Tenofovir Douche as HIV Preexposure Prophylaxis for Receptive Anal Intercourse: Safety, Acceptability, Pharmacokinetics, and Pharmacodynamics (DREAM 01)

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.

Prevalence and clinical features of HTLV neurologic disease in the HTLV Outcomes Study

BACKGROUND

Almost 20 years after its discovery, the prevalence and clinical course of human T-lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM, also known as tropical spastic paraparesis [TSP]) remain poorly defined. Whereas the causative association of HTLV-I and HAM/TSP is generally recognized, controversy still surrounds the relationship between HTLV-II and HAM/TSP.

METHODS

The HTLV Outcomes Study (HOST-formerly Retrovirus Epidemiology Donor Study [REDS]) is a prospective cohort study including 160 patients with HTLV-I, 405 patients with HTLV-II, and 799 uninfected controls who have been followed every 2 years since 1990-1992. Clinical outcomes are measured by health interviews and examinations, and blood samples are obtained.

RESULTS

Six cases of HTLV-I-associated myelopathy (3.7%, 95% CI 1.4 to 8.0) and four cases of HTLV-II myelopathy (1.0%, 95% CI 0.3 to 2.5) have been diagnosed since the formation of the cohort. There have been no cases of HAM/TSP diagnosed among HTLV-negative subjects (0.0%, 95% CI 0.0 to 0.5). Clinical features of the cases include lower extremity hyperreflexia, variably associated with weakness, spasticity, and bladder dysfunction.

CONCLUSIONS

Systematic screening of HTLV-infected blood donors reveals a high prevalence of HAM/TSP. The clinical course of HAM/TSP appears highly variable. HTLV-II-associated myelopathy generally presents with milder and more slowly progressive signs and symptoms.

HTLV-associated myelopathy in a cohort of HTLV-I and HTLV-II-infected blood donors. The REDS investigators

OBJECTIVE

HTLV-I-associated myelopathy (HAM) is a slowly progressive spastic paraparesis caused by infection with human T-lymphotropic virus type I (HTLV-I). The prevalence of HAM among those infected with HTLV-I is poorly defined, and the association of a similar myelopathy with HTLV-II infection has not been confirmed.

DESIGN

Cross-sectional examination of HTLV-I, HTLV-II, and control subjects from the baseline visit of a cohort study. SETTING/ SUBJECTS: Persons testing HTLV seropositive at the time of blood donation at five U.S. blood centers, their seropositive sex partners, and a matched control group of HTLV seronegative blood donors.

MEASUREMENTS

HTLV-I and HTLV-II were differentiated by serology and/or polymerase chain reaction. All subjects received systematic neurologic screening examinations.

RESULTS

A diagnosis of myelopathy was confirmed in four of 166 HTLV-I subjects (2.4%, 95% confidence interval 0.7%, 6.1%) and in one of 404 HTLV-II subjects (0.25%, 95% confidence interval 0.0%, 0.6%). None of the 798 controls had a similar myelopathy, although one had longstanding typical multiple sclerosis.

CONCLUSIONS

Our data also suggest that HAM occurs more frequently among HTLV-I-infected subjects than reported by previous studies. The HTLV-II infected myelopathy patient identified in this cohort, together with three other case reports in the literature, implies a pathogenic role for this human retrovirus. The diagnosis of HTLV-associated myelopathy should be considered in cases of spastic paraparesis or neurogenic bladder when risk factors for HTLV-I or HTLV-II infection are present.

Caloric loss from expressed mother's milk during continuous gavage infusion

Expressed mother's milk (EMM) provides innumerable immunologic and nutritional benefits. However, the nutritional value of EMM, especially the calorie-rich lipids, may be reduced during continuous gavage infusion (CGI). The purpose of the study was to compare the differences in lipid loss of EMM for two types of CGI tubing: standard bore and minibore. In an experimental design, 30 specimens of EMM were infused using a simulated CGI apparatus with a syringe pump; each of the 30 specimens was aliquotted to infuse through both types of CGI tubing. Preinfusion and postinfusion lipid concentrations were measured by the creamatocrit technique. The mean preinfusion creamatocrit value was 6.57 percent (SD = 2.09) with minimum and maximum values of 3.41 and 10.72 percent respectively (mean caloric content of 22.91 Kcal/oz). The mean postinfusion creamatocrit for standard bore tubing was 4.98 percent (SD = 1.59), with minimum and maximum values of 1.90 and 9.38 percent respectively (mean caloric content = 20.14 Kcal/oz). Mean percent of decrease in lipid concentration between preinfusion and postinfusion values for standard bore tubing was 1.59 percent (SD = 1.10) (mean caloric loss 2.77 Kcal/oz). The mean postinfusion creamatocrit value for the minibore tubing was 5.24 percent (SD = 1.77) with minimum and maximum values of 2.55 and 9.68 percent respectively. This equates to a mean caloric content of 20.59 Kcal/oz. Mean percent of decrease in lipid concentration between preinfusion and postinfusion values for minibore tubing was 1.34 percent (SD = 1.02) (mean caloric loss of 2.32 Kcal/oz).(ABSTRACT TRUNCATED AT 250 WORDS)

Trigeminal neuropathy: Gd-DTPA enhanced MR imaging

A review of 17 patients with Gd-DTPA enhancing lesions of the trigeminal nerve (6 patients with benign tumors, 4 with inflammatory disease, 7 with malignant tumors) was conducted to determine if contrast enhanced MR imaging is superior to nonenhanced imaging and to identify imaging characteristics that aid in separating benign and malignant disease. Contrast enhanced imaging appears to be superior to nonenhanced imaging in patients with intrinsic fifth nerve lesions. Malignant lesions are suggested by enlarged, enhancing fifth nerves with irregular margins and benign lesions by minimal or no enlargement with smooth margins. Overlap of imaging findings between benign and malignant disease strongly suggests that follow-up imaging and clinical findings are of utmost importance. Gadolinium-enhanced MR imaging of the fifth nerve is recommended in patients with trigeminal sensory or motor deficits as well as those with atypical trigeminal neuralgia.

Mutation frequency decline in Escherichia coli B/r after mutagenesis with ethyl methanesulfonate

Nonsense-defective auxotrophic strains of Escherichia coli B/r were used to study mutation frequency decline (MFD) after mutagenesis with ethyl methanesulfonate (EMS). The mutation frequencies for prototrophic revertants that were either converted or de novo glutamine tRNA suppressor mutations declined as treated auxotrophic parental cells were incubated with glucose but without required amino acids (a condition typically producing MFD). The decline for converted suppressor mutations was more rapid than the decline for de novo suppressor mutations after low or moderate EMS treatment, but both suppressor mutation types showed the same slow decline after extensive treatment. The declines for both types of suppressor mutation were eliminated in uvrA-defective cells, and the rapid decline seen for converted suppressor mutations appeared as a slow decline in mfd-defective cells. The results are interpreted that true MFD (the rapid process) affects only the EMS-induced converted glutamine tRNA suppressor mutations. This would account for the rapid decline that is blocked in cells with an mfd defect and in cells with deficient excision repair activity (uvrA or excessive DNA damage). In addition, a second non-specific antimutation mechanism is proposed that is dependent on excision repair only and accounts for the slow decline seen with converted suppressor mutations in some instances and with de novo suppressor mutations at all times. The true MFD mechanism may consist of a physiologically dependent facilitated excision repair specifically for premutational residues located in the transcribed strand of the target DNA sequence (for O6-ethylguanine in cells treated with ethyl methanesulfonate or pyrimidine-pyrimidine photoproducts after UV irradiation).

Interaction of DNA polymerase III gamma and beta subunits in vivo in Salmonella typhimurium

We show that temperature-sensitive mutations in dnaZ, the gene for the gamma subunit of DNA polymerase III holoenzyme, can be suppressed by mutations in the dnaN gene, which encodes the beta subunit. These results support a direct physical interaction of these two subunits during polymerase assembly or function. The suppressor phenotype is also sensitive to modulation by the dnaA genotype. Since dnaA is organized in an operon with dnaN, and dnaA is a regulatory gene of this operon, we propose that the dnaA effect on suppression can best be explained by modulation of suppressor dnaN levels.

UV-mutagenesis at a cloned target sequence: converted suppressor mutation is insensitive to mutation frequency decline regardless of the gene orientation

Premutational lesions produced by ultraviolet radiation in the Gln2 tRNA genes of E. coli B/r show differing sensitivities to a mutation avoidance phenomenon known as mutation frequency decline (MFD). A mutation event that changes the wild-type gene to an amber (UAG) suppressor is normally sensitive to MFD. Mutation of this amber suppressor to an ochre (UAA) suppressor is not sensitive to MFD. These two mutation events occur in the same anticodon region of the DNA. The dissimilarity of MFD sensitivity between these two mutations may result because the respective premutational photoproducts for the two are located in opposite strands of duplex DNA. To examine the effect of strand position of the premutational lesions on MFD, recombinant lambda phage were constructed that contained the amber suppressor as a mutation target in the two possible orientations. Comparison of MFD in bacterial lysogens containing either of the two types of recombinant prophage indicated that reversing the orientation of the target sequence relative to adjacent bacterial DNA had no effect on MFD. Since rotational inversion of the target sequence did not alter the sensitivity to MFD of mutation occurring at the cloned target gene, the antimutation process inherent to MFD can not be attributed to an asymmetrical interaction between the template strands and the DNA-replication complex.

Potential histidine decarboxylase inhibitors. 1. alpha- and beta-substituted histidine analogues

Histidine analogues with alkyl substitution at Calpha and Cbeta were prepared as potential inhibitors of specific histidine decarboxylase. Activity was assessed in vitro using extracts of rat pyloric stomach and a radioisotopic assay of 14CO2 evolved from carboxyl-14C-labeled histidine. alpha-Substituted analogues (C2-C4) including 2-hydroxyethyl were less potent than alpha-methylhistidine; the alpha-n-butyl analogue was completely inactive at 10(-3) M. Similarly, beta,beta-dimethylhistidine and homohistidine failed to exhibit activity at 10(-3) M.

Topical mosquito repellents VII: alkyl triethylene glycol monoethers

Normal and branched-chain aliphatic monoethers of triethylene glycol are effective topical mosquito repellents. In terms of duration of protection, they are generally superior to the corresponding diethylene glycol analogs and some are superior to diethyltoluamide. The n-heptyl monoether of triethylene glycol affords double the protection time of diethyltoluamide under controlled laboratory conditions and appears to be a useful new mosquito repellent.