The concept of preventing sexual transmission of the human immunodeficiency virus (HIV) infection via pre- exposure prophylaxis (PrEP) with antiretroviral drugs (ARV) has been clinically proven, yet its implementation remains difficult, as poor adherence has repeatedly confounded clinical progress. Individuals at high risk for HIV infection would benefit from ARV drug delivery systems with long duration and sustained/controlled drug release. Technological achievements in pharmaceutics and medicinal chemistry allow us to envision combining clinically advanced drug delivery technologies and extremely potent and long-acting ARV into drug delivery systems that could protect users from HIV for many months, and perhaps as long as a year. The objective of the Sustained Long-Acting Protection from HIV (SLAP-HIV) program is to test and clinically develop a long-acting drug delivery system of one of the following fourth generation ARV: cabotegravir, rilpivirine, tenofovir alafenamide fumarate, or the tenofovir analog CMX-157. Several parenteral drug delivery systems will be made and tested by three competing teams exploring three unique drug delivery platforms: reservoir implants, degradable implants, and controlled release injectables. We will compare our systems functionally for stability, manufacturability, duration, and pharmacokinetic and safety endpoints. We will work in parallel with high-risk groups to develop user based design input and criteria to inform the clinical development of the drug delivery systems. We will also investigate the acceptability of a wide variety of designs in high-risk individuals. A single lead formulation from each drug delivery project will be selected for further study of pharmacokinetics and pharmacodynamics in non-human primates. From these studies, a single lead formulation will be selected for clinical development, based on achieving a well-defined target product profile. Next, we will focus on studies required for an investigational new drug application (IND) along with the transfer of manufacturing methods to a contract research organization. We will conduct pharmacokinetics and pharmacodynamics studies in macaques to further study the prophylactic potential of the lead product and provide non-GLP support data for the IND. Finally, a Phase 1 clinical study will conclude the program to examine the safety, pharmacokinetics and acceptability of the lead ARV eluting drug delivery system. In total, these studies will advance our understanding of long-acting drug delivery systems and their ability to disrupt mechanisms of transmission. We have designed the program to ensure success and will be aided by the inclusion of many leading HIV experts, whose combined expertise spans drug delivery research, pharmaceutical development and HIV science. The impact of the product platforms developed from this research will extend beyond HIV PrEP and will advance our understanding of how to implement long-acting HIV therapy for those already infected, and to other therapeutic areas where long-acting systems are needed.

Public Health Relevance

The studies proposed could have a substantial impact on the national and global HIV/AIDS pandemic by developing new ways to prevent sexual transmission of HIV by making it easier for high-risk individuals to use medicines. The studies will advance our understanding on how to rapidly develop and test HIV prevention technology in humans and may be important in the development of new ways to treat those who are infected by HIV.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project with Complex Structure Cooperative Agreement (UM1)
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Special Emphasis Panel (ZAI1-JBS-A (M1))
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Turpin, Jim A
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Northwestern University at Chicago
Anatomy/Cell Biology
Schools of Medicine
United States
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Rael, Christine Tagliaferri; Martinez, Michelle; Giguere, Rebecca et al. (2018) Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City. AIDS Behav 22:3627-3636
Greene, George J; Swann, Greg; Fought, Angela J et al. (2017) Preferences for Long-Acting Pre-exposure Prophylaxis (PrEP), Daily Oral PrEP, or Condoms for HIV Prevention Among U.S. Men Who Have Sex with Men. AIDS Behav 21:1336-1349
Hope, Thomas J; Marrazzo, Jeanne M (2015) A Shot in the Arm for HIV Prevention? Recent Successes and Critical Thresholds. AIDS Res Hum Retroviruses 31:1055-9