Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences.
Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.
However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.
There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.
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The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.
“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”
Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women. https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.