Pharmacokinetics, the Immunological Impact, and the Effect on HIV Ex-Vivo Infectivity of Maraviroc, Raltegravir, and Lopinavir in Men Who Have Sex with Men Using Postexposure Prophylaxis

Abstract

Most of the studies using the colorectal tissue explants challenge model have been conducted after one single dose and before reaching a steady state. We consider that longer exposure as in 28-day postexposure prophylaxis (PEP) course and in an at-risk setting, such as after a sexual risk exposure to HIV could give us valuable information about these drugs. In a substudy we assessed pharmacokinetics, changes on immune system and ex-vivo rectal mucosal susceptibility to HIV-1 infection after taking maraviroc (MVC), raltegravir (RAL), and ritonavir-boosted lopinavir (LPV/r) PEP-based regimens in 30 men who have sex with men. Participants received 28 days of twice-daily MVC (n = 11), RAL (n = 10) or LPV/r (n = 9) all with tenofovir/emtricitabine (TDF/FTC) backbone. Blood, rectal fluid, and rectal tissue samples were collected at days 7, 28, and 90 after starting PEP. The samples obtained at day 90 were considered baseline. All studied antiretrovirals were quantifiable at 7 and 28 days in all tissues. Activation markers were increased in CD4 mucosal mononuclear cells (MMCs) after 28 days of MVC: CD38 + 68.5 versus 85.1, p = .008 and CD38+DR +16.1 versus 26.7, p = .008. Exposure to MVC at both endpoints (7 and 28 days) was associated with significant suppression of HIV-1_BAL (p = .005 and p = .028), but we did not observe this effect with RAL or LPV/r. Merging together changes in MMC in all arms, we found a positive correlation in the CD8 T cell lineage between the infectivity at day 7 and activation (CD38+ r = 0.43, p = .025, DR + r = 0.547, p = .003 and 38+DR+ r = 0.526, p = .05), senescence (CD57+CD28- r = 0.479, p = .012), naive cells (RA+CCR7+ r = 0.484, p = .01), and CCR5 expression (r = 0.593, p = .001). We conclude that MVC in combination with TDF/FTC was associated with viral suppression in rectal explants and that overall ex-vivo HIV infectivity correlated with activation and senescence in CD8 MMCs.

Keywords: HIV; maraviroc; postexposure prophylaxis; prevention; rectal explants.

FIG. 1.

Flowchart describing the participants' distribution and the different assessments performed during the study. LPV/r, ritonavir-boosted lopinavir; MVC, maraviroc; PK, pharmacokinetics; RAL, raltegravir.

FIG. 2.

(A–C) PK boxplots of each antiretroviral according to time since last dose, study time points (enrolment, days 7 and 28) and all three studied tissues: plasma, rectal fluid, and rectal tissue. Data collection about time since last dose was incomplete, which explains the large variability seen in the results.

FIG. 3.

Significant immunological effects in (A) PBMC and (B) MMC of the three studied antiretrovirals according to different time points. The interquartile range and median of the indicated subsets are shown. Pairwise comparisons were made using a Friedman test and Dunn's post-test for two pairwise comparisons. MMC, mucosal mononuclear cell; PBMC, peripheral blood mononuclear cell.

FIG. 4.

(A–C) HIV infectivity AUC in rectal tissue according to study drug between time points (baseline D90—no treatment, D7—treatment initiation, D28—end of treatment). AUC, area under the curve.