Research Gaps in Drug Interactions Raise Concerns for Transgender Women With HIV

A recent study finds that the majority of HIV-infected transgender women are anxious about taking ART and feminizing hormone therapy simultaneously due to hazardous drug interactions.

Results from a recent study conducted show that a majority of transgender women living with HIV in Los Angeles felt anxious about simultaneously taking antiretroviral therapy (ART) for the treatment of HIV and feminizing hormone therapy (HT), due to the possibility of hazardous drug interactions. This information is causing concerns because it indicates that the participants feel that they cannot safely take medicines for HIV while taking hormone therapy that affirms the gender that they identify with.

Transgender women are increasingly vulnerable to acquiring HIV. According to a meta-analysis released by the Centers for Disease Control and Prevention in 2013, 22% of transgender women were living with HIV in 5 of the world’s high-income nations, including the United States. This data echo the concerning conclusion of the survey, because ART is most effective when used early and steadily. The optimal use of anti-HIV medications is important for several reasons, including preventing serious HIV-related side effects and impeding the sexual transmission of HIV to others, which contributes to reducing the pandemic.

The research findings, which were conducted with support from the National Institutes of Health (NIH) and Gilead Sciences, were reported at the 9th International AIDS Society Conference on HIV Science yesterday in Paris, by representatives from the National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Mental Health (NIMH), which are part of NIH. The findings were reported from a survey of 87 transgender women receiving health care at an AIDS service organization in Los Angeles. More than half of the total population had been diagnosed with HIV and were prescribed ART. Sixty-nine percent of the participants were using HT, but a quarter of that population reported that they were using HT without proper medical supervision, according to the study. Thirty-four percent of transgender women with HIV were using HT without supervision, compared with only 13% of transgender women without HIV, according to the study.

The study also indicated that 57% of the participants living with HIV were worried about possible drug interactions between ART and HT, and 40% of participants attributed not using one or both therapies because of their concerns. Despite reporting their concerns in the study, only 49% discussed their concerns with their medical professional.

“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 Jordan Lake, MD, in the in a press release. Lake is a study leader at the University of California, Los Angeles David Geffen School of Medicine, and is conducting relevant research at the University of Texas Health Sciences Center at Houston. “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 two. By exploring the extent to which this is happening, we can find ways to better serve this population.”

The use of ART quickly and consistently following HIV infection is important in preventing early onset of AIDS-related complications. ART also improves other aspects of health and can contribute to extending life expectancy. Consistent use also limits the likelihood of transmitting the virus to sexual partners. Despite the positive outcomes that occur from using ART, there is very little information about the therapy’s reaction with hormone therapy.

The concerns about drug interactions between ART and HT are possibly related to the drug interactions between types of ART and types of hormonal contraceptives, which may be similar to components of HT. ART can lower the effectiveness of certain hormonal contraceptives, but if this occurs, a simple dose modification or drug substitution can be effective. However, NIH indicates that there not an accepted scientific conclusion about the safety and effectiveness of combining ART and HT in transgender women with HIV.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-director of the Center for AIDS Research and Education at the University of California, Los Angeles, 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.”