Chemoprophylaxis for HIV Prevention in Men

男性艾滋病毒的化学预防

• 批准号: 7749450
• 负责人: Robert M. Grant
• 金额: $ 786.01万
• 依托单位: J. DAVID GLADSTONE INSTITUTES
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-15 至 2012-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7749450
• 关键词: AIDS prevention; Chemoprophylaxis; men

DESCRIPTION (provided by applicant): UNAIDS estimates that 14,000 persons are newly infected with HIV every day throughout the world, of which one half are between the ages of 15 and 24. New infections occur despite widespread awareness of the modes of HIV-1 transmission, and the protection afforded by condom use. Novel concepts for HIV-1 prevention are urgently needed. We propose to evaluate the safety and efficacy of chemoprophylaxis for HIV prevention in a randomized and blinded trial of daily oral tenofovir 300 mg versus placebo among men in Peru, who have extremely high risk of acquiring HIV infection. Daily oral tenofovir 300 mg is selected for evaluation because it is FDA-licensed for human use, allows once a-day dosing, is well-tolerated, is active against many drug resistant HIV-1 strains, and was demonstrated to be effective for prevention in non-human primate models. We propose to enroll 2100 men who will be randomized 1:1 to receive daily oral tenofovir 300 mg versus placebo and followed for 13 months for HIV-1 seroconversion (aim 1), adverse events (aim 2), and viral load, drug resistance and CD4 T cell count after seroconversion (aim 3). Study sites are selected in Peru because of their well-developed prevention research infrastructure and their demonstrated ability to recruit men at high risk for HIV infection with outstanding rates of retention. Recruitment will be derived from 3 cities in Peru that had the highest incidence of HIV-1 infection in two recent surveys, have the required infrastructure to support a closely monitored clinical trial, and represent enormous genetic and geophysical diversity. The sample size is sufficient to detect cost-effective levels of HIV-1 prevention. The trial also aims to evaluate the safety of this agent in HIV uninfected persons, including the incidence of mild renal insufficiency and liver inflammation. Chemoprophylaxis may involve durable benefits or risks as well, possibly leading to an attenuated course of infection due to early inhibition of viral replication or drug resistance. The proposed research addresses important gaps of knowledge directly, including the safety and efficacy of daily oral tenofovir chemoprophylaxis among men exposed to HIV after rectal exposure. This unique and essential information bears directly on HIV prevention in the Americas and will not be available after the completion of other studies planned for the United States, Asia and Africa. The safety and efficacy of chemoprophylaxis may differ in men and women due to differences in reproductive biology, the mucosal surfaces that are typically exposed to HIV, behavioral differences, and pharmacokinetics. This research ultimately aims to break the epidemic cycle of HIV-1 by protecting men at risk for HIV, and may spare their sexual partners and their future children.

描述（由申请人提供）：联合国艾滋病规划署估计，全世界每天有 14,000 人新感染艾滋病毒，其中一半年龄在 15 岁至 24 岁之间。尽管人们普遍认识到 HIV-1 的传播方式以及使用安全套提供的保护，但新感染的情况仍然存在。迫切需要预防 HIV-1 的新概念。我们建议在秘鲁男性中进行一项每日口服替诺福韦 300 mg 与安慰剂的随机、盲法试验，评估化学预防治疗 HIV 预防的安全性和有效性，这些男性感染 HIV 的风险极高。选择每日口服替诺福韦 300 mg 进行评估，因为它已获得 FDA 许可供人类使用，允许每天一次给药，耐受性良好，对许多耐药 HIV-1 菌株具有活性，并且在非人类灵长类动物模型中被证明可有效预防。我们建议招募 2100 名男性，他们将按照 1:1 的比例随机接受每日口服替诺福韦 300 mg 与安慰剂的治疗，并随访 13 个月，了解 HIV-1 血清转化（目标 1）、不良事件（目标 2）以及血清转化后的病毒载量、耐药性和 CD4 T 细胞计数（目标 3）。研究地点选择在秘鲁，因为该国拥有完善的预防研究基础设施，并且有能力以出色的保留率招募艾滋病毒感染高危男性。招募对象将来自秘鲁的 3 个城市，在最近的两次调查中，这些城市的 HIV-1 感染率最高，拥有支持密切监测的临床试验所需的基础设施，并且代表着巨大的遗传和地球物理多样性。样本量足以检测 HIV-1 预防的成本效益水平。该试验还旨在评估该药物在未感染艾滋病毒的人中的安全性，包括轻度肾功能不全和肝脏炎症的发生率。化学预防也可能涉及持久的益处或风险，可能由于病毒复制或耐药性的早期抑制而导致感染过程减弱。拟议的研究直接解决了重要的知识空白，包括直肠暴露后暴露于艾滋病毒的男性每日口服替诺福韦化学预防的安全性和有效性。这一独特而重要的信息直接关系到美洲的艾滋病毒预防，并且在计划为美国、亚洲和非洲进行的其他研究完成后将无法提供。由于生殖生物学、通常暴露于 HIV 的粘膜表面、行为差异和药代动力学的差异，化学预防的安全性和有效性在男性和女性中可能有所不同。这项研究的最终目标是通过保护有感染艾滋病毒风险的男性来打破艾滋病毒-1 的流行循环，并可能避免他们的性伴侣和未来的孩子。