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Dosing rectal microbicide gels as lubricants may not provide adequate HIV protection for men who have sex with men (MSM). Manual lubricant application showed variable distribution and retention compared to applicator dosing.

Keywords:
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Area of Science:

  • Anorectal drug delivery
  • HIV prevention research
  • Pharmacokinetics

Background:

  • Rising HIV incidence in men who have sex with men (MSM) necessitates new prevention strategies.
  • Oral pre-exposure prophylaxis (PrEP) is effective but requires adherence.
  • Behaviorally congruent dosing, like using microbicides as lubricants, is under investigation.

Purpose of the Study:

  • To compare the rectal distribution and retention of microbicide gel when manually applied as a lubricant versus applicator dosing.
  • To assess the feasibility of using microbicide gels in a manner consistent with sexual lubricant use.

Main Methods:

  • Five HIV-negative MSM received radiolabeled hydroxyethyl cellulose gel intrarectally via manual or applicator dosing.
  • A radiolabeled sexual lubricant was also manually applied.
  • Rectal distribution and retention were assessed using SPECT/CT imaging 4 hours post-administration.

Main Results:

  • Manual lubricant dosing resulted in variable rectosigmoid distribution (4.4-15.3 cm from the anorectal junction).
  • Significantly less gel was retained in the colon with manual dosing (3.4%) compared to applicator dosing (94.9% and 88.4%).
  • Applicator dosing provided more uniform distribution within the rectosigmoid.

Conclusions:

  • Manual dosing of rectal microbicide gel as a sexual lubricant leads to variable and potentially inadequate mucosal coverage.
  • This dosing method may not ensure predictable protection against HIV transmission.
  • Further research is needed to optimize rectal microbicide delivery for effective HIV prevention.