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1. Dose finding study for on-demand HIV pre-exposure prophylaxis for insertive sex in sub-Saharan Africa: results from the CHAPS open label randomised controlled trialResearch in context

Author

Carolina Herrera, Jennifer Serwanga, Laura Else, Lebina Limakatso, Daniel Opoka, Andrew S. Ssemata, Azure-Dee Pillay, Patricia Namubiru, Thabiso B. Seiphetlo, Geoffrey Odoch, Susan Mugaba, Portia Seatlholo, Amara Alieu, Sujan Dilly Penchala, Richard Muhumuza, Berenice Alinde, Stefan Petkov, Kyle O'Hagan, Christian Callebaut, Janet Seeley, Helen Weiss, Saye Khoo, Francesca Chiodi, Clive M. Gray, Pontiano Kaleebu, Emily L. Webb, Neil Martinson, Julie Fox, Nadia Ahmed, Millicent Atujuna, Esther Awino, Linda-Gail Bekker, Mike Chirenje, Janan Dietrich, Jeffrey Dorfman, Clive Gray, Christian Holm Hansen, Stefanie Hornschuh, Ayoub Kakande, Charles Kelly, Mamkiri Khunwane, Limaktso Lebina, Joseph Makhura, Nomvuyo Mangxilana, Freddie Mukasa Kibengo, Gertrude Mutonyi, Lucia Mungate, Winnie Nabukeera, Rehema Nagawa, Phiona Nalubega, Stephen Nash, Denis Ndekezi, Teacler Nematadzira, Lumka Nobula, Jim Rooney, Elzette Rousseau, Eugene Ruzagira, Alison Sango, Ntombexolo Seatlholo, Thabiso Seiphetlo, Robin Shattock, Lynda Stranix-Chibanda, Gugulethu Tshabalala, and Emily Webb

Subjects
HIV-1, Foreskin, Oral PrEP, Adolescents, PK/PD, Tissue explants, Medicine, Medicine (General), R5-920
Abstract

Summary: Background: The efficacy of on-demand HIV pre-exposure prophylaxis (PrEP) for men in sub-Saharan Africa has not been evaluated, and the on-demand PrEP dosing requirement for insertive sex remains unknown. Methods: HIV-negative males 13–24 years, requesting voluntary medical male circumcision (VMMC), were enrolled into an open-label randomised controlled trial (NCT03986970), and randomised 1:1:1:1:1:1:1:1:1 to control arm or one of eight arms receiving emtricitabine-tenofovir disoproxil fumarate (F/TDF) or emtricitabine-tenofovir alafenamide (F/TAF) over one or two days, and circumcised 5 or 21 h thereafter. The primary outcome was foreskin p24 concentrations following ex vivo HIV-1BaL challenge. Secondary outcomes included peripheral blood mononuclear cell (PBMC) p24 concentration, and drug concentrations in foreskin tissue, PBMCs, plasma and foreskin CD4+/CD4-cells. In the control arm, post-exposure prophylaxis (PEP) activity of non-formulated tenofovir-emtricitabine (TFV-FTC) or TAF-FTC was assessed with ex vivo dosing 1, 24, 48 or 72 h post-HIV-1 challenge. Findings: 144 participants were analysed. PrEP with F/TDF or F/TAF prevented ex vivo infection of foreskins and PBMCs both 5 and 21 h after PrEP dosing. There was no difference between F/TDF and F/TAF (p24day15 geometric mean ratio 1.06, 95% confidence interval: 0.65–1.74). Additional ex vivo dosing did not further increase inhibition. In the control arm, PEP ex vivo dosing was effective up to 48 post-exposure diminishing thereafter, with TAF-FTC showing prolonged protection compared to TFV-FTC. Participants receiving F/TAF had higher TFV-DP concentrations in foreskin tissue and PBMCs compared with F/TDF, irrespective of dose and sampling interval; but F/TAF did not confer preferential TFV-DP distribution into foreskin HIV target cells. FTC-TP concentrations with both drug regimens were equivalent and ∼1 log higher than TFV-DP in foreskin. Interpretation: A double dose of either F/TDF or F/TAF given once either 5 or 21 h before ex vivo HIV-challenge provided protection across foreskin tissue. Further clinical evaluation of pre-coital PrEP for insertive sex is warranted. Funding: EDCTP2, Gilead Sciences, Vetenskapsrådet.

Published
2023
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2. Effects of cotrimoxazole on hematologic parameters in HIV-infected adults in a community-based clinic in Entebbe, Uganda

Author

George Miiro, Christine Watera, Juliet Mpendo, Jim Todd, James A. G. Whitworth, Heiner Grosskurth, Jessica Nakiyingi-Miiro, Peter Hughes, and Gertrude Mutonyi

Subjects
Adult, medicine.medical_specialty, Pediatrics, Anemia, Population, HIV Infections, Zidovudine, chemistry.chemical_compound, Hemoglobins, Leukocyte Count, Anti-Infective Agents, Hiv infected, Trimethoprim, Sulfamethoxazole Drug Combination, medicine, Humans, Pharmacology (medical), Uganda, Lymphocyte Count, Intensive care medicine, education, Community based, education.field_of_study, AIDS-Related Opportunistic Infections, business.industry, Platelet Count, medicine.disease, Blood Cell Count, CD4 Lymphocyte Count, Infectious Diseases, chemistry, Cohort, Antifolate, business, Malaria, medicine.drug
Abstract

We and others have previously reported reduced mortality and malaria incidence with cotrimoxazole prophylaxis for HIV-1-infected adults in Uganda and elsewhere. This evidence has led to widespread implementation of cotrimoxazole prophylaxis for HIV-1-infected persons in sub-Saharan Africa. The World Health Organization (WHO) recommends that implementation at the country level should be carefully monitored and that this monitoring should evaluate rates of toxicity including hematologic toxicity through the measurement of blood cell counts every 6 months. Cotrimoxazole interferes with folate metabolism and there have been several reports of hematologic abnormalities associated with its use. These abnormalities could potentially worsen if cotrimoxazole is used in conjunction with myelosuppressive or antifolate drugs such as zidovudine. There is scanty evidence of these abnormalities associated with cotrimoxazole use in Uganda however. Cotrimoxazole prophylaxis was introduced in August 2000 in an open cohort of HIV-1-infected participants in EntebbeUganda. Here we report hematologic changes in participants before and after the introduction of cotrimoxazole. (excerpt)

Published
2007

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