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Evaluation of the Cellular Pharmacology of Tenofovir and Emtricitabine According to HIV Infection Status

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Emtricitabine (FTC)
Tenofovir disoproxil fumarate (TDF)
Efavirenz (EFV)
Truvada
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring HIV Seronegativity, Treatment Experienced

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria for HIV-Uninfected Participants:

  • Ability to provide informed consent
  • Ability to comply with the study procedures

Exclusion Criteria for HIV-Uninfected Participants:

  • Positive screening test for HIV infection
  • Positive screening test for hepatitis B (HBV) infection
  • Pregnant or planning to become pregnant in the 3 months after study entry
  • Breastfeeding
  • If sexually active and fertile (no tubal ligation or hysterectomy), refusal to use two forms of birth control (e.g., condom and hormonal birth control) during the 60-day study
  • Estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m^2 by the Modification of Diet in Renal Disease (MDRD) method
  • Albuminuria (greater than 30 mg urine albumin per g of urine creatinine)
  • Blood donation within 56 days of the screening visit
  • Any grade I or higher abnormality in hemoglobin, platelets, serum phosphorous, and lipase on the screening visit; grade I abnormalities in other labs will be evaluated on a case by case basis (using DAIDS criteria)
  • Any greater than grade I abnormality in screening laboratory tests (using DAIDS grading criteria)
  • Medical history of chronic uncontrolled high blood pressure equal to or above 140/90 mm Hg
  • Use of any investigational medication in the 30 days before study entry
  • Daily anticoagulant therapy (daily aspirin or non-steroidal anti-inflammatory drugs [NSAIDs] will be allowed if discontinued for 1 week prior to the rectal biopsy)
  • Any nephrotoxic concomitant medication (e.g., aminoglycosides, cyclosporine, cidofovir, foscarnet, amphotericin B)
  • Active recreational drug or alcohol abuse
  • Any concomitant medication (or herbal product) that, in the opinion of the investigators, would interfere with the study outcomes (acceptable medications include acetaminophen, occasional ibuprofen/NSAID, vitamins, and birth control pills)
  • History of pathologic bone fractures
  • Any chronic or acute medical condition that, in the opinion of the investigator, would interfere with study conditions, such as cancer, heart disease, or diabetes
  • Body weight under 110 pounds

Inclusion Criteria for HIV-Infected Participants:

  • HIV-infected adults (HIV documented in medical record or by the primary clinician)
  • Clinician/participant plan to initiate TDF/FTC/EFV therapy and agree to separate TDF/FTC and EFV prescriptions for the initial 30 days of the study
  • Ability to provide informed consent
  • Ability to comply with the study procedures

Exclusion Criteria for HIV-Infected Participants:

  • Antiretroviral therapy in the preceding 6 months
  • Pregnant or planning to become pregnant in the 3 months after study entry
  • Breastfeeding
  • If sexually active and fertile (no tubal ligation or hysterectomy), refusal to use two forms of birth control (e.g., condom and hormonal birth control) during the 60-day study
  • Estimated GFR less than 60 mL/min/1.73 m^2 by the MDRD method
  • Albuminuria (greater than 30 mg urine albumin per g of urine creatinine)
  • Greater than a grade II abnormality in hemoglobin or platelets. Greater than a grade II abnormality in other clinical chemistry or hematology tests that, in the opinion of the investigators (principal investigator, study coordinator, and study physician) and primary clinician, would preclude participation in the study. DAIDS grading criteria will be used.
  • Use of any investigational medication in the 30 days before study entry
  • Daily anticoagulant therapy (daily aspirin or NSAIDs will be allowed if discontinued for 1 week prior to the rectal biopsy)
  • Any nephrotoxic concomitant medication (e.g., aminoglycosides, cyclosporine, cidofovir, foscarnet, amphotericin B)
  • Any concomitant medication (or herbal product) that, in the opinion of the investigators, would interfere with the study outcomes (acceptable medications include acetaminophen, occasional ibuprofen/NSAID, vitamins, and birth control pills)
  • Any chronic or acute medical condition that, in the opinion of the investigator, could lead to emergent health complications, or could interfere with the participant's ability to follow study procedures
  • Body weight under 110 pounds

Sites / Locations

  • University of Colorado CTRC CRS

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

HIV-Infected Participants

HIV-Uninfected Participants

Arm Description

HIV-infected participants will receive FTC, TDF, and EFV for 60 days by prescription from their physicians. Participants will receive Truvada (FTC/TDF) and EFV for the first 30 days. After Day 30, participants may switch to the TDF/FTC/EFV co-formulation through Day 60 as directed by their physician.

HIV-uninfected participants will receive Truvada (FTC/TDF) for 30 days.

Outcomes

Primary Outcome Measures

Comparison of the first dose tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) area under the concentration-time curve (AUC) in HIV-uninfected adults versus HIV-infected adults
Comparison of average steady-state plasma deoxyguanosine concentrations before therapy and after 30 days of TDF/FTC therapy
Comparison of TFV-DP and FTC-TP in HIV-seroconverters versus matched non-seroconverters from the iPrEx study
Modeling describing intracellular pharmacokinetics of TFV-DP and FTC-TP in PBMCs so dosing strategies can be tested on the model to identify the optimal dosing that most rapidly achieves and sustains the desired prophylactic threshold for HIV prevention

Secondary Outcome Measures

Definition of the terminal elimination phase of TFV-DP and FTC-TP in HIV-uninfected adults
Characterization of TFV-DP and FTC-TP according to cell types: PBMCs, CD4-purified PBMCs (as well as erythrocytes-to include dried blood spot analyses, CD8 cells, B-cells, and monocytes), genital mononuclear cells, and rectal mucosal mononuclear cells
Comparison of TFV-DP and FTC-TP between male and female participants
Characterization of intracellular TFV, tenofovir-monophosphate (TFV-MP), emtricitabine-monophosphate (FTC-MP), and emtricitabine-diphosphate (FTC-DP)
Evaluation of markers of cell activation (HLA-DR and CD38 expression) and the relationship to TFV-DP and FTC-TP concentrations
Effects of TFV-DP and FTC-TP (and plasma EFV) on plasma HIV-RNA and CD4 counts in the HIV-infected participants
Evaluation of relationships between adherence measures collected in iPrEx with TFV-DP and FTC-TP
Comparison of TFV-DP and FTC-TP between African-American and non-African-American participants
Evaluation of polymorphisms in MRP2 (eg, -24C>T, 1249G>A), MRP4 (eg, 1612C>T, 3463G>A, 3724G>A, 4131T>G), BCRP (eg, 421C>A, 34G>A) and other potentially important enzymes for the study drugs for relationships with pharmacokinetics and pharmacodynamics
Comparison of Day 30 AUC and overall AUC (AUC over Day 1 to Day 30) TFV-DP and FTC-TP in HIV-uninfected versus HIV-infected participants
HLA-DR / CD38 on T cells will be correlated with changed intracellular and extracellular purine levels in the HIV-uninfected participants to address potential immune-modulation associated with PNP inhibition
Characterization of the ratios of TFV-DP and FTC-TP to corresponding endogenous deoxyribose nucleotides
Comparison of TFV-DP and FTC-TP according to iPrEx study sites

Full Information

First Posted
December 23, 2009
Last Updated
December 15, 2016
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT01040091
Brief Title
Evaluation of the Cellular Pharmacology of Tenofovir and Emtricitabine According to HIV Infection Status
Official Title
Cellular Pharmacology of Tenofovir and Emtricitabine for HIV Prophylaxis (Cell Prep)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2014
Overall Recruitment Status
Completed
Study Start Date
December 2009 (undefined)
Primary Completion Date
April 2014 (Actual)
Study Completion Date
April 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) are two antiretroviral medications used for the treatment and prevention of HIV/AIDS. This study will examine how these medications are processed in the body of people who are HIV-infected, as well as in people who are HIV-uninfected.
Detailed Description
Tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) are both nucleoside reverse transcriptase inhibitors (NRTIs), a class of medications used for the treatment and prevention of HIV/AIDS. Analyzing how the body interacts with these medications at the cellular level may lead to more effective dosing strategies for both HIV prevention and treatment. This study will examine the pharmacokinetics of TDF and FTC at the cellular level in HIV-infected people (N=20) and HIV-uninfected people (N=20). HIV-infected participants will be allowed to take part in this study only if their doctor already plans to prescribe TDF, FTC, and efavirenz (EFV) for their HIV care, regardless of their participation in this study. HIV-infected participants will receive Truvada (TDF/FTC) and EFV for the first 30 days. After Day 30, participants will continue to receive TDF, FTC, and EFV through Day 60, under the direction of their physician. HIV-infected participants will remain on their therapy throughout the study as part of their HIV care. HIV-uninfected volunteers will receive 30 days of Truvada (TDF/FTC). The study duration is 60 days. Study visits will occur at baseline and on Days 1, 3, 7, 20, 30, and 60. At most study visits, participants will undergo blood and urine collection for pharmacology studies, a medication history review, and an adverse effects questionnaire. HIV-uninfected participants will also attend two additional study visits at Days 35 and 45 - while off study medication - for blood and urine collection, adverse effects questionnaires, and a medication history review. At varying study visits during the first 30 days, all participants will undergo one rectal biopsy, female participants will undergo one cervical cell and fluid sampling procedure, and male participants will provide one semen sample. In addition to the collections from enrolled participants, study researchers will also analyze previously collected and stored blood samples from participants in the "Chemoprophylaxis for HIV Prevention in Men (iPrEx)" study, which examined the use of TDF and FTC for the prevention of HIV in men who have sex with men (MSM).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
HIV Seronegativity, Treatment Experienced

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
HIV-Infected Participants
Arm Type
Active Comparator
Arm Description
HIV-infected participants will receive FTC, TDF, and EFV for 60 days by prescription from their physicians. Participants will receive Truvada (FTC/TDF) and EFV for the first 30 days. After Day 30, participants may switch to the TDF/FTC/EFV co-formulation through Day 60 as directed by their physician.
Arm Title
HIV-Uninfected Participants
Arm Type
Active Comparator
Arm Description
HIV-uninfected participants will receive Truvada (FTC/TDF) for 30 days.
Intervention Type
Drug
Intervention Name(s)
Emtricitabine (FTC)
Intervention Description
200 mg once a day
Intervention Type
Drug
Intervention Name(s)
Tenofovir disoproxil fumarate (TDF)
Intervention Description
300 mg once a day
Intervention Type
Drug
Intervention Name(s)
Efavirenz (EFV)
Intervention Description
600 mg once a day
Intervention Type
Drug
Intervention Name(s)
Truvada
Intervention Description
200 mg emtricitabine + 300 mg TDF once a day
Primary Outcome Measure Information:
Title
Comparison of the first dose tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) area under the concentration-time curve (AUC) in HIV-uninfected adults versus HIV-infected adults
Time Frame
Measured at the time of the first dose
Title
Comparison of average steady-state plasma deoxyguanosine concentrations before therapy and after 30 days of TDF/FTC therapy
Time Frame
Measured through Day 30
Title
Comparison of TFV-DP and FTC-TP in HIV-seroconverters versus matched non-seroconverters from the iPrEx study
Time Frame
Measured throughout the 4-year study
Title
Modeling describing intracellular pharmacokinetics of TFV-DP and FTC-TP in PBMCs so dosing strategies can be tested on the model to identify the optimal dosing that most rapidly achieves and sustains the desired prophylactic threshold for HIV prevention
Time Frame
Measured throughout the 4-year study
Secondary Outcome Measure Information:
Title
Definition of the terminal elimination phase of TFV-DP and FTC-TP in HIV-uninfected adults
Time Frame
Measured from Day 30 to 60
Title
Characterization of TFV-DP and FTC-TP according to cell types: PBMCs, CD4-purified PBMCs (as well as erythrocytes-to include dried blood spot analyses, CD8 cells, B-cells, and monocytes), genital mononuclear cells, and rectal mucosal mononuclear cells
Time Frame
Measured through Day 30
Title
Comparison of TFV-DP and FTC-TP between male and female participants
Time Frame
Measured through Day 30
Title
Characterization of intracellular TFV, tenofovir-monophosphate (TFV-MP), emtricitabine-monophosphate (FTC-MP), and emtricitabine-diphosphate (FTC-DP)
Time Frame
Measured through Day 30
Title
Evaluation of markers of cell activation (HLA-DR and CD38 expression) and the relationship to TFV-DP and FTC-TP concentrations
Time Frame
Measured through Day 30
Title
Effects of TFV-DP and FTC-TP (and plasma EFV) on plasma HIV-RNA and CD4 counts in the HIV-infected participants
Time Frame
Measured through Day 60
Title
Evaluation of relationships between adherence measures collected in iPrEx with TFV-DP and FTC-TP
Time Frame
Measured throughout the 4-year study
Title
Comparison of TFV-DP and FTC-TP between African-American and non-African-American participants
Time Frame
Measured through Day 30
Title
Evaluation of polymorphisms in MRP2 (eg, -24C>T, 1249G>A), MRP4 (eg, 1612C>T, 3463G>A, 3724G>A, 4131T>G), BCRP (eg, 421C>A, 34G>A) and other potentially important enzymes for the study drugs for relationships with pharmacokinetics and pharmacodynamics
Time Frame
Measured throughout the 4-year study
Title
Comparison of Day 30 AUC and overall AUC (AUC over Day 1 to Day 30) TFV-DP and FTC-TP in HIV-uninfected versus HIV-infected participants
Time Frame
Measured through Day 30
Title
HLA-DR / CD38 on T cells will be correlated with changed intracellular and extracellular purine levels in the HIV-uninfected participants to address potential immune-modulation associated with PNP inhibition
Time Frame
Measured throughout the 4-year study
Title
Characterization of the ratios of TFV-DP and FTC-TP to corresponding endogenous deoxyribose nucleotides
Time Frame
Measured throughout the 4-year study
Title
Comparison of TFV-DP and FTC-TP according to iPrEx study sites
Time Frame
Measured throughout the 4-year study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria for HIV-Uninfected Participants: Ability to provide informed consent Ability to comply with the study procedures Exclusion Criteria for HIV-Uninfected Participants: Positive screening test for HIV infection Positive screening test for hepatitis B (HBV) infection Pregnant or planning to become pregnant in the 3 months after study entry Breastfeeding If sexually active and fertile (no tubal ligation or hysterectomy), refusal to use two forms of birth control (e.g., condom and hormonal birth control) during the 60-day study Estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m^2 by the Modification of Diet in Renal Disease (MDRD) method Albuminuria (greater than 30 mg urine albumin per g of urine creatinine) Blood donation within 56 days of the screening visit Any grade I or higher abnormality in hemoglobin, platelets, serum phosphorous, and lipase on the screening visit; grade I abnormalities in other labs will be evaluated on a case by case basis (using DAIDS criteria) Any greater than grade I abnormality in screening laboratory tests (using DAIDS grading criteria) Medical history of chronic uncontrolled high blood pressure equal to or above 140/90 mm Hg Use of any investigational medication in the 30 days before study entry Daily anticoagulant therapy (daily aspirin or non-steroidal anti-inflammatory drugs [NSAIDs] will be allowed if discontinued for 1 week prior to the rectal biopsy) Any nephrotoxic concomitant medication (e.g., aminoglycosides, cyclosporine, cidofovir, foscarnet, amphotericin B) Active recreational drug or alcohol abuse Any concomitant medication (or herbal product) that, in the opinion of the investigators, would interfere with the study outcomes (acceptable medications include acetaminophen, occasional ibuprofen/NSAID, vitamins, and birth control pills) History of pathologic bone fractures Any chronic or acute medical condition that, in the opinion of the investigator, would interfere with study conditions, such as cancer, heart disease, or diabetes Body weight under 110 pounds Inclusion Criteria for HIV-Infected Participants: HIV-infected adults (HIV documented in medical record or by the primary clinician) Clinician/participant plan to initiate TDF/FTC/EFV therapy and agree to separate TDF/FTC and EFV prescriptions for the initial 30 days of the study Ability to provide informed consent Ability to comply with the study procedures Exclusion Criteria for HIV-Infected Participants: Antiretroviral therapy in the preceding 6 months Pregnant or planning to become pregnant in the 3 months after study entry Breastfeeding If sexually active and fertile (no tubal ligation or hysterectomy), refusal to use two forms of birth control (e.g., condom and hormonal birth control) during the 60-day study Estimated GFR less than 60 mL/min/1.73 m^2 by the MDRD method Albuminuria (greater than 30 mg urine albumin per g of urine creatinine) Greater than a grade II abnormality in hemoglobin or platelets. Greater than a grade II abnormality in other clinical chemistry or hematology tests that, in the opinion of the investigators (principal investigator, study coordinator, and study physician) and primary clinician, would preclude participation in the study. DAIDS grading criteria will be used. Use of any investigational medication in the 30 days before study entry Daily anticoagulant therapy (daily aspirin or NSAIDs will be allowed if discontinued for 1 week prior to the rectal biopsy) Any nephrotoxic concomitant medication (e.g., aminoglycosides, cyclosporine, cidofovir, foscarnet, amphotericin B) Any concomitant medication (or herbal product) that, in the opinion of the investigators, would interfere with the study outcomes (acceptable medications include acetaminophen, occasional ibuprofen/NSAID, vitamins, and birth control pills) Any chronic or acute medical condition that, in the opinion of the investigator, could lead to emergent health complications, or could interfere with the participant's ability to follow study procedures Body weight under 110 pounds
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter L. Anderson, PharmD
Organizational Affiliation
University of Colorado, Denver
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado CTRC CRS
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
27572401
Citation
Castillo-Mancilla J, Seifert S, Campbell K, Coleman S, McAllister K, Zheng JH, Gardner EM, Liu A, Glidden DV, Grant R, Hosek S, Wilson CM, Bushman LR, MaWhinney S, Anderson PL. Emtricitabine-Triphosphate in Dried Blood Spots as a Marker of Recent Dosing. Antimicrob Agents Chemother. 2016 Oct 21;60(11):6692-6697. doi: 10.1128/AAC.01017-16. Print 2016 Nov.
Results Reference
derived
PubMed Identifier
27353267
Citation
Chen X, Castillo-Mancilla JR, Seifert SM, McAllister KB, Zheng JH, Bushman LR, MaWhinney S, Anderson PL. Analysis of the Endogenous Deoxynucleoside Triphosphate Pool in HIV-Positive and -Negative Individuals Receiving Tenofovir-Emtricitabine. Antimicrob Agents Chemother. 2016 Aug 22;60(9):5387-92. doi: 10.1128/AAC.01019-16. Print 2016 Sep.
Results Reference
derived
PubMed Identifier
25763783
Citation
Castillo-Mancilla JR, Meditz A, Wilson C, Zheng JH, Palmer BE, Lee EJ, Gardner EM, Seifert S, Kerr B, Bushman LR, MaWhinney S, Anderson PL. Reduced immune activation during tenofovir-emtricitabine therapy in HIV-negative individuals. J Acquir Immune Defic Syndr. 2015 Apr 15;68(5):495-501. doi: 10.1097/QAI.0000000000000529.
Results Reference
derived
Links:
URL
http://clinicaltrials.gov/ct2/show/NCT00458393
Description
Click here for the "Chemoprophylaxis for HIV Prevention in Men (iPrEx)" ClinicalTrials.gov study record.

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Evaluation of the Cellular Pharmacology of Tenofovir and Emtricitabine According to HIV Infection Status

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