily 
for six consecutive days during two menstrual 
cycles. In one
  cycle, it was inserted via a douche and, in the 
other, via a modified tampon soaked in lime 
juice.
  All the women were carefully checked for 
vaginal infections, irritation and other problems 
before and
  after the study and were treated for any 
problems they had. The result showed that some women 
got small
  but serious abrasions (injuries) in the walls 
of their vaginas after using 50% and 100% lime 
juice. The
  women who used 25% juice or plain water didn't 
get these abrasions. So the juice had a 
dose-dependent
  effect - meaning the likelihood of damage 
increases as the concentration of juice increases. 
Among the
  women using 100% lime juice with no water, more 
than 65% experienced genital irritation, 50%
  experienced deep epithelial abrasions and more 
than 70% reported experiencing pain.
   
  Carol Lackman-Smith of the Southern Research 
Institute did a laboratory study comparing the
  cytotoxicity (cell-damaging effect) and 
anti-HIV activity of lemon and lime juice to that of the 
spermicide
  nonoxynol-9 (N-9). She tested these three 
substances on cervical explant tissue (human cells 
obtained from routine hysterectomies and kept alive 
in lab cultures) to find out what impact they 
might have on the
  same kinds of cells in the human body. She 
found the amount of cell damage caused by lemon and 
lime
  juice was similar to the damage caused by N-9, 
a product dropped from consideration as a 
microbicide in
  2000 when it was shown capable of increasing 
women's vulnerability to HIV infection if used 
frequently.
   
  Lackman-Smith also looked at how much lemon or 
lime juice was needed to stop HIV and found that 
it
  was the same concentration (50% or greater) 
that also caused cell damage. She concluded that, 
when the
  juice is diluted to a point where no cell 
damage occurred, it also had little or no effect on 
HIV.
   
  Robin Shattock (at St. George's Hospital, 
London) and Gustavo Doncel (CONRAD) also did lab 
studies
  on lemon and lime juice. Dr. Shattock showed 
that lime juice inactivates HIV more effectively 
than lemon
  juice. He also showed that a 25% concentration 
of lime juice could cause cell damage in tissue 
samples
  from the penis. Dr. Doncel showed that even a 
25% concentration could damage vaginal cells. Both
  found that, to inactivate HIV in semen, one had 
to expose it to a 50% concentration of lime juice 
for 30
  minutes.

  So what does all this research mean?

  This research suggests that, in real life use 
(in the vagina along with semen), a 50% 
concentration of lime
  juice is needed to stop HIV. BUT a 
concentration of 50% or higher is also likely to cause damage 
to the
  vagina - and possibly the penis. This damage 
could make it easier for HIV infection to occur.
  Therefore, as the Economist magazine wrote on 
29 April, 2006, "as a microbicide, lime juice is 
safe
  when it is ineffective and effective when it is 
unsafe."
   
What messages should we be giving to women about lime and lemon juice?
   
  Using lime or lemon juice to try to protect 
against HIV is risky, and may actually increase a 
woman's risk
  of becoming infected. Scientific studies show 
that lime and lemon juice do not meet the 
standards of
  safety and effectiveness (clinical trials) that 
must be required of any microbicide.
  Even though they are natural substances and 
readily available in many places, they are more 
likely to
  increase a woman's risk of becoming infected 
than to decrease it. We must caution women against 
using
  these juices just as we now caution them 
against using N-9 for HIV prevention - because it 
doesn't work.

  Are "natural" microbicides even possible?

  Dozens of other candidate microbicides are 
currently in the research pipeline, including several 
derived
  from "natural substances" such seaweed or the 
oil of the Indian Neem Tree. But all potential
  microbicides-whether derived from naturally 
occurring substances or manufactured ones-have to go
  through a rigorous testing process to find out 
whether they are safe for women to use and 
whether they
  work. One of these is Carraguard, a product 
made from the seaweed gel carrageenan. It has been 
proven
  to be safe for vaginal use and is now in 
large-scale effectiveness trials in South Africa to see 
if it reduces
  HIV transmission.
  Just because something is natural doesn't mean 
it is safe. It is not advisable to use an 
available, natural
  product in the hope that it may protect you or 
because someone tells you that it works. If it 
turns out to be
  unsafe - as lime and lemon juice have - using 
it could actually increase your risk of getting 
HIV.
   
When will the first proven microbicides become available?

  More than two-dozen product leads are now being 
tested to see which are safe and effective for 
regular
  use. Five of these are in large-scale 
effectiveness trials to see if they actually reduce HIV 
risk when used.
  If one of the five is effective, a microbicide 
could be ready for distribution in a handful of 
countries by the
  end of 2010.(1)
  If none of them work, we will continue to wait 
as the next wave of candidates, those now being 
tested for
  safety, goes through effectiveness testing. 
While this research is going on, the microbicide 
community is
  working hard to accelerate development and 
ensure that a safe, effective product - once proven - 
gets into
  the hands of all who need it as quickly as 
possible.
   
  Global Campaign for Microbicides. June 2006. 
Reproduction encouraged.
  For info contact: info@global-campaign.org 
  Updates available at: 
www.global-campaign.org/download.htm 
   
  (1) Results from the trials furthest along could 
become available in late 2007 or 2008, but it 
will take additional time for the products to be 
reviewed and approved for licensure.