This is a double-blinded, randomized, safety, acceptability, pharmacokinetic, and ex vivo efficacy study of three rectally-applied tenofovir-based microbicide formulations. Approximately 18 total evaluable HIV-negative men and women (\~9 per site) will be enrolled across two study sites: University of California at Los Angeles (UCLA) and Magee-Womens Research Institute (MWRI) at University of Pittsburgh. Each participant will experience seven rectal exposures to the rectal-specific formulation (RF) and seven rectal exposures to the reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gel, but only one exposure to the vaginal formulation (VF), which will be coupled with six preceding exposures to the Universal HEC Placebo Gel to balance out the VF study stage. Participant accrual will take approximately 6 months and each participant will be on study for approximately 3 months. The total duration of the study will be approximately 1 year. The primary objectives of the study are safety, acceptability, and pharmacokinetics, specifically: * To evaluate the safety of each tenofovir-based microbicide gel formulation when applied rectally * To evaluate the acceptability of each tenofovir-based microbicide gel formulation when applied rectally * To compare systemic and compartment pharmacokinetics among the three tenofovir-based microbicide gel formulations when applied rectally Secondary objective of the study is to evaluate the mucosal immunotoxicity of each tenofovir-based microbicide gel formulation when applied rectally. And the exploratory objective of the study is to assess the preliminary (ex vivo) efficacy of each tenofovir-based microbicide gel formulation using biopsy explants after each product is applied rectally.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
13
The RF is a translucent colorless viscous gel formulation containing 1% (w/w) of tenofovir (PMPA) formulated in purified water with EDTA, glycerin, methylparaben, propylparaben, carbopol, sodium carboxy methyl cellulose, and pH adjusted to 7. The RF is close to isoosmolar with an osmolality of 479 mOsmol/kg. Seven doses of this formulation will be used.
The original VF is a transparent, viscous gel formulation containing 1% (weight/weight) of tenofovir (PMPA, 9-\[(R)-2-(phosphonomethoxy) propyl\]adenine monohydrate), formulated in purified water with edetate disodium, citric acid, glycerin, methylparaben, propylparaben, hydroxyethylcellulose, and pH adjusted to 4-5. One dose of this formulation will be used, with 6 doses of the HEC placebo gel preceding it to balance out this study stage. The reduced glycerin formulation (RGVF) is a modification of the original VF - it has lower glycerin content than the VF and a significantly reduced osmolality (836 or 846 versus 3111 mOsmol/kg). Lowering the glycerin content lowered the viscosity, so the HEC concentration was increased by 10% (a change considered to be insignificant). The amount of parabens was increased by 10% each to improve the antimicrobial effectiveness. The RGVF formulation has since been modified to increase the viscosity. Seven doses of RGVF will be used in this study.
The Universal HEC Placebo Gel contains hydroxyethylcellulose as the gelling agent, purified water, sodium chloride, sorbic acid and sodium hydroxide. The gel is isotonic and formulated at a pH of 4.4 to avoid disrupting the normal vaginal pH and has minimal buffering capacity to avoid the inactivation of sexually transmitted pathogens. Hydroxyethylcellulose is used to approximate the viscosity of microbicide gel candidates. Each pre-filled applicator will deliver approximately 4 mL of HEC placebo gel. Six doses of this gel will be used to balance out the VF stage of the study.
UCLA Center for Prevention Research
Los Angeles, California, United States
Magee/University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Occurrence of adverse events and/or abnormal laboratory values Grade 2 or higher
Grade 2 or higher clinical and laboratory adverse events as defined by the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0, Dec 2004 and Addenda 1 and 3 (Female Genital and Rectal Grading Tables for Use in Microbicide Studies) will be used to assess safety.
Time frame: Participants will be followed for the duration of study, an expected average of 12 weeks
Proportion of participants reporting product characteristics as barriers in use
We will calculate the proportion of participants who report product characteristics to be considered a barrier in use, operationalized as having a rating of lower than 3 on a 5-point Likert scale, in disliking or likelihood of future barrier in use. The phone interviews will be audio-taped, transcribed, and analyzed for content. In this process, we will be able to integrate the qualitative data to gain insights about the quantitative responses.
Time frame: 24 hours post seventh dose administration of each study product
Area Under Curve (AUC)
Tenofovir concentrations will be measured via: * Plasma * PBMC (intracellular) * Rectal fluid * Vaginal fluid, in female participants * Rectal mucosal tissue homogenates * Rectal MMC Tenofovir diphosphate concentrations will be measured via: * PBMC * Rectal mucosal tissue homogenates * Rectal MMC
Time frame: 30 min, 2hr, 4hr, and 24hr post-dose at Visits 4, 5, 7, 8, 10, and 11
Changes in rectal microflora
Microflora measures will be graded on a 0 to 4 ordinal scale and recorded at baseline and post-exposure. Depending on the empirical distributions across the points in this scale, statistical procedures will either involve analysis of the actual pre-post differences (ordinal) or dichotomized versions of the pre and post scores (binary).
Time frame: 30 min before first dose and 24 hr after seventh dose of each study gel
Changes in cytokine levels in rectal secretions
Comparisons will be used to examine whether (i) there is an overall change in cytokine levels before/after (24 hours) each product exposure and (ii) whether the study products differ significantly from each other in pre-post change.
Time frame: 30 min before first dose, 30 min before seventh dose, and 24 hr after seventh dose of each study gel
Changes in rectal histology
Examination of two point (normal versus abnormal) or three point (normal, slightly abnormal, abnormal) scales will be undertaken. As above, comparisons will be used to examine whether (i) there is an overall change in histology scores before/after (24 hours) each product exposure and (ii) whether the study products differ significantly from each other in pre-post change.
Time frame: 30 min post seventh dose of each study gel
Changes in rectal tissue CD4 cell phenotype
comparisons will be used to examine whether (i) there is an overall change in cell populations before/after (24 hours) each product exposure and (ii) whether the study products differ significantly from each other in pre-post change.
Time frame: 30 min post seventh dose of each study gel
Changes in intestinal mucosal cytokine mRNA levels
mRNA levels will be used to evaluate stability (intra-subject correlations) and clinically meaningful differences between treatment groups.
Time frame: 30 min post administration of seventh dose each study gel
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