HRT (GAHT) & HIV

Gender Affirming Hormone Therapy & HIV:

Gender Affirming Hormone Therapy (GAHT) and HIV medications used today can be taken together and do not have any known effects on the influence or outcome of either medication. Often it is the inability to break through social and healthcare-related barriers that create health complications, not the drug interactions between PrEP and GAHT. This theme comes up frequently in research literature, for example, Rainbow Health’s Transgender Men’s 2010 Sexual Health and HIV Risk Rapid Response Report points out that it’s individual, interpersonal, and structural/societal factors that are likely harmful to good health outcomes for transgender folks. “Barriers to employment, social services, housing, legal assistance and health and mental health care” were among the leading structural societal barriers.   

The established standard of care for HIV in Canada is highly active antiretroviral therapy (HAART). This is a combination of different drugs is so effective at suppressing the virus they significantly reduce the amount of HIV in the blood and resulting in better health for the person living with HIV and decreasing the chances of transmitting HIV to another person. The National Institute of Health recommends that all transgender people living with HIV take HAART. Although “some antiretroviral drugs may have interactions with gender-affirming hormone therapy”, there are many successful HAART regiments that don’t interact. So, it is important to keep your health care provider informed of your hormone regiment so they can monitor that regiment along with your T cell levels and viral load levels regularly. 

Contrary to previous clinical reports using older HIV medications, a 2020 published article by the Clinical Infectious Disease journal found no difference in effectiveness of HAART in trans women taking GAHT than they did in cis women and men living with HIV on an HAART regimen. However, one 2019 study found that “rates of viral suppression were significantly greater among transgender women with HIV (TGWWH) receiving GAHT when compared with those who were not.” Trans women living with HIV who maintain successful HAART and GAHT regiments experienced higher rates of HIV suppression. 

The CDC (Centre for Disease Control and Prevention) states that “there are no known drug interactions between (most) HIV medications and hormone therapy. This appears true of HIV treatments as well as HIV preventative medication.” 

Practically Speaking,

• PrEP is recommended for all trans folks on GAHT who are at risk for HIV.
• The Pre-Exposure Prophylaxis (PrEP) drug Descovy is not approved for trans masculine folks who are receiving frontal penetration, as the known effectiveness has not been adequately evaluated. It is recommended trans men and cis women receiving front hole penetration review other PrEP choices with their medical provider.
• For someone with a front hole, GAHT may reduce natural lubrication as well as thin the inner tissue of the front hole, which can increase the chances exposure to blood and opening to the blood stream, and in turn increase the chances for STBBI (sexually transmitted infection blood borne infections). However, there is very little published research on trans men, sexual health, and HIV transmission, and only slightly more regarding trans women, but this research is still scarce. Using lubrication can reduce these risks (and make sex a lot more comfortable) if you notice this is an issue.

Understanding the sex that you want, will help choose the best methods of STBBI prevention and/or a treatment regimen that works for you. As medical professionals prescribing PrEP are also involved in monitoring kidneys and other health issues, disclosing if you are taking hormones to them can be useful for them to keep in mind.

Resources

Medical News Today – How does having HIV affect gender-affirming hormone therapy? https://www.medicalnewstoday.com/articles/hiv-and-gender-affirming-hormone-therapy#hormone-therapy-with-hiv 

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV – Considerations for Antiretroviral Use in Special Patient Populations: Transgendered People with HIV https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/transgender-people-hiv

Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis: https://academic.oup.com/cid/article/70/6/1131/5477380 

Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women: https://academic.oup.com/ofid/article/8/9/ofab404/6331030 

Considerations for Antiretroviral Use in Special Patient Populations: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/transgender-people-hiv#:~:text=Antiretroviral%20therapy%20(ART)%20is%20recommended,to%20sexual%20partners%20(AI)

Feminizing hormone therapy in a Canadian cohort of transgender women with and without HIV: https://journals.sagepub.com/doi/full/10.1177/13596535231182505

Transgender Men’s Sexual Health and HIV Risk https://www.rainbowhealthontario.ca/wp-content/uploads/2010/09/RR33-2010-TransMen-HIV.pdf