This multi-center Phase I study is designed to characterize the safety, PK, and PD of TFV/LNG IVR to assess systemic and genital tract bioavailability in healthy women. The IVRs to be used in the study are TFV/LNG IVR (8-10mg per day/20μg per day) or placebo IVR. Samples will be obtained before, during and after 90 days of continuous or interrupted IVR use.
The purpose of this multi-center Phase I protocol, titled Phase I, 90-Day Safety, Pharmacokinetic, and Pharmacodynamic Study of Intravaginal Rings Releasing Tenofovir and Levonorgestrel is to assess the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of the Tenofovir/Levonorgestrel Intravaginal Ring (TFV/LNG IVR). The study will enroll healthy, non-pregnant, ovulatory, HIV-uninfected women aged 18 to 50 with a body mass index (BMI) less than 30 kg/m2, regular menstrual cycles (approximately 26-35 days) by participant report, and willing to use non-spermicidal condoms for sex and follow other study restrictions. Women will be protected from pregnancy by abstinence from vaginal intercourse or agreeing to consistently use condoms. The enrollment goal is for approximately 60 participants to complete the study. A subset of approximately 20 women will be selected for an in-depth interview to take place during the first month of IVR use and again after 90 days of use. Women will be randomized to one of four arms: TFV/LNG IVR (8-10mg per day/20μg per day) for 90 days (Continuous), TFV/LNG IVR (8-10mg per day/20μg per day) for 3x28 days (Interrupted), placebo IVR for 90 days (Continuous), or placebo IVR for 3x28 days (Interrupted) and will undergo blood, cervicovaginal and rectal fluid sample collections, and cervicovaginal tissue collections for PK and PD assessments before, during and after 90 days of continuous or interrupted IVR use.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
66
Used for 90 days (Continuous or Interrupted)
Used for 90 days (Continuous or Interrupted)
Eastern Virginia Medical School
Norfolk, Virginia, United States
Profamilia
Santo Domingo, Dominican Republic
Percentage of women with Treatment-emergent adverse events
Treatment-emergent adverse events (TEAEs)
Time frame: Day 90
Changes in systemic laboratory values
Systemic laboratory values
Time frame: Change from Baseline at Day 90
Changes in cervicovaginal mucosa by visual inspection
Mucosal safety
Time frame: Change from Baseline at Day 90
Changes in soluble markers
Soluble markers in cervicovaginal fluid
Time frame: Change from Baseline at Day 90
Changes in inflammatory markers in cervicovaginal tissue
Inflammatory markers in cervicovaginal tissue
Time frame: Change from Baseline at Day 90
Changes in endogenous vaginal bacteria
Endogenous vaginal bacteria in cervicovaginal fluid
Time frame: Change from Baseline at Day 90
Microbial growth
Microbial growth on returned IVRs
Time frame: Day 90
Maximum Plasma Concentrations [Cmax]
Maximum Plasma Concentrations \[Cmax\] of TFV and LNG
Time frame: Baseline, 8 hours post-IVR insertion, Day 2 or 3 or 4 (randomized time point), 10, 21, 28, 32, 42, 53, 59, 63, 73, 84, 90; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
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Maximum CV Fluid Concentrations
Maximum CV Fluid Concentrations of TFV
Time frame: 2 and 8 hours post-IVR insertion, Day 2 or 3 or 4 (randomized time point), 10, 21, 32, 42, 53, 63, 73, 84; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Maximum Rectal Fluid Concentrations
Maximum Rectal Fluid Concentrations of TFV
Time frame: Day 2 or 3 or 4 (randomized time point), 21, 53, 84; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Maximum CV Tissue Concentrations
Maximum CV Tissue Concentrations of TFV
Time frame: Changes from baseline at day 90; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Maximum CV Tissue Metabolite Concentrations
Maximum CV Tissue Concentrations of TFV-DP
Time frame: Changes from baseline at day 90; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Maximum Serum Concentrations of LNG
Maximum Serum Concentrations of LNG
Time frame: Baseline, 1, 2, 4, and 8 hours post-IVR insertion, Day 2 or 3 or 4 (randomized time point), 10, 21, 28, 32, 42, 53, 59, 63, 73, 84, 90; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Residual Drug Concentrations
Residual drug (TFV and LNG) in returned IVRs
Time frame: Day 90
Surrogates of contraceptive efficacy of Mucus
Surrogates of contraceptive efficacy: Cervical mucus assessment (Cervical mucus quality \[score of \>10\])
Time frame: Day 30
Surrogates of contraceptive efficacy of Sperm
Surrogates of contraceptive efficacy: Cervical mucus assessment (Sperm migration on the Simplified Slide test)
Time frame: Day 30
Ovulation
Ovulation by serum progesterone (P4)
Time frame: Changes from baseline at day 90
Follicular Development
Effect on follicular development by serum estradiol concentration
Time frame: Changes from baseline at day 90
Antiviral activity in CV Fluid--HIV
Anti-HIV-1 activity in CV fluid
Time frame: Changes from baseline at day 90
Antiviral activity in CV Fluid--HSV-2
Anti-HSV-2 activity in CV fluid
Time frame: Changes from baseline at day 90
Changes in Antiviral Activity
Comparison of HIV-1 ex vivo infection in CV tissue (EVMS only) at baseline and after 90 days of IVR use
Time frame: Changes from baseline at day 90
Bleeding Patterns
Participant self-report of bleeding
Time frame: Baseline through Day 90 of IVR use
Forgiveness--LNG
Decay of LNG during 3-day periods of non-use in interrupted regimen, and after 90 days of IVR use
Time frame: Day 32 and 63; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Forgiveness--TFV
Decay of TFV during 3-day periods of non-use in interrupted regimen, and after 90 days of IVR use
Time frame: Day 32 and 63; and 48 or 72 hours or 5 days after IVR removal (randomized time point)
Acceptability--Qualitative
Responses to key questions on acceptability and psychosocial questionnaire(s) (all participants), and feedback during in-depth interviews (subset of participants)
Time frame: Baseline, Day 28 and 90
Acceptability--IDI
Responses to key questions on acceptability and psychosocial questionnaire(s) (all participants), and feedback during in-depth interviews (subset of participants)
Time frame: During first month of IVR use and Day 90
Adherence
Percentage of participants with Discontinuations/Expulsions/Removals by self-report
Time frame: Baseline, Day 28 and 90