Sex Hormone Therapy and Mucosal Tissues

Study Design:

This is an observational study of tenofovir/emtricitabine (TFV/FTC) concentrations in the
genital and lower gastrointestinal tracts. Participants will be selected on the basis of
receiving TFV/FTC as part of their ongoing HIV care. After participant education, informed
consent, and screening for study eligibility, participants will be evaluated at baseline. All
samples will be collected over the course of an outpatient sampling visit.

Study Sampling:

1. A blood sample will be collected to measure the concentration of TFV/FTC in the blood
plasma, the concentration of TFV/FTC active metabolite concentrations (TFVdp/FTCtp) in
the PBMCs, and the concentration of sex hormones in the blood stream.

2. Vaginal and cervical tissue will be collected (for cisgender women) to measure for
concentrations of TFVdp/FTCtp, HIV RNA, and estrogen/progesterone.

3. Rectal tissue samples will be collected to measure for concentrations of TFVdp/FTCtp,
HIV RNA, estrogen/progesterone (for cisgender and transgender women), and testosterone
(for cisgender men).

4. A semen sample will be collected (for cisgender men) to measure the concentrations of
TFV/FTC, HIV RNA and testosterone.

Pharmacokinetic Analysis:

All blood, cervical, vaginal, semen and rectal tissue samples will be analyzed by the
Clinical Pharmacology and Analytical Chemistry Laboratory (CPAC) at the UNC School of
Pharmacy. TFV/FTC will be measured in blood and seminal plasma and TFVdp/FTCtp will be
measured in PBMCs, SMCs using validated LC-MS/MS methods. HIV RNA will be measured in blood
and seminal plasma using the Abbott Real Time HIV-1 quantitative assay. HIV RNA within the
cervical and seminal cells and rectal tissues will be measured using an established Droplet
Digital PCR method. Estradiol and progesterone will be measured in serum using validated
florescent immunoassays.

Inclusion Criteria:

All subjects eligible to enroll must meet the following inclusion criteria, regardless of
cohort:

- HIV-positive adults aged 18-65, inclusive on the date of screening, clinically
healthy, with an intact gastrointestinal tract. Any screening test may be repeated
once in the screening window to confirm or verify eligibility.

- Evidence of a personally signed and dated informed consent document indicating that
the subject has been informed of all the pertinent details of the study.

- Willing and able to comply with scheduled visits, treatment plan laboratory tests, and
other trial procedures

- Subjects must not be actively involved in the conception process, currently
pregnant/lactating/ or in the immediate post-partum period.

- Subjects must be willing to abstain from all sexual activity, and all intravaginal and
intrarectal products for at least 72 hours prior to the sampling day, until seven days
later

- HIV RNA viral load undetectable (<50 copies/mL or less per institution) within at
least the previous six months prior to screening. Repeat HIV RNA Viral load testing
may be conducted at screening, if indicated.

-->80% adherent to their antiretroviral regimen per self-report, and a compliant diary
card 5 days before intensive sampling

- Actively adherent to an antiretroviral regimen containing both tenofovir (TDF) and
emtracitabine (FTC) for >1 month (if switched from previous regimen) or >3 months (if
previously antiretroviral naive) as part of their standard clinic care

- Negative, or treated, sexually transmitted infections at screening including syphilis,
gonorrhea, chlamydia, and trichomoniasis

- All subjects must have an estimated calculated creatinine clearance of (eCcr) at least
60mL/min by the Cockcroft-Gault formula

- No clinical or surgical abnormalities (i.e. hysterectomy) that would preclude sample
collection

- Hemoglobin Grade 2 or lower, with no clinical significant medical issues that would
preclude blood sampling

- Coagulation testing Grade 2 or lower, with no clinically significant medical issues
that would preclude tissue sampling

Exclusion Criteria:

- Age outside of desired range

- Subject is HIV negative

- Impaired renal function, as documented with a creatinine clearance <60mL/min with the
Cockcroft-Gault equation

- Receiving an antiretorivral regimen that does not include TDF/FTC, or adherent to a
TDF/FTC regimen less than one month, or patient is unlikely to remain on this regimen
during the sampling period

- Less than 80% adherence to anti-retroviral medications, and more than 3 missed doses
in the month preceding enrollment

- Subject is not able or willing to follow the diet and lifestyle guidelines necessary
for the study period

- Active, untreated, sexually transmitted infection, including syphilis, gonorrhea,
chlamydia or trichomoniasis or symptomatic bacterial vaginosis

- Clinical, laboratory, or surgical abnormalities that would preclude sample collection
(for example but not limited to: hysterectomy)

- Subjects actively involved in the conception process, currently pregnant or lactating,
or immediately post-partum