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Gupta N, Swindells S, Scarsi KK, Furl R, Thomas DL, Weld ED, Ofimboudem JD, Desalegn H, Hamid S, Rosas ADLT, Miranda AE, Owen A, Rannard S, Hiebert L, Sun K, Ward JW. Preferences and feasibility of long-acting technologies for treatment of hepatitis C virus in low- and middle-income countries: A survey of providers and policymakers. J Viral Hepat 2024; 31:221-232. [PMID: 38545826 DOI: 10.1111/jvh.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 04/18/2024]
Abstract
Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among providers, 93% (113/122) expressed willingness to prescribe LAT and 72% (88/120) of providers preferred LAT if provided at comparable efficacy, safety and cost as current oral treatments. Of providers preferring HCV LAT to daily oral medication, 67% (59/88) preferred injection, 24% (21/88) preferred patch and 9% (8/88) preferred implant. Only 20% (24/122) would prescribe LAT if it were more costly than oral treatment. In regression analysis, no provider characteristics were associated with preference for LAT over oral treatment. Policymakers reported high likelihood that LAT would be included in treatment guidelines (42/50; 84%) and national drug formularies (39/50; 78%) if efficacy, safety and cost were similar to oral treatment. HCV LATs could advance progress to HCV elimination in LMICs by diversifying treatment options to improve treatment coverage and outcomes. Provider preferences from LMICs are a critical consideration in the development of HCV LATs to ensure its early and equitable availability in LMICs.
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Affiliation(s)
- Neil Gupta
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Susan Swindells
- Section of Infectious Diseases, Department of Internal Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Renae Furl
- Section of Infectious Diseases, Department of Internal Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - David L Thomas
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethel D Weld
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Clinical Pharmacology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Saeed Hamid
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Angelica E Miranda
- Post-Graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Steve Rannard
- Department of Chemistry, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Katherine Sun
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
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2
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Weld ED, McGowan I, Anton P, Fuchs EJ, Ho K, Carballo-Dieguez A, Rohan LC, Giguere R, Brand R, Edick S, Bakshi RP, Parsons T, Manohar M, Seigel A, Engstrom J, Elliott J, Jacobson C, Bagia C, Wang L, Al-khouja A, Hartman DJ, Bumpus NN, Spiegel HML, Marzinke MA, Hendrix CW. Tenofovir Douche as HIV Preexposure Prophylaxis for Receptive Anal Intercourse: Safety, Acceptability, Pharmacokinetics, and Pharmacodynamics (DREAM 01). J Infect Dis 2024; 229:1131-1140. [PMID: 38019657 PMCID: PMC11011183 DOI: 10.1093/infdis/jiad535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Despite highly effective HIV preexposure prophylaxis (PrEP) options, no options provide on-demand, nonsystemic, behaviorally congruent PrEP that many desire. A tenofovir-medicated rectal douche before receptive anal intercourse may provide this option. METHODS Three tenofovir rectal douches-220 mg iso-osmolar product A, 660 mg iso-osmolar product B, and 660 mg hypo-osmolar product C-were studied in 21 HIV-negative men who have sex with men. We sampled blood and colorectal tissue to assess safety, acceptability, pharmacokinetics, and pharmacodynamics. RESULTS The douches had high acceptability without toxicity. Median plasma tenofovir peak concentrations for all products were several-fold below trough concentrations associated with oral tenofovir disoproxil fumarate (TDF). Median colon tissue mucosal mononuclear cell (MMC) tenofovir-diphosphate concentrations exceeded target concentrations from 1 hour through 3 to 7 days after dosing. For 6-7 days after a single product C dose, MMC tenofovir-diphosphate exceeded concentrations expected with steady-state oral TDF 300 mg on-demand 2-1-1 dosing. Compared to predrug baseline, HIV replication after ex vivo colon tissue HIV challenge demonstrated a concentration-response relationship with 1.9 log10 maximal effect. CONCLUSIONS All 3 tenofovir douches achieved tissue tenofovir-diphosphate concentrations and colorectal antiviral effect exceeding oral TDF and with lower systemic tenofovir. Tenofovir douches may provide a single-dose, on-demand, behaviorally congruent PrEP option, and warrant continued development. Clinical Trials Registration . NCT02750540.
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Affiliation(s)
- Ethel D Weld
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Orion Biotechnology, Ottawa, Ontario, Canada
| | - Peter Anton
- Division of Gastroenterology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies, Columbia University and NewYork State Psychiatric Institute, New York, New York, USA
| | - Lisa C Rohan
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Columbia University and NewYork State Psychiatric Institute, New York, New York, USA
| | - Rhonda Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Stacey Edick
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rahul P Bakshi
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Parsons
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madhuri Manohar
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Seigel
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Jared Engstrom
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Elliott
- Division of Gastroenterology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Cindy Jacobson
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Christina Bagia
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Lin Wang
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Amer Al-khouja
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Namandje N Bumpus
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans M L Spiegel
- Kelly Government Solutions, Contractor to Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Mark A Marzinke
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Weld ED, Parsons TL, Gollings R, McCauley M, Grinsztejn B, Landovitz RJ, Marzinke MA. Development and validation of a liquid chromatographic-tandem mass spectrometric assay for the quantification of cabotegravir and rilpivirine from dried blood spots. J Pharm Biomed Anal 2023; 228:115307. [PMID: 36842333 PMCID: PMC10065945 DOI: 10.1016/j.jpba.2023.115307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Dried blood spots (DBS) have been utilized as a blood plasma alternative for therapeutic drug monitoring and pharmacologic analysis. There are analytical and physiochemical considerations in bridging drug concentrations from plasma to DBS. Recently, the long-acting antiretroviral cabotegravir (CAB) has been approved for HIV prevention, and a co-packaged regimen of long-acting CAB and rilpivirine (RPV) has been approved for HIV treatment. Measurement of these drugs in blood collected as DBS may offer increased capacity and flexibility in translational applications. METHODS Whole blood was spiked with CAB and RPV and spotted on DBS cards. Following extraction and addition of isotopically labeled internal standards, samples were subjected to liquid chromatographic-tandem mass spectrometric (LC-MS/MS) analysis. The method was validated according to regulatory recommendations, and the assay was evaluated in remnant samples from an HIV prevention trial in which paired DBS and plasma samples were collected. RESULTS DBS CAB and RPV concentrations were linear from 25 to 20,000 ng/mL and 2-2500 ng/mL, respectively. Precision, accuracy, and matrix effect results were acceptable. DBS RPV demonstrated stability under all tested conditions; DBS CAB showed mean biases of - 23.5% when stored at room temperature for 36 days, and - 18.0% at 40 °C and 100% humidity for two days. DBS measurements for CAB and RPV were an average 54.0% and 14.1% lower, respectively, as compared to paired plasma samples. Derived conversion factors of 1.79 and 1.16 were applied to DBS CAB and RPV measurements, respectively, to estimate plasma concentrations. Estimated plasma CAB and RPV concentrations showed mean biases of 2.2% and 0.6%, respectively. In a CAB clinical trial, application of the conversion factor resulted in agreement between estimated plasma CAB concentrations from DBS and plasma CAB concentrations (y = 1.08x - 79.2, r = 0.932; mean bias of -3.2%; 95% CI: -48.2% to 41.9%). CONCLUSIONS We developed and validated a novel LC-MS/MS assay for the quantification of CAB and RPV from DBS, and identified conversion factors to estimate plasma concentrations from spotted blood.
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Affiliation(s)
- Ethel D Weld
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teresa L Parsons
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryann Gollings
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raphael J Landovitz
- Center for Clinical AIDS Research and Education, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Mark A Marzinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Werbel WA, Weld ED, Advani SD, Patel PK, Sundaram ME, Phadke VK. Your outpatient has COVID-19: what are their treatment options in the current SARS-CoV-2 variant climate? Clin Infect Dis 2023:7097790. [PMID: 36999905 DOI: 10.1093/cid/ciad178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
Mutations accumulated by novel SARS-CoV-2 Omicron sublineages contribute to evasion of previously effective monoclonal antibodies for treatment or prevention of COVID-19. Other authorized or approved antiviral drugs such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir are, however, predicted to maintain activity against these sublineages and are key tools to reduce severe COVID-19 outcomes in vulnerable populations. A stepwise approach may be taken to target the appropriate antiviral drug to the appropriate patient, beginning with identifying whether a patient is at high risk for hospitalization or other complications of COVID-19. Among higher-risk individuals, patient profile (including factors such as age, organ function, and comedications) and antiviral drug access inform suitable antiviral drug selection. When applied in targeted fashion, these therapies serve as a complement to vital ongoing non-pharmaceutical interventions and vaccination strategies that reduce morbidity and maximize protection against COVID-19.
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Affiliation(s)
- William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ethel D Weld
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sonali D Advani
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Varun K Phadke
- Department of Medicine, Emory University School of Medicine, Atlanta, MD, USA
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5
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Kilcrease C, Yusuf H, Park J, Powell A, Rn LJ, Rn JO, Lmsw BD, Weld ED, Dooley KE, Arrington-Sanders R, Agwu AL. Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series. AIDS Res Ther 2022; 19:56. [PMID: 36435793 PMCID: PMC9701425 DOI: 10.1186/s12981-022-00477-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral treatment (ART) remains the cornerstone of optimal HIV outcomes, including viral suppression (VS), immune recovery, and decreased transmission risk. For many people with HIV (PWH), particularly those with early-acquired HIV, structural, behavioral, and cognitive barriers to adherence and competing priorities related to life events may be difficult to overcome, resulting in nonadherence. Long-acting injectable antiretroviral therapies (LAI-ART) may be a useful strategy to overcome some of these barriers. However, to date, the approved LAI-ART strategies (e.g., cabotegravir and rilpivirine (CAB/RPV)) have targeted those who have already attained viral suppression, precluding their use in the 40% of adolescents and young adults (AYA) that VS has eluded. CASE PRESENTATION Ms. X is a 30-year-old woman with perinatally-acquired HIV and barriers to adherence. Despite many interventions, she remained persistently viremic, with resultant immune suppression and multiple comorbid opportunistic conditions, and viral load (VL) > 10,000,000 copies/ml. Given her longstanding history of poor adherence to an oral regimen, a switch to monthly intramuscular (IM) injections and biweekly infusions of ibalizumab were initiated leading to decreased viral load to 8,110 copies/ml within two weeks. Ms. H is a 33-year-old woman with cognitive limitations due to childhood lead poisoning. Her viral load trajectory took a downward turn, precipitated by various life events, remaining elevated despite intensive case management. Initiation of LAI-ART (CAB/RPV) in this patient led to an undetectable VL (< 20 copies/ml) within two months of treatment initiation. Miss Y. is a 37-year-old woman with perinatally-acquired HIV and chronic challenges with nonadherence and longstanding immunosuppression with CD4 < 200 cells/mm3 for > 5 years. She received a 1-month oral lead-in (OLI) of cabotegravir/rilpivirine, followed by the injectable loading dose. She has since adhered to all her monthly dosing appointments, sustained VS, and transitioned to a bi-monthly injection schedule. CONCLUSION These three individuals with HIV (perinatally and non-perinatally acquired) with longstanding nonadherence and persistent viremia were successfully initiated on LAI-ART through the process of care coordination and the collective efforts of the care team, highlighting the barriers, challenges, and the multidisciplinary coordination needed to assure successful implementation of this strategy for the most vulnerable of patients.
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Affiliation(s)
- Christin Kilcrease
- Department of Clinical Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hasiya Yusuf
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joan Park
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aaron Powell
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Leon James Rn
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacob Oates Rn
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Brittany Davis Lmsw
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ethel D Weld
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelly E Dooley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Renata Arrington-Sanders
- 7Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allison L Agwu
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Pediatric Adolescent Young Adult HIV/AIDS Program Medical Director, Accessing Care Early (ACE) Clinic, Johns Hopkins University School of Medicine, 21287, Baltimore, MD, USA.
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6
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Yu Y, Bigos KL, Marzinke MA, Landovitz RJ, McCauley M, Ford S, Hendrix CW, Bies RR, Weld ED. A population pharmacokinetic model based on HPTN 077 of long-acting injectable cabotegravir for HIV PrEP. Br J Clin Pharmacol 2022; 88:4623-4632. [PMID: 35949044 PMCID: PMC10077525 DOI: 10.1111/bcp.15477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS Cabotegravir delivered as a long-acting intramuscular injection has shown superior efficacy to oral tenofovir-emtricitabine as pre-exposure prophylaxis (PrEP) for HIV. Cabotegravir pharmacokinetics (PK), like those of other long-acting depot preparations, exhibit variability between individuals and between injection occasions. The aim of this study is to describe the population pharmacokinetics of long-acting cabotegravir (CAB-LA). METHODS Using available PK measurements from 133 participants in the HIV Prevention Trials Network (HPTN) 077 trial, we analysed CAB-LA PK data using nonlinear mixed-effects modelling to develop a population PK model. RESULTS A two-compartment model with first order absorption best described the CAB-LA PK. The analysis identified between-occasion variability (BOV, i.e., differences in PK within one individual from one injection to the next) as a significant covariate affecting the absorption rate, with an estimated contribution of BOV to PK variability on the absorption rate (ka ) of 38.5%. Sex and body weight were identified as significant covariates influencing the absorption rate and apparent clearance of CAB-LA after intramuscular injection at various doses and frequencies. Male participants had 67% higher ka than female participants. Serially adding to the model body weight on clearance, sex on ka , and BOV on ka led to a decrease in the objective function value (OFV) of 24.4, 36 and 321.4, respectively. CONCLUSION The public availability of this model will facilitate and enable a wide variety of future clinically relevant simulations to inform the optimal use of CAB-LA.
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Affiliation(s)
- Yifan Yu
- State University of New York at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Kristin L. Bigos
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Psychiatry, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Pharmacology and Molecular Sciences, Baltimore, MD, USA
| | - Mark A. Marzinke
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD, USA
| | - Raphael J. Landovitz
- The University of California, Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, CA, USA
| | | | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Craig W. Hendrix
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Pharmacology and Molecular Sciences, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, MD, USA
| | - Robert R. Bies
- State University of New York at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Ethel D. Weld
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Pharmacology and Molecular Sciences, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, MD, USA
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7
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Minkove SJ, Geiger G, Llibre JM, Montgomery MW, West NE, Chida NM, Antar AAR, Dandachi D, Weld ED, Karmen-Tuohy S, Carlucci PM, Zacharioudakis IM, Rahimian J, Zervou FN, Rebick G, Stachel A, Tang S, Ding D, Jones JL, Farley JE, Dooley KE, Wilgus BE, Sanchez M, Chow J, Kitchell E, Koh S, Maxwell D, Lau A, Brooks S, Chu J, Estrada J, Lazarte SM, Arinze F, Francis A, Paranjape N, Sax PE, Wanjalla CN, Kheshti AN, Bailin S, Koethe J, Kelly SG, Raffanti SP, Patel SM, Xu TH, Goebel M, Santiago ADD, Ray M, Slim J, Kratz AMP, Koren DE, Hiryak K, Hill B, Dare RK, Bordelon S, Bailey B, Baddley JW, Matthew Shoemaker D, Rodriguez-Nava G, Shweta FNU, Chu C, Pearson C, Treakle A, Furin JJ, Bogorodskaya M, Desai S, Osterholzer D, Arquiette J, Ford ES, Ching PR, Sun L, Buggy BP, Tirmizi A, Argentine S, Desai B, Swartz TH, Latimer D, Camazine M. Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series. AIDS Res Ther 2022; 19:6. [PMID: 35148782 PMCID: PMC8832430 DOI: 10.1186/s12981-022-00430-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking. CASE PRESENTATION We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died. CONCLUSIONS In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.
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8
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Weld ED, Waitt C, Barnes K, Garcia Bournissen F. Twice neglected? Neglected diseases in neglected populations. Br J Clin Pharmacol 2021; 88:367-373. [PMID: 34888909 DOI: 10.1111/bcp.15148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/20/2023] Open
Abstract
It is unfortunately true that clinicians lack the necessary evidence to know how to use medications properly in large sections of the population and do not have optimal treatments to use for many neglected tropical diseases (NTDs). NTDs often disproportionately affect neglected populations that are left out of research efforts, such as children and pregnant women. As reliable access to safe, effective preventives and treatments can break the cycle of poverty, illness, and ensuing debility that further perpetuates poverty, it is of paramount importance to investigate and develop new medicines for neglected populations suffering from NTDs. Furthermore, there is not only a need to develop and evaluate novel therapies, but also to ensure that these are affordable, available, and adapted to the communities who need them. The NIH has proposed a "4 C's" framework which is relevant for neglected diseases and populations and should be leveraged for the study of the Twice Neglected: Consider inclusion; Collect data from neglected populations with neglected conditions; Characterize differences through meaningful analysis; Communicate findings pertaining to neglected diseases and populations. With this editorial, the British Journal of Clinical Pharmacology hereby launches a call for high-quality articles focusing on NTDs in special populations, to facilitate and encourage the reversal of this dual neglect.
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Affiliation(s)
- Ethel D Weld
- Department of Medicine, Division of Infectious Diseases and Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catriona Waitt
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Infectious Disease Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Royal Liverpool University Hospital, Liverpool, UK
| | - Karen Barnes
- Division of Clinical Pharmacology, The University of Cape Town, Cape Town, South Africa
| | - Facundo Garcia Bournissen
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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9
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Weld ED, Astemborski J, Kirk GD, Sulkowski MS, Stephanie K, Rothman R, Solomon SS, Matthews GV, Hsieh YH, Verma M, Traverso G, Swindells S, Owen A, Feld J, Flexner C, Mehta SH, Thomas DL. Preferences of Persons with or at Risk for Hepatitis C for Long-Acting Treatments. Clin Infect Dis 2021; 75:3-10. [PMID: 34699587 DOI: 10.1093/cid/ciab913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Whereas safe, curative treatments for hepatitis C virus (HCV) have been available since 2015, there are still 58 million infected persons worldwide, and global elimination may require new paradigms. We sought to understand the acceptability of long-acting HCV treatment approaches. METHODS A cross-sectional, 43-question survey was administered to 1457 individuals with HCV or at risk of HCV at 28 sites in 9 countries to assess comparative interest in a variety of long-acting strategies in comparison to oral pills. RESULTS Among HCV-positive participants, 37.7% most preferred an injection, 5.6% an implant, and 6% a gastric residence device, as compared to 50.8% who stated they would most prefer taking 1 to 3 pills per day. When compared directly to taking pills, differences were observed in the relative preference for an injection based on age (p<0.001), location (p<0.001), and prior receipt of HCV treatment (p=0.005), but not sex. When an implant was compared to pills, greater preference was represented by women (p=0.01) and adults of younger ages (p=0.012 per 5 years). Among participants without HCV, 49.5% felt that injections are stronger than pills, and 34.7% preferred taking injections to pills. Among those at-risk participants who had received injectable medications in the past, 123 out of 137 (89.8%) expressed willingness to receive one in the future. CONCLUSIONS These data point to high acceptability of long-acting treatments, which for a substantial minority, might even be preferred to pills for the treatment of HCV infection. Long-acting treatments for HCV infection might contribute to global efforts to eliminate hepatitis C.
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Affiliation(s)
- Ethel D Weld
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacqueline Astemborski
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Division of Infectious Disease Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark S Sulkowski
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katz Stephanie
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Rothman
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Swindells
- Department of Internal Medicine, Section of Infectious Diseases, The University of Nebraska Medical Center, Omaha, NE, USA
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Jordan Feld
- The Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Charles Flexner
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Division of Infectious Disease Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L Thomas
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Jucker BM, Fuchs EJ, Lee S, Damian V, Galette P, Janiczek R, Macura KJ, Jacobs MA, Weld ED, Solaiyappan M, D'Amico R, Shaik JS, Bakshi K, Han K, Ford S, Margolis D, Spreen W, Gupta MK, Hendrix CW, Patel P. Multiparametric magnetic resonance imaging to characterize cabotegravir long-acting formulation depot kinetics in healthy adult volunteers. Br J Clin Pharmacol 2021; 88:1655-1666. [PMID: 34240449 PMCID: PMC9290983 DOI: 10.1111/bcp.14977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/26/2022] Open
Abstract
AIM Cabotegravir long-acting (LA) intramuscular (IM) injection is being investigated for HIV preexposure prophylaxis due to its potent antiretroviral activity and infrequent dosing requirement. A subset of healthy adult volunteers participating in a Phase I study assessing cabotegravir tissue pharmacokinetics underwent serial magnetic resonance imaging (MRI) to assess drug depot localization and kinetics following a single cabotegravir LA IM targeted injection. METHODS Eight participants (four men, four women) were administered cabotegravir LA 600 mg under ultrasonographic-guided injection targeting the gluteal muscles. MRI was performed to determine injection-site location in gluteal muscle (IM), subcutaneous (SC) adipose tissue and combined IM/SC compartments, and to quantify drug depot characteristics, including volume and surface area, on Days 1 (≤2 hours postinjection), 3 and 8. Linear regression analysis examined correlations between MRI-derived parameters and plasma cabotegravir exposure metrics, including maximum observed concentration (Cmax ) and partial area under the concentration-time curve (AUC) through Weeks 4 and 8. RESULTS Cabotegravir LA depot locations varied by participant and were identified in the IM compartment (n = 2), combined IM/SC compartments (n = 4), SC compartment (n = 1) and retroperitoneal cavity (n = 1). Although several MRI parameter and exposure metric correlations were determined, total depot surface area on Day 1 strongly correlated with plasma cabotegravir concentration at Days 3 and 8, Cmax and partial AUC through Weeks 4 and 8. CONCLUSION MRI clearly delineated cabotegravir LA injection-site location and depot kinetics in healthy adults. Although injection-site variability was observed, drug depot surface area correlated with both plasma Cmax and partial AUC independently of anatomical distribution.
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Affiliation(s)
| | - Edward J Fuchs
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Katarzyna J Macura
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael A Jacobs
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ethel D Weld
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Meiyappan Solaiyappan
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | - Craig W Hendrix
- Departments of Internal Medicine and Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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11
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Shaik JS, Weld ED, Edick S, Fuchs E, Riddler S, Marzinke MA, D'Amico R, Bakshi K, Lou Y, Hendrix C, Han K, Ford SL, Margolis D, Spreen W, Patel P. Multicompartmental pharmacokinetic evaluation of long-acting cabotegravir in healthy adults for HIV preexposure prophylaxis. Br J Clin Pharmacol 2021; 88:1667-1678. [PMID: 34240467 PMCID: PMC9290068 DOI: 10.1111/bcp.14980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/21/2021] [Accepted: 06/09/2021] [Indexed: 12/02/2022] Open
Abstract
Aims Cabotegravir is an integrase strand transfer inhibitor in clinical development as long‐acting (LA) injectable HIV preexposure prophylaxis. Methods This phase I study assessed pharmacokinetics of cabotegravir in plasma and anatomical sites associated with sexual HIV‐1 transmission after repeated oral and single intramuscular (IM) LA dosing in healthy adults. Following a 28‐day oral lead‐in period of cabotegravir 30 mg and a washout period of 14–42 days, participants were administered a single ultrasound‐guided gluteal IM cabotegravir LA 600‐mg injection. The study objective was to characterize cabotegravir concentrations in plasma, cervical, vaginal and rectal tissues, and cervicovaginal and rectal fluids and up to Week 12 after IM injection. Results Nineteen participants enrolled and 16 completed the study through Week 52. Cabotegravir was detected in plasma and all tissues and fluids. Median plasma cabotegravir concentrations exceeded the in vitro protein‐adjusted 90% maximal inhibitory concentration through Week 12. Median tissue‐ and fluid‐to‐plasma cabotegravir concentration ratios across all visits were 0.32 for rectal fluid and 0.08–0.16 for other tissues and fluids. Adjusted R2 coefficients between cabotegravir concentrations in plasma and cervical, vaginal and rectal tissues were 0.78, 0.79 and 0.90, respectively. Injection‐site reactions were common (88% of participants) and were mostly grade 1 in intensity (82%). Two participants reported 11 non–drug‐related serious adverse events. Conclusion Concentrations of cabotegravir in tissues and fluids were proportional to plasma over time, with strong correlations between tissue and plasma concentrations. Cabotegravir LA tissue‐to‐plasma ratios may be important for understanding its use as preexposure prophylaxis.
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Affiliation(s)
| | - Ethel D Weld
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Edward Fuchs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mark A Marzinke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Yu Lou
- Precision Biosciences, Durham, NC, USA
| | - Craig Hendrix
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Susan L Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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12
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Al-Khouja A, Shieh E, Fuchs EJ, Marzinke MA, Bakshi RP, Hummert P, Ham AS, Buckheit KW, Breakey J, Weld ED, Chen H, Caffo BS, Buckheit RW, Hendrix CW. Examining the Safety, Pharmacokinetics, and Pharmacodynamics of a Rectally Administered IQP-0528 Gel for HIV Pre-Exposure Prophylaxis: A First-In-Human Study. AIDS Res Hum Retroviruses 2021; 37:444-452. [PMID: 33371779 DOI: 10.1089/aid.2020.0188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A lubricating microbicide gel designed for rectal and vaginal use would provide a behaviorally congruent strategy to enhance pre-exposure prophylaxis adherence and reduce HIV infection risk. In this study, we report the first-in-human evaluation of such a gel containing 1% IQP-0528, an investigational antiretroviral. Seven HIV-1-negative participants received one 10 mL rectal dose of radiolabeled 1% IQP-0528 gel. We assessed safety; IQP-0528 pharmacokinetics in plasma, and rectal and vaginal tissue; ex vivo local pharmacodynamics (PD); and colorectal distribution. The 1% gel was determined to be safe with one mild event attributed to study product and no effects on rectal tissue histology. All concentrations measured in plasma and vaginal tissue were below the limit of quantitation. Median IQP-0528 concentrations in rectal tissue exceeded the in vitro EC95 against HIV-1 (0.07 ng/mg) by 3-5 h of dosing and remained above this concentration for at least 24 h, despite a 3-log reduction in concentration over this duration of time. Rectal tissue PD-assessed by ex vivo HIV challenge-demonstrated significant p24 antigen reduction 3-5 h postdose compared with baseline (p = .05), but not 24-26 h postdose (p = .75). Single-photon emission computed tomography/computed tomography imaging revealed that product distribution was localized to the rectosigmoid. The IQP-0528 gel possesses desirable features for a topical microbicide including: local safety with no systemic absorption, delivery of locally high IQP-0528 concentrations, and significant reductions in ex vivo HIV infectivity. However, the gel is limited by its rapid clearance and inability to penetrate vaginal tissues following rectal dosing. Clinical Trial Registration number: NCT03082690.
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Affiliation(s)
- Amer Al-Khouja
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eugenie Shieh
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward J. Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark A. Marzinke
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rahul P. Bakshi
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela Hummert
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Jennifer Breakey
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethel D. Weld
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Huan Chen
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian S. Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Craig W. Hendrix
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Weld ED, Bailey TC, Waitt C. Ethical issues in therapeutic use and research in pregnant and breastfeeding women. Br J Clin Pharmacol 2021; 88:7-21. [PMID: 33990968 DOI: 10.1111/bcp.14914] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 12/15/2022] Open
Abstract
Pregnant or potentially pregnant women have historically been excluded from clinical trials of new medications. However, it is increasingly recognised that it is imperative to generate evidence from the population in whom the drugs are likely to be used to inform safe, evidence-based shared clinical decision making. Reluctance by researchers and regulators to perform such studies often relates to concerns about risk, particularly to the foetus. However, this must be offset against the risk of untreated disease or using a drug in pregnancy where safety, efficacy and dosing information are not known. This review summarises the historical perspective, and the ethical and legal frameworks that inform the conduct of such research, then highlights examples of innovative practice that have enabled high quality, ethical research to proceed to inform the evidence-based use of medication in pregnancy.
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Affiliation(s)
- Ethel D Weld
- Divisions of Clinical Pharmacology & Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodore C Bailey
- Division of Infectious Diseases, Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Catriona Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK.,Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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14
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Scully EP, Weld ED, Blankson JN. Challenges in optimizing preexposure prophylaxis development, engagement, and access for HIV prevention. J Clin Invest 2020; 129:5071-5073. [PMID: 31710315 DOI: 10.1172/jci134389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | | | - Joel N Blankson
- Department of Medicine and.,Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Weld ED. Limits of Detection and Limits of Infection: Quantitative HIV Measurement in the Era of U = U. J Appl Lab Med 2020; 6:324-326. [PMID: 33438739 DOI: 10.1093/jalm/jfaa176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Ethel D Weld
- Divisions of Infectious Diseases and Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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DeLong K, Bensouda S, Zulfiqar F, Zierden HC, Hoang TM, Abraham AG, Coleman JS, Cone RA, Gravitt PE, Hendrix CW, Fuchs EJ, Gaydos CA, Weld ED, Ensign LM. Conceptual Design of a Universal Donor Screening Approach for Vaginal Microbiota Transplant. Front Cell Infect Microbiol 2019; 9:306. [PMID: 31555606 PMCID: PMC6722226 DOI: 10.3389/fcimb.2019.00306] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/09/2019] [Indexed: 01/08/2023] Open
Abstract
The success of fecal microbiota transplant (FMT) in treating recurrent Clostridioides difficile infection has led to growing excitement about the potential of using transplanted human material as a therapy for a wide range of diseases and conditions related to microbial dysbiosis. We anticipate that the next frontier of microbiota transplantation will be vaginal microbiota transplant (VMT). The composition of the vaginal microbiota has broad impact on sexual and reproductive health. The vaginal microbiota in the "optimal" state are one of the simplest communities, dominated by one of only a few species of Lactobacillus. Diversity in the microbiota and the concomitant depletion of lactobacilli, a condition referred to as bacterial vaginosis (BV), is associated with a wide range of deleterious effects, including increased risk of acquiring sexually transmitted infections and increased likelihood of having a preterm birth. However, we have very few treatment options available, and none of them curative or restorative, for "resetting" the vaginal microbiota to a more protective state. In order to test the hypothesis that VMT may be a more effective treatment option, we must first determine how to screen donors to find those with minimal risk of pathogen transmission and "optimal" vaginal microbiota for transplant. Here, we describe a universal donor screening approach that was implemented in a small pilot study of 20 women. We further characterized key physicochemical properties of donor cervicovaginal secretions (CVS) and the corresponding composition of the vaginal microbiota to delineate criteria for inclusion/exclusion. We anticipate that the framework described here will help accelerate clinical studies of VMT.
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Affiliation(s)
- Kevin DeLong
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sabrine Bensouda
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Fareeha Zulfiqar
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hannah C. Zierden
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Thuy M. Hoang
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alison G. Abraham
- Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Jenell S. Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Richard A. Cone
- Department of Biophysics, Johns Hopkins University, Baltimore, MD, United States
| | - Patti E. Gravitt
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
- Department of Global Health, George Washington University, Washington, DC, United States
| | - Craig W. Hendrix
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edward J. Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Charlotte A. Gaydos
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ethel D. Weld
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laura M. Ensign
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, United States
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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17
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Garcia-Prats AJ, Svensson EM, Weld ED, Schaaf HS, Hesseling AC. Current status of pharmacokinetic and safety studies of multidrug-resistant tuberculosis treatment in children. Int J Tuberc Lung Dis 2019; 22:15-23. [PMID: 29665949 DOI: 10.5588/ijtld.17.0355] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
After decades of neglect, data are finally becoming available on the appropriate, safe dosing of key second-line anti-tuberculosis drugs used for treating multidrug-resistant tuberculosis (MDR-TB) in children, including levofloxacin (LVX), moxifloxacin (MFX), linezolid (LZD) and delamanid (DLM). Much needed data on some novel and repurposed drugs are still lacking, including for bedaquiline (BDQ), pretomanid (PTM) and clofazimine (CFZ). We review the status of pharmacokinetic (PK) and safety studies of key anti-tuberculosis medications in children with MDR-TB, identify priority knowledge gaps and note ongoing work to address those gaps, in the context of planning for an efficacy trial in children with MDR-TB. There is international consensus that an efficacy trial of a novel, all-oral, shortened MDR-TB treatment trial in children is both needed and feasible. Key novel and repurposed second-line anti-tuberculosis drugs include BDQ, DLM, PTM, MFX, LVX, CFZ and LZD. The rapidly emerging PK and safety data on these medications in children with MDR-TB from studies that are underway, completed or planned, will be critical in supporting such an efficacy trial. Commitment to addressing the remaining knowledge gaps, developing child-friendly formulations of key medications, improving the design of paediatric PK and safety studies, and development of international trial capacity in children with MDR-TB are important priorities.
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Affiliation(s)
- A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - E M Svensson
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - E D Weld
- Department of Medicine, Divisions of Clinical Pharmacology & Infectious Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Seddon JA, Weld ED, Schaaf HS, Garcia-Prats AJ, Kim S, Hesseling AC. Conducting efficacy trials in children with MDR-TB: what is the rationale and how should they be done? Int J Tuberc Lung Dis 2019; 22:24-33. [PMID: 29665950 DOI: 10.5588/ijtld.17.0359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Paediatric anti-tuberculosis treatment trials have traditionally been limited to Phase I/II studies evaluating the drug pharmacokinetics and safety in children, with assumptions about efficacy made by extrapolating data from adults. However, it is increasingly being recognised that, in some circumstances, efficacy trials are required in children. The current treatment for children with multidrug-resistant tuberculosis (MDR-TB) is long and toxic; shorter, safer regimens, using novel agents, require urgent evaluation. Given the changing pattern of drug metabolism, disease spectrum and rates of TB disease confirmation with age, decisions around inclusion criteria require careful consideration. The most straightforward MDR-TB efficacy trial would include only children with confirmed MDR-TB and no additional drug resistance. Given that it may be unclear at the time treatment is initiated whether the diagnosis will ultimately be confirmed and what the final drug resistance profile will be, this presents a unique challenge in children. Recruiting only these children would, however, limit the generalisability of such a trial, as in reality the majority of children with TB do not have bacteriologically confirmed disease. Given the good existing treatment outcomes with current routine regimens for children with MDR-TB, conducting a superiority trial may not be the optimal design. Demonstrating non-inferiority of efficacy, but superiority with regard to safety, would be an alternative strategy. Using standardised control and experimental MDR-TB treatment regimens is challenging given the wide spectrum of paediatric disease. However, using variable regimens would make interpretation challenging. A paediatric MDR-TB efficacy trial is urgently needed, and with global collaboration and capacity building, is highly feasible.
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Affiliation(s)
- J A Seddon
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - E D Weld
- Division of Clinical Pharmacology, Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Kim
- Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Weld ED, Dooley KE. State-of-the-Art Review of HIV-TB Coinfection in Special Populations. Clin Pharmacol Ther 2018; 104:1098-1109. [PMID: 30137652 DOI: 10.1002/cpt.1221] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022]
Abstract
Children and pregnant and postpartum women experience an undue burden of HIV-associated tuberculosis (TB), but data are lacking on key aspects of their complex management. Often excluded from clinical trials, they are left with limited options for HIV-TB cotreatment. This review will focus on pharmacologic aspects of the treatment of HIV-TB coinfection in the special populations of children and pregnant and postpartum women. Pharmacogenomic considerations, rational dosing, drug-drug interactions, safety, immune reconstitution inflammatory syndrome, and ethical and policy aspects of the inclusion of special populations in research will be surveyed. Considerations related to the treatment of both HIV-associated TB disease and HIV-associated latent TB infection will be summarized. Relevant knowledge gaps and research priorities in special populations will be outlined.
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Affiliation(s)
- Ethel D Weld
- Division of Clinical Pharmacology, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dooley
- Division of Clinical Pharmacology, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Shieh EC, Weld ED, Fuchs EJ, Hiruy H, Buckheit KW, Buckheit RW, Breakey J, Hendrix CW. Lubricant Provides Poor Rectal Mucosal HIV Coverage. AIDS Res Hum Retroviruses 2017. [PMID: 28649870 DOI: 10.1089/aid.2016.0318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Given the rising HIV incidence in men who have sex with men (MSM) despite repeatedly proven effectiveness of oral HIV pre-exposure prophylaxis, behaviorally congruent periodic dosing strategies, such as dosing microbicides as lubricants, are now in demand. Rectal microbicide gel studies largely administer gels using vaginal applicators, which have not been well received and do not mimic lubricant use. We compared rectal gel manually dosed as lubricant with applicator dosing in five healthy, HIV-negative MSM who received 10 or 3.5 ml of 99mTc-DTPA-radiolabeled hydroxyethyl cellulose universal placebo gel intrarectally. After washout, participants received 10 ml of radiolabeled Wet® Original® lubricant to apply to the anus with fingers and/or a phallus in a manner typical of sexual lubricant use with a partner, followed by simulated receptive anal intercourse. Single-photon emission computed tomography with transmission computed tomography was performed 4 h after each gel administration. Manual dosing was associated with more variable rectosigmoid distribution, 4.4-15.3 cm from the anorectal junction, compared with more uniform distribution, 5.9-7.4 and 5.3-7.6 cm after 10 and 3.5 ml applicator dosing, respectively. A significantly smaller fraction of the initial 10 ml dose was retained within the colon after manual dosing, 3.4%, compared with 94.9% and 88.4% after 10 and 3.5 ml applicator dosing, respectively (both p < .001). Manual dosing of a sexual lubricant delivered a small, variable fraction of the dose with variable rectosigmoid distribution compared with applicator dosing. These results raise concern that dosing a rectal microbicide gel as a sexual lubricant may not provide adequate or predictable mucosal coverage for HIV protection.
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Affiliation(s)
- Eugenie C. Shieh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ethel D. Weld
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Edward J. Fuchs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hiwot Hiruy
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | - Jennifer Breakey
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Craig W. Hendrix
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Weld ED, Hiruy H, Guthrie KM, Fava JL, Vargas SE, Buckheit K, Buckheit R, Spiegel H, Breakey J, Fuchs EJ, Hendrix CW. A Comparative Pre-Phase I Study of the Impact of Gel Vehicle Volume on Distal Colon Distribution, User Experience, and Acceptability. AIDS Res Hum Retroviruses 2017; 33:440-447. [PMID: 27824253 DOI: 10.1089/aid.2016.0167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
For persons at risk of HIV infection who practice receptive anal intercourse (RAI), topical rectal microbicides represent a promising option for coitally dependent protection. The study compared colorectal distribution and user sensory experiences of two different volumes of rectal gel for suitability as rectal microbicide. Eight HIV-negative men with a history of recent RAI were enrolled into a two-period, sequence-randomized dosing study comparing 3.5 and 10 ml of radiolabeled (1 mCi 99mTc-DTPA) universal placebo, hydroxyethyl cellulose gel. Each participant received two doses in the research unit, one of each volume, separated by a washout period of at least 2 weeks. Each research unit dose was followed by a self-administered take-home dose in the context of preparing for RAI. Safety and gastrointestinal distribution were assessed after the research unit doses, safety, perceptibility, and acceptability, were assessed after take-home doses. There were no adverse effects of Grade 2 or higher and all resolved spontaneously. Both volumes were well tolerated and received high acceptability scores. Perceptibility scores showed meaningful effect size differences ranging from Cohen's d = 0.5 to d = 1.2. The 3.5 and 10 ml gel volumes distributed similarly (p > .2) within the rectosigmoid, ranging from 0.69 to 18.84 cm and 1.21 to 19.01 cm from the anorectal junction, respectively. Both volumes covered the typical gastrointestinal distribution of ejaculate following simulated intercourse based on other studies. Either of these gel volumes could reasonably be pursued for the next phase of development of rectal microbicides.
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Affiliation(s)
- Ethel D Weld
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 2 Department of Medicine (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Hiwot Hiruy
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 Department of Pediatrics (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Kate Morrow Guthrie
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
- 5 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University . Providence, Rhode Island
| | - Joseph L Fava
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
| | - Sara E Vargas
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
- 5 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University . Providence, Rhode Island
| | | | | | | | - Jennifer Breakey
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Edward J Fuchs
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Craig W Hendrix
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 2 Department of Medicine (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
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Weld ED, Garcia-Prats AJ, Furin JJ, Bailey TC, Hesseling AC, Dooley KE. The time has come: sparing injectables in paediatric MDR-TB. Lancet Respir Med 2017; 5:S2213-2600(17)30078-4. [PMID: 28344008 PMCID: PMC9181438 DOI: 10.1016/s2213-2600(17)30078-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/15/2017] [Accepted: 02/22/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Ethel D Weld
- The Johns Hopkins University School of Medicine, Department of Medicine, Divisions of Clinical Pharmacology & Infectious Disease, Baltimore, MD, USA.
| | - Anthony J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jennifer J Furin
- Harvard Medical School, Department of Global Health & Social Medicine, Boston, MA, USA
| | - Theodore C Bailey
- The Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD, USA
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kelly E Dooley
- The Johns Hopkins University School of Medicine, Department of Medicine, Divisions of Clinical Pharmacology & Infectious Disease, Baltimore, MD, USA
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Simon JK, Maciel M, Weld ED, Wahid R, Pasetti MF, Picking WL, Kotloff KL, Levine MM, Sztein MB. Antigen-specific IgA B memory cell responses to Shigella antigens elicited in volunteers immunized with live attenuated Shigella flexneri 2a oral vaccine candidates. Clin Immunol 2011; 139:185-92. [PMID: 21388888 DOI: 10.1016/j.clim.2011.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/14/2011] [Accepted: 02/01/2011] [Indexed: 01/26/2023]
Abstract
We studied the induction of antigen-specific IgA memory B cells (B(M)) in volunteers who received live attenuated Shigella flexneri 2a vaccines. Subjects ingested a single oral dose of 10(7), 10(8) or 10(9) CFU of S. flexneri 2a with deletions in guaBA (CVD 1204) or in guaBA, set and sen (CVD 1208). Antigen-specific serum and stool antibody responses to LPS and Ipa B were measured on days 0, 7, 14, 28 and 42. IgA B(M) cells specific to LPS, Ipa B and total IgA were assessed on days 0 and 28. We show the induction of significant LPS-specific IgA B(M) cells in anti-LPS IgA seroresponders. Positive correlations were found between anti-LPS IgA B(M) cells and anti-LPS IgA in serum and stool; IgA B(M) cell responses to IpaB were also observed. These B(M) cell responses are likely play an important role in modulating the magnitude and longevity of the humoral response.
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Affiliation(s)
- J K Simon
- Division of Infectious Diseases and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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Affiliation(s)
- Ethel D Weld
- University of Maryland Medical Center, Baltimore, Maryland, USA
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