{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:09:06Z","timestamp":1779106146827,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T00:00:00Z","timestamp":1383264000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Research and Human Retroviruses"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:p>\n                    Rectally applied antiretroviral microbicides for preexposure prophylaxis (PrEP) of HIV infection are currently in development. Since enemas (rectal douches) are commonly used by men who have sex with men prior to receptive anal intercourse, a microbicide enema could enhance PrEP adherence by fitting seamlessly within the usual sexual practices. We assessed the distribution, safety, and acceptability of three enema types\u2014hyperosmolar (Fleet), hypoosmolar (distilled water), and isoosmolar (Normosol-R)\u2014in a crossover design. Nine men received each enema type in random order. Enemas were radiolabeled [\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-diethylene triamine pentaacetic acid (DTPA)] to assess enema distribution in the colon using single photon emission computed tomography\/computed tomography (SPECT\/CT) imaging. Plasma\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-DTPA indicated mucosal permeability. Sigmoidoscopic colon tissue biopsies were taken to assess injury as well as tissue penetration of the\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-DTPA. Acceptability was assessed after each product use and at the end of the study. SPECT\/CT imaging showed that the isoosmolar enema had greater proximal colonic distribution (up to the splenic flexure) and greater luminal and colon tissue concentrations of\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-DTPA when compared to the other enemas (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt;0.01). Colon biopsies also showed that only the hyperosmolar enema caused sloughing of the colonic epithelium (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt;0.05). In permeability testing, the hypoosmolar enema had higher plasma\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-DTPA 24-h area under the concentration-time curve and peak concentration compared to the hyperosmolar and isoosmolar enemas, respectively. Acceptability was generally good with no clear preferences among the three enema types. The isoosmolar enema was superior or similar to the other enemas in all categories and is a good candidate for further development as a rectal microbicide vehicle.\n                  <\/jats:p>","DOI":"10.1089\/aid.2013.0189","type":"journal-article","created":{"date-parts":[[2013,7,26]],"date-time":"2013-07-26T07:25:31Z","timestamp":1374823531000},"page":"1487-1495","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":44,"title":["Isoosmolar Enemas Demonstrate Preferential Gastrointestinal Distribution, Safety, and Acceptability Compared with Hyperosmolar and Hypoosmolar Enemas as a Potential Delivery Vehicle for Rectal Microbicides"],"prefix":"10.1177","volume":"29","author":[{"given":"Francisco J.","family":"Leyva","sequence":"first","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul P.","family":"Bakshi","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward J.","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liye","family":"Li","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian S.","family":"Caffo","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Bloomberg School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur J.","family":"Goldsmith","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Bloomberg School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Ventuneac","sequence":"additional","affiliation":[{"name":"New York State Psychiatric Institute and Columbia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Carballo-Di\u00e9guez","sequence":"additional","affiliation":[{"name":"New York State Psychiatric Institute and Columbia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Du","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey P.","family":"Leal","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda A.","family":"Lee","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Torbenson","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig W.","family":"Hendrix","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,11,1]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"CDC. HIV and AIDS in the United States. 2010."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540120902883127"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2009.009381"},{"issue":"5","key":"e_1_3_3_5_2","first-page":"700","article-title":"[Factors associated with infrequent condom use amongst men having sex with other men in Ciudad Juarez]","volume":"11","author":"Mendoza-Perez JC","year":"2009","unstructured":"Mendoza-Perez JC, , Ortiz-Hernandez L. [Factors associated with infrequent condom use amongst men having sex with other men in Ciudad Juarez] Rev Salud Publica (Bogota), 2009; 11,5:700\u2013712.","journal-title":"Rev Salud Publica (Bogota)"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000194596.78637.8e"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11079-8"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283522272"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1110711"},{"issue":"1","key":"e_1_3_3_12_2","first-page":"560","article-title":"Assessing priorities for combination HIV prevention research for men who have sex with men (MSM) in Africa","volume":"17","author":"Baral S","year":"2012","unstructured":"Baral S, , Scheibe A, , Sullivan P et al. Assessing priorities for combination HIV prevention research for men who have sex with men (MSM) in Africa. AIDS Behav, 2012; 17,Suppl 1:560\u2013568.","journal-title":"AIDS Behav"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3181bf9b2d"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9301-0"},{"key":"e_1_3_3_15_2","unstructured":"Hylton J Fuchs EJ Hendrix CW. An assessment of sexual practices affecting the feasibility of microbicide development among MSM. 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