Drug Interaction Concerns Negatively Impact Certain Patients With HIV

HIV-positive patients may not remain adherent to antiretroviral therapy and feminizing hormone therapy due to concerns over drug interactions.

A new study reveals that fear of drug-drug interactions among transgender women may heighten the risk of their disease worsening and increase HIV transmission.

The study, which was supported by the National Institutes of Health and Gilead Sciences, indicated that more than 50% of transgender women living with HIV were concerned that taking antiretroviral therapy (ART) and feminizing hormone therapy (HT) may be linked to drug interactions.

The concerns over adverse events resulted in patients not taking ART, HT, or both treatments as prescribed, according to a press release. These findings are particularly concerning because ART can prevent HIV-related complications and transmission.

“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 at the National Institute of Allergy and Infectious Disease. “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.”

Included in the study were 87 transgender women receiving care at an AIDS service organization in Los Angeles, CA. Of these patients, 69% were treated with HT, with one-quarter of patients using the drugs without medical supervision, according to the release. The authors noted that more than half of the patients were HIV-positive and were prescribed ART.

Interestingly, patients with HIV were observed to be more than twice as likely to use HT without supervision by a medical professional.

Approximately 57% of patients with HIV expressed concern that using ART and HT would lead to drug interactions, with 40% of patients not using the drugs as prescribed due to the risk of adverse events, according to the study.

However, nearly half of these patients discussed potential drug interactions with their healthcare providers, which suggests that the concerns of patients may not be based in fact, according to the study authors.

“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 lead author 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.”

Current research has found that initiating ART soon after diagnosis and remaining adherent to treatment can prevent complications, improve outcomes, and lengthen life. Additionally, adhering to treatment leads to viral suppression.

Drug interactions between ART and HT are largely unknown, according to the study. Concerns of drug interactions may have been sparked by known interactions between ART and hormonal contraceptives. While the components of contraceptives and HT may be similar, the dosages are different, the authors reported.

There is currently no consensus about the safety and efficacy of ART and HT among this population, which highlights the need for additional research, according to the study.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said researcher 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.”