Trans Women with HIV Are Skipping ART Because of Fears That It May Affect Feminine Hormone Therapy

Transgender women with HIV are adhering poorly to their treatment regimens because of concerns that combining antiretroviral therapies (ART) with feminine hormone therapies (HT) can lead to poor outcomes.

Little is clinically known about how the therapies interact, but new research from the National Institutes of Health and Gilead Sciences reveals that speculation is causing many transgender women to come off therapies that could otherwise save their lives or help them transition genders.

These findings are concerning for medical professionals because transgender women are a high-risk group for HIV. A 2013 meta-analysis by the Centers for Disease Control and Prevention (CDC) found that roughly 22% of transgender women in high-income nations, including the U.S., have HIV.

“Hopefully, these results will raise provider awareness of these issues, which are critical to the health of transgender women,” Jordan E. Lake (pictured), MD, MSc, an associate professor in the Division of Infectious Diseases at the McGovern Medical School at the University of Texas Health Science Center at Houston, told MD Magazine. “We have many things left to learn, but I will be happy if these findings result in better communication between providers and their transgender patients.”

Anthony S. Fauci MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), echoed Lake's sentiment, stating that doctors need to better understand how to “optimally tailor care and treatment for those living with HIV” in groups such as transgender women.

The investigators surveyed a group of 87 transgender women who were receiving AIDS services at a community-based organization and found that 69% were on some sort of HT, while more than half were living with HIV and were prescribed ART. They found that those living with HIV were more likely to use HT without proper medical supervision (34% compared to 13% without HIV), and that 25% of the total surveyed were using HT without proper supervision.

Among those living with HIV, 57% were concerned with potential drug interactions between HT and ART, and 40% claimed to not use one of the drugs due to that concern, the study read. Despite that, only 49% of the group shared their concern with a health care team.

Lake added that the study suggests that there is a void of information on how to treat this specific community, and that “by exploring the extent to which this is happening, we can find ways to better serve this population.”

Lake cited that concerns may stem from the fact that certain forms of ART have been known to have a negative effect on hormonal contraceptives, which share similarities to drugs used in HT, but with different dosages. However, when drug substitutions or dose modifications are made, drug interaction can be minimized.

Still, the fact remains that there is no agreement in the scientific community on the safety or efficacy of the combination of ART and HT in the population of transgender women with HIV, per the study.

“Transgender women are the only population likely to have the potential need for concomitant HIV medications and feminizing hormone therapy. They are a unique group,” Lake told MD Magazine. “However, these results may translate to 1) HIV-uninfected trans women considering PrEP (HIV Pre-Exposure Prophylaxis, essentially taking HIV medications to prevent HIV infection) and, 2) Trans men, who may have concerns about testosterone/other medication interactions.”

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