P14-07. Offering new prevention modalities in HIV vaccine trials: experience with male circumcision in the Phambili trial

Background: New prevention options will be added to the 'standard of prevention' offered in HIV vaccine efficacy trials as new methods prove effective. The HVTN503/Phambili trial was initiated in January 2007, shortly after results from 3 randomized controlled trials of male circumcision (MC) demonstrated that MC reduces the risk of HIV acquisition. Thus, HVTN503 investigators made plans to offer MC at no cost to enrolled male participants. Methods: All participants were informed of the benefits of MC as a component of HIV risk reduction counseling, including how and where MC could be accessed. One site offered on-site MC and the others provided referral to local services for men who requested MC. We present data on uptake of MC post-enrollment. Results: Prior to discontinuation of enrolment, 441 men joined the trial, of whom 312 (70.7%) were uncircumcised. Of these, 82 (26.3% of uncircumcised men) requested MC after enrolment. Uptake varied by site, being lower (70%) at the eThekwini site, the site with lowest baseline MC prevalence. Among 3 sites with intermediate baseline MC prevalence, uptake varied from 3.3 to 37.6%, being highest at the site providing MC on site. Uptake was similar in vaccine and placebo arms of the trial [42 (26.1%) vs. 40 (26.5%)]. There was no significant difference by arm in the timing of circumcision relative to randomization assignment being provided to participants following release of the STEP trial results [post-unblinding, vaccine 18 (42.9%) vs. placebo 13 (32.5%), p = 0.37]. Conclusion: MC, a new prevention modality, was offered as part of HIV prevention services in HVTN503. Uptake varied by provision of care model and inversely with baseline MC prevalence, but did not differ between treatment arms, and remained similar even after provision of treatment

Towards a harmonized method for the global reconnaissance of multi-class antimicrobials and other pharmaceuticals in wastewater and receiving surface waters

Antimicrobial resistance is a worldwide problem that is both pressing and challenging due to the rate at which it is spreading, and the lack of understanding of the mechanisms that link human, animal and environmental sources contributing to its proliferation. One knowledge gap that requires immediate attention is the significance of antimicrobial residues and other pharmaceuticals that are being discharged from wastewater treatment plants (WWTPs) on the dissemination of antimicrobial resistance in the environment. In this work we provide an approach to develop a harmonized analytical method for 8 classes of antimicrobials and other pharmaceuticals that can be used for global monitoring in wastewater and receiving waters. Analysis of these trace organic chemicals in the influent and effluent wastewater, and in the respective upstream and downstream receiving waters from different countries across the globe is not trivial. Here, we demonstrated that sample preparation using solid-phase extraction (SPE) not only provides a convenient and cost-effective shipping of samples, but also adds stability to the analytes during international shipping. It is important that SPE cartridges are maintained at cold temperature during shipment if the duration is longer than 7 days because a significant decrease in recoveries were observed after 7 days in the cartridges stored at room temperature, especially for sulfonamides and tetracyclines. To compensate for sample degradation during shipment, and matrix effects in liquid chromatography/mass spectrometry, the use of stable isotope labeled compounds should be employed when available and affordable. The importance of applying a defined tolerance for the ion ratios (Q/q) that have been optimized for wastewater and surface water is discussed. The tolerance range was set to be the mean Q/q of the analyte standard at various concentrations ±40% for the influent, and ±30% for the effluent, upstream, and downstream samples; for tetracyclines and quinolones, however, the tolerance range was ±80% in order to minimize false negative and false positive detection. The optimized procedures were employed to reveal differences in antimicrobial and pharmaceutical concentrations in influent, effluent, and surface water samples from Hong Kong, India, Philippines, Sweden, Switzerland, and United States. The antimicrobials with the highest concentrations in influent and effluent samples were ciprofloxacin (48,103 ng/L, Hong Kong WWTP 1) and clarithromycin (5178 ng/L, India WWTP 2), respectively. On the other hand, diclofenac (108,000 ng/L, Sweden WWTP 2), caffeine (67,000 ng/L, India WWTP 1), and acetaminophen (28,000 ng/L, India WWTP 1) were the highest detected pharmaceuticals in the receiving surface water samples. Hong Kong showed the highest total antimicrobial concentrations that included macrolides, quinolones, and sulfonamides with concentrations reaching 60,000 ng/L levels in the influent. Antidepressants were predominant in Sweden, Switzerland, and the United States

Re: Comparison of single photon emission computed tomography findings in cases of healthy adults and solvent-exposed adults

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34818/1/19_ftp.pd

Safety and Immunogenicity of an HIV-1 Gag DNA Vaccine with or without IL-12 and/or IL-15 Plasmid Cytokine Adjuvant in Healthy, HIV-1 Uninfected Adults

DNA vaccines are a promising approach to vaccination since they circumvent the problem of vector-induced immunity. DNA plasmid cytokine adjuvants have been shown to augment immune responses in small animals and in macaques.We performed two first in human HIV vaccine trials in the US, Brazil and Thailand of an RNA-optimized truncated HIV-1 gag gene (p37) DNA derived from strain HXB2 administered either alone or in combination with dose-escalation of IL-12 or IL-15 plasmid cytokine adjuvants. Vaccinations with both the HIV immunogen and cytokine adjuvant were generally well-tolerated and no significant vaccine-related adverse events were identified. A small number of subjects developed asymptomatic low titer antibodies to IL-12 or IL-15. Cellular immunogenicity following 3 and 4 vaccinations was poor, with response rates to gag of 4.9%/8.7% among vaccinees receiving gag DNA alone, 0%/11.5% among those receiving gag DNA+IL-15, and no responders among those receiving DNA+high dose (1500 ug) IL-12 DNA. However, after three doses, 44.4% (4/9) of vaccinees receiving gag DNA and intermediate dose (500 ug) of IL-12 DNA demonstrated a detectable cellular immune response.This combination of HIV gag DNA with plasmid cytokine adjuvants was well tolerated. There were minimal responses to HIV gag DNA alone, and no apparent augmentation with either IL-12 or IL-15 plasmid cytokine adjuvants. Despite the promise of DNA vaccines, newer formulations or methods of delivery will be required to increase their immunogenicity.Clinicaltrials.gov NCT00115960 NCT00111605