COMPLETED

Pre-Exposure Prophylaxis (PrEP)- Gender Affirming Hormone Therapy (GAHT) Interactions in TGW

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

This is a research study to determine the best way to dose Truvada®, an oral medication licensed to be taken as Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection, in transgender women who are also taking feminizing hormones. The duration of the study is about 4 months, and involves a screening visit, a baseline visit with colon biopsies and kidney function testing, and several outpatient visits, including 5 intensive sampling visits that last about 9 hours and involve colon biopsies, kidney function testing and other blood specimen collections. After the baseline visit, participants will start on PrEP, daily Truvada® pills, and will continue on the Truvada® for 5 weeks. Participants will then receive either an injection of Lupron, oral low-dose estradiol or oral high-dose estradiol, which will be taken along with the Truvada® PrEP for 1-2 weeks before returning for an intensive sampling visit.

Official Title

A Phase I Trial for the Evaluation of the Two-way Pharmacokinetic-pharmacodynamic (PD) Interaction of Gender Affirming Exogenous Estrogen (With Testosterone Suppression) on TDF/FTC PrEP in Transgender Women (TGW)

Quick Facts

Study Start:2021-03-01

Study Completion:2025-03-24

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:COMPLETED

Study ID

NCT04760691

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years

Sexes Eligible for Study:MALE

Accepts Healthy Volunteers:Yes

Standard Ages:ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
1. 18 years of age or older 2. Self-identifying as a transgender woman 3. Not currently taking any gender affirming hormonal therapy (GAHT) with a total testosterone concentration of ≥ 200 ng/dL, or willing to abstain from feminizing therapies (including estradiol, spironolactone, progesterone, etc.) until total total testosterone concentrations are ≥ 200 ng/dL. Note: Testosterone may be retested every 2-4 weeks during screening to determine eligibility up to 6 weeks. 4. HIV-1 uninfected at screening as documented by Combo Ag/Ab HIV-1/HIV-2 immunoassay 5. Understand and agree to local STI reporting requirements 6. Able and willing to communicate in English 7. Able and willing to provide written informed consent to take part in the study 8. Able and willing to provide adequate information for locator purposes 9. Able and willing to participate in a directly observed study, which may occur in person, using live streaming or a time stamped video? 10. Availability to return for all study visits, barring unforeseen circumstances 11. Willing to abstain from insertion of anything (drug, enema, penis, or sex toy) in rectum for 72 hours before and 72 hours after each flexible sigmoidoscopy 12. Willing to refrain from aspirin and NSAID use for one week before and after each study biopsy visit 13. Willing and able to use condoms for all Receptive Anal Intercourse (RAI) for the duration of participation 14. Willing and able to participate in a directly observed study, which may occur in person, using live streaming or a time stamped video 15. Has an identified healthcare provider for transgender health management 16. Agree not to participate in other research studies involving drugs and/or medical devices for the duration of the study	1. Not currently on any PrEP regimen (e.g., Truvada®, tenofovir alafenamide/ emtricitabine) 2. History of chronic Hepatitis B infection, as documented by positive HBsAg at screening 3. ≥ Grade 2 laboratory abnormality at baseline as defined by Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1 - July 2017, and Addendum 3 (Rectal Grading Tables for Use in Microbicide Studies) 4. Significant colorectal symptom(s) as determined by medical history or by participant self- report (including but not limited to presence of any unresolved injury, infectious or inflammatory condition of the local mucosa, history of inflammatory bowel disease, presence of symptomatic hemorrhoids, and presence of any painful anorectal conditions that would be tender to manipulation) 5. At screening or within the past 2 months: participant-reported symptoms and/or clinical or laboratory diagnosis of active rectal infection requiring treatment per current Centers for Disease Control (CDC) guidelines or symptomatic urinary tract infection (UTI). Infections requiring treatment include Chlamydia (CT), gonorrhea (GC), syphilis, active herpes simplex virus (HSV) lesions, chancroid, genital sores or ulcers, and, if clinically indicated, genital warts. Note that HSV seropositivity with no active genital lesions is not an exclusion criterion. (Note: if an Sexually Transmitted Infection (STI) apart from HIV is detected, the participant will be referred for treatment and can be retested in 30 days and rescreened once.) 6. History of an underlying clinically significant cardiac arrhythmia or renal disease (including creatinine clearance \< 60 mL/min using Cockcroft-Gault equation) 7. Serum phosphate \< 2.3 mg/dL 8. History of severe or recent cardiac or pulmonary event 9. History of significant gastrointestinal bleeding 10. Current use of warfarin or heparin or other anticoagulant medications associated with increased risk for bleeding following mucosal biopsy (e.g., daily high dose aspirin \[\>81 mg\], Non-steroidal anti-inflammatory drug \[NSAIDs\], or Pradaxa®) 11. Use of systemic or anorectal immunomodulatory medications within 4 weeks of enrollment or planned use at any time during study participation

Inclusion Criteria

Exclusion Criteria

1. 18 years of age or older
2. Self-identifying as a transgender woman
3. Not currently taking any gender affirming hormonal therapy (GAHT) with a total testosterone concentration of ≥ 200 ng/dL, or willing to abstain from feminizing therapies (including estradiol, spironolactone, progesterone, etc.) until total total testosterone concentrations are ≥ 200 ng/dL. Note: Testosterone may be retested every 2-4 weeks during screening to determine eligibility up to 6 weeks.
4. HIV-1 uninfected at screening as documented by Combo Ag/Ab HIV-1/HIV-2 immunoassay
5. Understand and agree to local STI reporting requirements
6. Able and willing to communicate in English
7. Able and willing to provide written informed consent to take part in the study
8. Able and willing to provide adequate information for locator purposes
9. Able and willing to participate in a directly observed study, which may occur in person, using live streaming or a time stamped video?
10. Availability to return for all study visits, barring unforeseen circumstances
11. Willing to abstain from insertion of anything (drug, enema, penis, or sex toy) in rectum for 72 hours before and 72 hours after each flexible sigmoidoscopy
12. Willing to refrain from aspirin and NSAID use for one week before and after each study biopsy visit
13. Willing and able to use condoms for all Receptive Anal Intercourse (RAI) for the duration of participation
14. Willing and able to participate in a directly observed study, which may occur in person, using live streaming or a time stamped video
15. Has an identified healthcare provider for transgender health management
16. Agree not to participate in other research studies involving drugs and/or medical devices for the duration of the study

1. Not currently on any PrEP regimen (e.g., Truvada®, tenofovir alafenamide/ emtricitabine)
2. History of chronic Hepatitis B infection, as documented by positive HBsAg at screening
3. ≥ Grade 2 laboratory abnormality at baseline as defined by Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1 - July 2017, and Addendum 3 (Rectal Grading Tables for Use in Microbicide Studies)
4. Significant colorectal symptom(s) as determined by medical history or by participant self- report (including but not limited to presence of any unresolved injury, infectious or inflammatory condition of the local mucosa, history of inflammatory bowel disease, presence of symptomatic hemorrhoids, and presence of any painful anorectal conditions that would be tender to manipulation)
5. At screening or within the past 2 months: participant-reported symptoms and/or clinical or laboratory diagnosis of active rectal infection requiring treatment per current Centers for Disease Control (CDC) guidelines or symptomatic urinary tract infection (UTI). Infections requiring treatment include Chlamydia (CT), gonorrhea (GC), syphilis, active herpes simplex virus (HSV) lesions, chancroid, genital sores or ulcers, and, if clinically indicated, genital warts. Note that HSV seropositivity with no active genital lesions is not an exclusion criterion. (Note: if an Sexually Transmitted Infection (STI) apart from HIV is detected, the participant will be referred for treatment and can be retested in 30 days and rescreened once.)
6. History of an underlying clinically significant cardiac arrhythmia or renal disease (including creatinine clearance \< 60 mL/min using Cockcroft-Gault equation)
7. Serum phosphate \< 2.3 mg/dL
8. History of severe or recent cardiac or pulmonary event
9. History of significant gastrointestinal bleeding
10. Current use of warfarin or heparin or other anticoagulant medications associated with increased risk for bleeding following mucosal biopsy (e.g., daily high dose aspirin \[\>81 mg\], Non-steroidal anti-inflammatory drug \[NSAIDs\], or Pradaxa®)
11. Use of systemic or anorectal immunomodulatory medications within 4 weeks of enrollment or planned use at any time during study participation

Contacts and Locations

Principal Investigator

Mark A Marzinke, PhD

PRINCIPAL_INVESTIGATOR

Johns Hopkins School of Medicine

Study Locations (Sites)

Johns Hopkins School of Medicine Drug Development Unit

Baltimore, Maryland, 21287

United States

Collaborators and Investigators

Sponsor: Johns Hopkins University

Mark A Marzinke, PhD, PRINCIPAL_INVESTIGATOR, Johns Hopkins School of Medicine

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2021-03-01

Study Completion Date2025-03-24

Study Record Updates

Study Start Date2021-03-01

Study Completion Date2025-03-24

Terms related to this study

Additional Relevant MeSH Terms

Hiv
Prophylaxis
Transgender