Project Gel a Randomized Rectal Microbicide Safety and Acceptability Study in Young Men and Transgender Women

Ian McGowan, Ross D Cranston, Kenneth H Mayer, Irma Febo, Kathryn Duffill, Aaron Siegel, Jarret C Engstrom, Alexyi Nikiforov, Seo-Young Park, Rhonda M Brand, Cindy Jacobson, Rebecca Giguere, Curtis Dolezal, Timothy Frasca, Cheng-Shiun Leu, Jill L Schwartz, Alex Carballo-Diéguez, Ian McGowan, Ross D Cranston, Kenneth H Mayer, Irma Febo, Kathryn Duffill, Aaron Siegel, Jarret C Engstrom, Alexyi Nikiforov, Seo-Young Park, Rhonda M Brand, Cindy Jacobson, Rebecca Giguere, Curtis Dolezal, Timothy Frasca, Cheng-Shiun Leu, Jill L Schwartz, Alex Carballo-Diéguez

Abstract

Objectives: The purpose of Project Gel was to determine the safety and acceptability of rectal microbicides in young men who have sex with men (MSM) and transgender women (TGW) at risk of HIV infection.

Methods: MSM and TGW aged 18-30 years were enrolled at three sites; Pittsburgh, PA; Boston, MA; and San Juan, PR. Stage 1A was a cross-sectional assessment of sexual health and behavior in MSM and TGW. A subset of participants from Stage 1A were then enrolled in Stage 1B, a 12-week evaluation of the safety and acceptability of a placebo rectal gel. This was followed by the final phase of the study (Stage 2) in which a subset of participants from Stage 1B were enrolled into a Phase 1 rectal safety and acceptability evaluation of tenofovir (TFV) 1% gel.

Results: 248 participants were enrolled into Stage 1A. Participants' average age was 23.3 years. The most common sexually transmitted infection (STIs) at baseline were Herpes simplex (HSV)-2 (16.1% by serology) and rectal Chlamydia trachomatis (CT) (10.1% by NAAT). 134 participants were enrolled into Stage 1B. During the 12 week period of follow-up 2 HIV, 5 rectal CT, and 5 rectal Neisseria gonorrhea infections were detected. The majority of adverse events (AEs) were infections (N = 56) or gastrointestinal (N = 46) and were mild (69.6%) or moderate (28.0%). Of the participants who completed Stage 1B, 24 were enrolled into Stage 2 and randomized (1:1) to receive TFV or placebo gel. All participants completed Stage 2. The majority of AEs were gastrointestinal (N = 10) and of mild (87.2%) or moderate (10.3%) severity.

Conclusions: In this study we were able to enroll a sexually active population of young MSM and TGW who were willing to use rectal microbicides. TFV gel was safe and acceptable and should be further developed as an alternative HIV prevention intervention for this population.

Trial registration: ClinicalTrials.gov NCT01283360.

Conflict of interest statement

Competing Interests: The authors of this manuscript have read the journal's policy and have the following competing interests: IM is a consultant for Novicol Life Science Inc., who have a surfactant microbicide in preclinical development. RDC is the husband of IM and is therefore potentially conflicted by nature of his relationship with IM. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Overview of study design and…
Fig 1. Overview of study design and visit schedule.
Fig 2. Microbicide applicators used in Project…
Fig 2. Microbicide applicators used in Project Gel.
(A) A rectal specific applicator was used to deliver the placebo gel in Stage 1B of the study [37]. (B) The HTI applicator was used to deliver placebo or tenofovir gel in Stage 2 of Project Gel.

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