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Foreskin HIV SusceptibilityNCT03412071

Effect of Antibiotics on Penile Microbiome and HIV Susceptibility Study in Ugandan Men

A study testing Oral Tinidazole, Topical metronidazole and Topical Clindamycin in people with Foreskin HIV Susceptibility, run by University of Toronto at 1 site in Uganda.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This pilot study will assess the impact of four antimicrobial products (3 topical, one systemic) on the foreskin microbiome and HIV susceptibility of foreskin-derived CD4+ T cells. Participants will include HIV-uninfected Ugandan men presenting for elective male circumcision to reduce their HIV risk. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Foreskin HIV Susceptibility
What is being tested?
Oral Tinidazole, Topical metronidazole and Topical Clindamycin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
125 participants
Where
1 siteUganda
Study dates
7 Dec 2017to 7 Dec 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Enrollment criteria include:

  1. Aged 18 years or older
  2. Biological male
  3. Uncircumcised
  4. HIV seronegative
  5. Willing to comply with the requirements of the protocol
  6. No current sexually transmitted infection (N. gonorrhoeae or C. trachomatis)
  7. No clinically relevant genital symptoms / signs

Trial locations and contacts

1 site in 1 country.

Rupert Kaul, MD/PhD contact

(416) 946-7054

rupert.kaul@utoronto.ca

Uganda1 site, 1 recruiting
  • UVRI-IAVI HIV Vaccine Program

    Entebbe, Wakiso

    Bernard S Bagaya, PhD, +256787082820, bbagaya@iavi.or.ug

    Recruiting

Other trials in Uganda

About this study

Official title: Testing the Ability of a Microbiome - Focused Intervention to Reduce HIV Susceptibility in Ugandan Men

This pilot study will assess the impact of four antimicrobial products (3 topical, one systemic) on the foreskin microbiome and HIV susceptibility of foreskin-derived CD4+ T cells. Participants will include HIV-uninfected Ugandan men presenting for elective male circumcision to reduce their HIV risk.

Read the detailed description

RATIONALE: The foreskin is the site of most HIV acquisition in uncircumcised heterosexual men, and male circumcision (MC) reduces HIV risk by almost 60%. However, cultural and practical barriers have led to suboptimal uptake. Foreskin inflammation, defined by elevated levels of pro-inflammatory cytokines in the prepuce, is a key determinant of HIV acquisition risk in uncircumcised men, and anaerobic bacteria within the foreskin microbiome may be an important cause of this inflammation.

OBJECTIVES: A pilot in vivo - in vitro clinical study of four potential interventions to reduce HIV susceptibility in the foreskin by altering the microbiome. The study is a collaboration between the University of Toronto, IAVI-UVRI, and the Entebbe General Hospital. We will recruit 125 men presenting for elective MC, along with regular female sexual partners (if applicable). Participants will be randomized (n=25 per group) to immediate MC, or to one of four intervention arms: twice-daily application of topical metronidazole 0.75%; twice-daily application of topical clindamycin 2%; twice daily application of hydrogen peroxide 1%; or oral tinidazole 2g once a day for two days. Swabs for immune and microbiome studies will be collected before and after product. After 4 weeks the MC procedure will be performed; foreskin CD4+ T cell susceptibility to HIV will be quantified using a flow cytometry-based pseudovirus assay, and tissue immunohistochemistry performed. The primary and secondary endpoints are outlined below. A secondary study will assess the impact of penile topical antibiotic application on immunology and the microbiome in the genital tract of female sexual partners.

OUTCOMES: This in vivo - in vitro clinical trial will define the causal role of the penile microbiome in HIV susceptibility, and will assess potential strategies to take forward into HIV efficacy trials in uncircumcised heterosexual men.

Being tested
Oral Tinidazole, Topical metronidazole, Topical Clindamycin, Topical Hydrogen Peroxide

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Oral TinidazoleDrug

    Also called FASIGYN 500mgs

    Please see description under arms

  • Topical metronidazoleDrug

    Also called Rozex 0.75%

    Please see description under arms

  • Topical ClindamycinDrug

    Also called Dalacin cream 2%

    Please see description under arms

  • Topical Hydrogen PeroxideDrug

    Also called Crystacide 1%

    Please see description under arms

Study groups in NCT03412071
Study groupRoleWhat they receive
Control groupNo intervention25 HIV-uninfected, uncircumcised men will be immediately circumcised following enrollment. This group will serve as the comparison to the four intervention groups.
Oral tinidazole groupActive comparator25 HIV-uninfected, uncircumcised men will be randomized to receive oral tinidazole 2g once a day for two days.
Receives: Drug: Oral Tinidazole
Topical metronidazole (0.75%) groupActive comparator25 HIV-uninfected, uncircumcised men will be randomized to apply topical 0.75% metronidazole cream to the foreskin twice a day for one week, and then twice a week for three weeks.
Receives: Drug: Topical metronidazole
Topical clindamycin (2%) groupActive comparator25 HIV-uninfected, uncircumcised men will be randomized to apply topical 2% clindamycin cream to the foreskin twice a day for one week, and then twice a week for three weeks.
Receives: Drug: Topical Clindamycin
Topical hydrogen peroxide (1%) groupActive comparator25 HIV-uninfected, uncircumcised men will be randomized to apply 1% hydrogen peroxide cream to the foreskin twice a day for one week, and then twice a week for three weeks.
Receives: Drug: Topical Hydrogen Peroxide

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. % HIV entry into foreskin derived CD4+ T cells

    This measure will utilize a validated pseudovirus entry assay.

    Measured: 4 weeks

Secondary outcomes (6)
  1. Tissue density of HIV-susceptible CD4+ T cells

    The density of CD4+ T cells in foreskin tissues will be assayed using immunohistochemistry, and the % pseudovirus entry (see primary endpoint, above) will be used to calculate the tissue density of HIV-susceptible CD4+ T cells.

    Measured: 4 weeks

  2. CD4+ T cell subsets in foreskin tissue

    Immunofluorescence microscopy (IF) will be used to quantify CD4+ T cell subsets foreskin tissue after circumcision.

    Measured: 4 weeks

  3. Density of Langerhans cells in foreskin tissue

    Immunofluorescence microscopy (IF) will be used to quantify Langerhans cells in foreskin tissue after circumcision.

    Measured: 4 weeks

  4. Presence of foreskin inflammation

    Cytokine/chemokines will be assayed by ELISA, and foreskin inflammation defined as the presence of ≥3/7 inflammatory cytokines within the top quartile for that cytokine.

    Measured: 4 weeks

  5. Foreskin microbiome composition

    The foreskin (prepuce) microbiome will be characterized based on 16S rRNA sequencing.

    Measured: 4 weeks

  6. Foreskin tissue explant HIV susceptibility

    Foreskin tissue susecptibility to HIV infection will be quantified, based on p24 ELISA after ex vivo incubation with a primary HIV isolate.

    Measured: 4 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Jan 2018
  2. Study start7 Dec 2017
  3. Primary completion7 Dec 2019 (estimated)
  4. Study completion7 Dec 2019 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized, open label with 5 arms
Masking
None (open label)
Enrolment
125 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03412071
Sponsor's protocol ID
Penile microbiome antibiotics
Status last verified
Jan 2018
First submitted
19 Jan 2018
Last updated
26 Jan 2018
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Gray RH, Wawer MJ, Kigozi G. Programme science research on medical male circumcision scale-up in sub-Saharan Africa. Sex Transm Infect. 2013 Aug;89(5):345-9. doi: 10.1136/sextrans-2012-050595. Epub 2013 May 22.

    PubMed 23698513
  • Liu CM, Hungate BA, Tobian AA, Serwadda D, Ravel J, Lester R, Kigozi G, Aziz M, Galiwango RM, Nalugoda F, Contente-Cuomo TL, Wawer MJ, Keim P, Gray RH, Price LB. Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria. mBio. 2013 Apr 16;4(2):e00076. doi: 10.1128/mBio.00076-13.

    PubMed 23592260
  • Prodger JL, Gray R, Kigozi G, Nalugoda F, Galiwango R, Hirbod T, Wawer M, Hofer SO, Sewankambo N, Serwadda D, Kaul R. Foreskin T-cell subsets differ substantially from blood with respect to HIV co-receptor expression, inflammatory profile, and memory status. Mucosal Immunol. 2012 Mar;5(2):121-8. doi: 10.1038/mi.2011.56. Epub 2011 Nov 16.

    PubMed 22089029
  • Prodger JL, Gray RH, Shannon B, Shahabi K, Kong X, Grabowski K, Kigozi G, Nalugoda F, Serwadda D, Wawer MJ, Reynolds SJ, Liu CM, Tobian AA, Kaul R. Chemokine Levels in the Penile Coronal Sulcus Correlate with HIV-1 Acquisition and Are Reduced by Male Circumcision in Rakai, Uganda. PLoS Pathog. 2016 Nov 29;12(11):e1006025. doi: 10.1371/journal.ppat.1006025. eCollection 2016 Nov.

    PubMed 27898732
  • Prodger JL, Hirbod T, Kigozi G, Nalugoda F, Reynolds SJ, Galiwango R, Shahabi K, Serwadda D, Wawer MJ, Gray RH, Kaul R; Rakai Genital Immunology Research Group. Immune correlates of HIV exposure without infection in foreskins of men from Rakai, Uganda. Mucosal Immunol. 2014 May;7(3):634-44. doi: 10.1038/mi.2013.83. Epub 2013 Oct 23.

    PubMed 24150258
  • Menard JP. Antibacterial treatment of bacterial vaginosis: current and emerging therapies. Int J Womens Health. 2011;3:295-305. doi: 10.2147/IJWH.S23814. Epub 2011 Aug 23.

    PubMed 21976983
  • Rashed HT. Evaluation of the effect of hydrogen peroxide as a mouthwash in comparison with chlorhexidine in chronic periodontitis patients: A clinical study. J Int Soc Prev Community Dent. 2016 May-Jun;6(3):206-12. doi: 10.4103/2231-0762.183114. Epub 2016 May 30.

    PubMed 27382535
  • Armstrong NR, Wilson JD. Tinidazole in the treatment of bacterial vaginosis. Int J Womens Health. 2010 Aug 9;1:59-65. doi: 10.2147/ijwh.s4455.

    PubMed 21072275
  • Baggaley R, Doherty M, Ball A, Ford N, Hirnschall G. The Strategic Use of Antiretrovirals to Prevent HIV Infection: A Converging Agenda. Clin Infect Dis. 2015 Jun 1;60 Suppl 3:S159-60. doi: 10.1093/cid/civ091.

    PubMed 25972496
  • TenoRes Study Group. Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study. Lancet Infect Dis. 2016 May;16(5):565-575. doi: 10.1016/S1473-3099(15)00536-8. Epub 2016 Jan 29.

    PubMed 26831472
  • Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. doi: 10.1371/journal.pmed.0020298. Epub 2005 Oct 25.

    PubMed 16231970
  • Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF, Campbell RT, Ndinya-Achola JO. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-56. doi: 10.1016/S0140-6736(07)60312-2.

    PubMed 17321310
  • Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, Sewankambo NK, Wabwire-Mangen F, Bacon MC, Williams CF, Opendi P, Reynolds SJ, Laeyendecker O, Quinn TC, Wawer MJ. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-66. doi: 10.1016/S0140-6736(07)60313-4.

    PubMed 17321311
  • Sgaier SK, Reed JB, Thomas A, Njeuhmeli E. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs. PLoS Med. 2014 May 6;11(5):e1001641. doi: 10.1371/journal.pmed.1001641. eCollection 2014 May.

    PubMed 24800840
  • Kigozi G, Wawer M, Ssettuba A, Kagaayi J, Nalugoda F, Watya S, Mangen FW, Kiwanuka N, Bacon MC, Lutalo T, Serwadda D, Gray RH. Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters). AIDS. 2009 Oct 23;23(16):2209-13. doi: 10.1097/QAD.0b013e328330eda8.

    PubMed 19770623

Questions about this trial

What is this clinical trial studying?

A study testing Oral Tinidazole, Topical metronidazole and Topical Clindamycin in people with Foreskin HIV Susceptibility, run by University of Toronto at 1 site in Uganda.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 26 Jan 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Uganda. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Rupert Kaul, MD/PhD ((416) 946-7054, rupert.kaul@utoronto.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

% HIV entry into foreskin derived CD4+ T cells (time frame: 4 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03412071, which also lists 23 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Jan 2018.

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