Transgender Women Voice Concerns About Potential Harmful HIV Drug Interaction with Hormones

Despite the positive impact of antiretrovirals in the HIV landscape, treatment adherence remains an issue. Transgender women have a high incidence of HIV acquisition, with an estimated 22% living with HIV in 5 high-income countries, including the United States.

The results of a new survey conducted by the National Institutes of Health (NIH) reveal that adherence among this subpopulation may be particularly challenging. More than half of transgender individuals in Los Angeles with HIV were concerned about taking both antiretroviral therapy (ART) and feminizing hormone therapy, and the potential risk for harmful drug interactions.

Most notably, many of the respondents cited these concerns as reasons for being non-adherent to ART, hormone therapy, or both.

For the study, investigators surveyed 87 transgender women receiving care at an AIDS service organization in Los Angeles.

Among the respondents, 69% were on some type of hormone therapy and one-quarter reported using hormone therapy without supervision from a health care professional. More than half of the transgender women were HIV-positive and undergoing ART.

Of the participants, 34% of HIV-positive transgender women were more likely to use HT without supervision compared with 13% of HIV-negative transgender women.

Fifty-seven percent of respondents living with HIV reported concerns that using both ART and hormone therapy might lead to drug interactions, and 40% attributed non-adherence to ART, HT, or both due to these fears.

Despite these concerns, only 49% of the respondents discussed the possibility of drug interactions with their health care team.

“Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize co-administration of ART and hormonal therapies in this population,” said study leader Jordan Lake, MD. “This study suggests this void of information may mean some transgender women forgo life-sustaining HIV medications, identity-affirming hormone therapy, or some combination of the 2. By exploring the extent to which this is happening, we can find ways to better serve this population.”

Although drug interactions between the 2 therapies are not well understood, concerns may stem from the known drug-drug interactions between certain forms of ART and components of hormonal contraceptives. Specific types of ART can lower the concentrations of components in hormonal contraceptives, ultimately reducing the efficacy, according to the study.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said co-investigator Judith Currier, MD. “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.”

The immediate initiation of ART following an HIV diagnosis prevents the onset of AIDS-related complications, improves overall health outcomes, and can lengthen life expectancy, research suggests.

“The best thing a person living with HIV can do is to start and stay on safe, effective antiretroviral therapy, both to maintain their own health and to prevent sexual transmission of the virus,” said Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. “We need to ensure we understand the perspectives of groups disproportionately affected by this pandemic to provide the best health care for them. Further study is needed to help determine how health care teams can optimally tailor care and treatment for those living with HIV.”