This study will evaluate the hypothesis that intravaginal rings (IVRs) can safely and in a sustained fashion, deliver the antiretroviral (ARV) drugs - tenofovir disoproxil fumarate (TDF), emtricitabine (FTC), and maraviroc (MVC), in healthy women when used in the following drug combinations: 1) TDF ("Single" IVR); 2) TDF-FTC ("Dual" IVR) and; 3) TDF-FTC-MVC ("Triple" IVR).

TDF = tenofovir disoproxil fumarate; FTC = emtrcitabine; MVC = maraviroc

The broad long term goal of this project is to empower women to protect themselves from HIV through woman-controlled sustained local delivery of ARTs via intravaginal rings. The short-term general investigational plan is to evaluate IVRs releasing TDF, TDF-FTC and TDF-FTC-MVC in healthy women for up to 7 days in an open-label study to determine safety and drug concentrations in plasma and cervicovaginal lavage and secretions. Additional exploratory studies will be considered and planned based in part on the results obtained in this study. The long-term investigational plan is to evaluate the safety and efficacy of sustained release TDF, TDF-FTC and TDF-FTC-MVC for their ability to decrease HIV transmission to vulnerable women.

Inclusion Criteria:

• Provides written informed consent
• Healthy female 18-45 years of age
• HIV negative per subject report and results of screening examination
• Negative for sexually transmitted diseases in the past 3 months and at screening exam
• No history of genital herpes simplex I or II per subject report
• Currently using contraception with plans to continue throughout the study duration or having sex with females only
• Pre-menopausal with a regular menstrual cycle with at least 21 days between menses and no history of intermenstrual bleeding or with suppressed menstrual cycle by hormonal contraception such as Depo-Provera or continuous oral contraceptive agents
• Subjects must agree to abstain from vaginal, anal, and oral sex throughout the first week of each dosing period and then use condoms for vaginal/rectal intercourse until after the final visit for use of each IVR
• Subjects must agree to not douche or use any vaginal product other than the Single, Dual and Triple ARV IVRs, including lubricants, feminine hygiene products, and vaginal drying agents throughout the dosing period and until after the final visit
• Subjects must agree to blood draws and vaginal exams throughout the course of the study

Exclusion Criteria:

• HIV positive by subject report or results of screening examination
• Positive history for autoimmune disease
• Abnormal genital exam defined as grade 1 or higher adverse event by DAIDS genital AE grading table
• Abnormal ALT or AST or Hepatitis B infection
• Active vaginal infection as determined by site IoR
• Abnormal renal function (defined as a creatinine clearance of <50mL/min/1.73 m2)
• Pregnant or less than 6 months post-partum or current lactation
• Current use of an IVR (i.e., Nuvaring, Estring, Femring)
• History of TDF, FTC, and MVC use and/or adverse reaction to any of these drugs
• History of adverse reaction to silicone
• History of toxic shock syndrome
• Currently receiving chemotherapy or immunosuppressive agents
• Use of investigative drugs within 30 days or 5 half-lives
• Currently using or suspected to be using non-therapeutic injection drugs

6 subjects were screened, entered, and completed Period 1: TDF-IVR (Single IVR).

The 6 subjects then completed Period 2: TDF-FTC (Dual IVR). 4 of the 6 subjects dropped out afterward.

2 of the 6 original subjects, plus 4 new subjects entered Period 3: TDF-FTC-MVC (Triple IVR).

Here, baseline data of all subjects are presented.

Adverse event data was collected Days 0-21 following insertion of each IVR. Safety measures include: daily participant reports, colposcopy examinations, vaginal microbiome evaluations, or histology from vaginal biopsy.

The study's main limitations include the small sample size, short duration (7 days), and the lack of FTC triphosphate measurements in vaginal tissue biopsies.