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Wascher J, Hazra A, Fisher AR. Sexual Health for Transgender and Gender Diverse Individuals: Routine Examination, Sexually-Transmitted Infection Screening, and Prevention. Obstet Gynecol Clin North Am 2024; 51:405-424. [PMID: 38777492 DOI: 10.1016/j.ogc.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Gynecologists play a critical role in the office evaluation of transgender and gender diverse individuals. This includes the provision of essential healthcare services including the treatment and prevention of human immunodeficiency virus and sexually-transmitted infections and screening for human papillomavirus infection-related diseases and cancers. Caring for patients who identify as transgender or gender diverse (TGD) and who have undergone gender-affirming surgical treatments is challenging due in part to clinical gaps in knowledge resulting from insufficient training and educational resources. A patient-centered approach to the care of TGD individuals requires knowledge of the general principles of affirming, holistic care with attention to the risk factors, and anatomic considerations unique to this population. This review aims to provide basic knowledge needed for the successful gynecologic evaluation of a gender diverse patient.
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Affiliation(s)
- Jocelyn Wascher
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Aniruddha Hazra
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Pritzker School of Medicine, 924 E 57th Street #104, Chicago, IL 60637, USA
| | - Andrew R Fisher
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Pritzker School of Medicine, 924 E 57th Street #104, Chicago, IL 60637, USA.
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2
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Patel N, Morris S, Burke L, Chow K, Pacheco D, Anderson P, Stancyzk F, Blumenthal J. No observed bidirectional effect between tenofovir diphosphate concentrations and gender-affirming hormone concentrations among transgender persons switching from tenofovir disoproxil fumarate/emtricitabine to tenofovir alafenamide/emtricitabine for HIV pre-exposure prophylaxis. Br J Clin Pharmacol 2024. [PMID: 38646796 DOI: 10.1111/bcp.16071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
AIMS Many transgender and gender diverse (TGD) individuals have expressed concerns about the potential for oral pre-exposure prophylaxis to affect hormonal concentrations achieved from taking gender-affirming hormone therapy (GAHT). The purpose of this study was to understand the bidirectional effects between hormone and intraerythrocytic tenofovir diphosphate concentrations when switching from tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) to tenofovir alafenamide/emtricitabine (TAF/FTC) in TGD users/nonusers of GAHT. METHODS The study evaluated stored blood samples and dried blood spot cards from TGD adults without HIV who took ≥12 weeks of TDF/FTC and then switched to ≥12 weeks of TAF/FTC for pre-exposure prophylaxis. RESULTS Thirty-nine individuals met the study inclusion criteria. Regardless of sex assigned at birth and the use of GAHT, there were no significant differences in hormone concentrations when individuals taking GAHT were taking TDF/FTC and then switched to TAF/FTC. Further, there was no significant difference in intraerythrocytic tenofovir diphosphate concentrations between users and nonusers of GAHT. CONCLUSION There are no bidirectional effects between hormone and intraerythocytic tenofovir diphosphate concentrations when switching from TDF/FTC to TAF/FTC in TGD users/nonusers of GAHT.
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Affiliation(s)
- Nimish Patel
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Sheldon Morris
- School of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, La Jolla, California, USA
| | - Leah Burke
- AntiViral Research Center, University of California San Diego, La Jolla, California, USA
| | - Karen Chow
- AntiViral Research Center, University of California San Diego, La Jolla, California, USA
| | - Deedee Pacheco
- AntiViral Research Center, University of California San Diego, La Jolla, California, USA
| | - Peter Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frank Stancyzk
- University of Southern California, Los Angeles, California, USA
| | - Jill Blumenthal
- School of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, La Jolla, California, USA
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3
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Rosen JG, Beckham SW, Glick JL, White RH, Park JN, Footer KH, Sherman SG. Acceptability of Event-Driven and Long-Acting HIV Pre-Exposure Prophylaxis Formulations Among Transgender Women Engaged in Street-Based Sex Work in Baltimore, Maryland. Transgend Health 2024; 9:185-191. [PMID: 38585249 PMCID: PMC10998007 DOI: 10.1089/trgh.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We assessed acceptability of nonoral HIV pre-exposure prophylaxis (PrEP) formulations among transgender women (TW) engaged in street-based sex work in Baltimore, Maryland. In a K-means cluster analysis, TW (N=36) were partitioned into groups characterized by high interest in long-acting injectable PrEP only (Injectable Enthusiasts, 36%), high interest in injectables and subdermal implants (Long-Acting Acceptors, 36%), and low interest across PrEP formulations (Non-Acceptors, 28%). TW's interest in novel PrEP agents varied widely across formulations (range: 22-66%) and clustered around numerous relational, occupational, and structural factors, highlighting the importance of availing multiple PrEP formulations for this impacted population.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health and Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S. Wilson Beckham
- Department of International Health and Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine H.A. Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lam K, Kraft WK, Zhan T, Lam E. Bidirectional pharmacokinetics of doravirine, tenofovir, and feminizing hormones in transgender women (IDentify): A randomized crossover trial. Clin Transl Sci 2024; 17:e13721. [PMID: 38421210 PMCID: PMC10903328 DOI: 10.1111/cts.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024] Open
Abstract
Transgender women may have concerns of drug interactions between feminizing hormone therapy (FHT) and antiretrovirals, leading to nonadherence. This randomized, three-period crossover, open-label, phase I trial assessed the effects of doravirine (DOR) and tenofovir disoproxil fumarate (TDF) on the pharmacokinetics (PKs) of estradiol, spironolactone, and total testosterone and vice versa in healthy transgender women. Volunteers were randomized 1:1 into two sequences containing three treatment groups (DOR, lamivudine [3TC], and TDF alone; estradiol, spironolactone, and placebo; and DOR/3TC/TDF, estradiol, and spironolactone). Eight subjects enrolled in the study and six had completed all study periods. The geometric mean ratios for DOR area under the concentration-time curve from zero to last measured concentration (AUC0-last ), maximum concentration (Cmax ), and concentration at 24 h (C24 ) were similar. However, tenofovir (TFV) AUC0-last , Cmax , and C24 moderately increased by 14%-38%. Last, estradiol AUC0-last , Cmax , and C24 were increased by 10%-13%. Whereas most 90% confidence intervals did not meet the bioequivalence bounds of 80%-125%, the point estimates fell within the intervals. Log-transformed DOR, TFV, and estradiol PK parameters computed with and without co-administration were not statistically different (p > 0.05). There were no serious adverse events. There is not a clinically significant impact of FHT on DOR/TFV PKs. Similarly, there is no observed impact on estradiol PKs and total testosterone following use of DOR/3TC/TDF.
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Affiliation(s)
- Kevin Lam
- Department of Pharmacology, Physiology, and Cancer BiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Walter K. Kraft
- Department of Pharmacology, Physiology, and Cancer BiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Tingting Zhan
- Department of Pharmacology, Physiology, and Cancer BiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Edwin Lam
- Clinical Pharmacokinetics Research LabNational Institutes of HealthBethesdaMarylandUSA
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Cespedes MS, Das M, Yager J, Prins M, Krznaric I, de Jong J, Xiao D, Shao Y, Wong P, Kintu A, Carter C, Hoornenborg E, Ruane P, Phoenix J, Younis I, Halperin J. Gender Affirming Hormones Do Not Affect the Exposure and Efficacy of F/TDF or F/TAF for HIV Preexposure Prophylaxis: A Subgroup Analysis from the DISCOVER Trial. Transgend Health 2024; 9:46-52. [PMID: 38312459 PMCID: PMC10835152 DOI: 10.1089/trgh.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Transgender women are disproportionately affected by HIV and are underutilizing preexposure prophylaxis (PrEP). The lower uptake of PrEP by transgender women may be, in part, owing to the perception that taking PrEP may lower the efficacy of gender-affirming hormone therapy (GAHT) or to provider concerns that GAHT may lower the efficacy of PrEP. Methods DISCOVER was a randomized, double-blind, noninferiority trial comparing emtricitabine (FTC, F) and tenofovir alafenamide (F/TAF) versus emtricitabine and tenofovir disoproxil fumarate (F/TDF) as PrEP among transgender women and cisgender men who have sex with men (MSM). This nested substudy of the DISCOVER trial compared the exposure of the active intracellular metabolites of FTC and tenofovir (TFV), FTC triphosphate (FTC-TP) and TFV diphosphate (TFV-DP), in peripheral blood mononuclear cells (PBMC) among transgender women receiving GAHT versus MSM within the F/TAF and F/TDF groups. Results Our results demonstrate that TFV-DP and FTC-TP levels in PBMC were comparable between transgender women on GAHT and MSM receiving F/TAF, and between transgender women on GAHT and MSM receiving F/TDF. TFV-DP concentrations remained above the EC90 of 40 fmol/106 cells across all groups. No clinically significant drug-drug interactions of GAHT were observed with either F/TAF or F/TDF in this subanalysis. Conclusions These findings are consistent with the clinical pharmacology of GAHT, FTC, TDF, and TAF reported in previous studies, and support the continued use of F/TAF and F/TDF for PrEP in transgender women. Clinicaltrials.gov registration number: NCT02842086.
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Affiliation(s)
- Michelle S Cespedes
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moupali Das
- Gilead Sciences, Foster City, California, USA
| | - Jenna Yager
- Gilead Sciences, Foster City, California, USA
| | - Maria Prins
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Ivanka Krznaric
- Zentrum für Infektiologie Berlin Prenzlauer Berg, Berlin, Germany
| | - Jan de Jong
- Gilead Sciences, Foster City, California, USA
| | - Deqing Xiao
- Gilead Sciences, Foster City, California, USA
| | - Yongwu Shao
- Gilead Sciences, Foster City, California, USA
| | - Pamela Wong
- Gilead Sciences, Foster City, California, USA
| | | | | | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Peter Ruane
- Ruane Clinical Research Group, Inc., Los Angeles, California, USA
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Rodriguez A, Horvath KJ, Dowshen N, Voss R, Warus J, Jacobs M, Kidd KM, Inwards-Breland DJ, Blumenthal J. Awareness and utilization of pre-exposure prophylaxis and HIV prevention services among transgender and non-binary adolescent and young adults. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 5:1150370. [PMID: 38318604 PMCID: PMC10839107 DOI: 10.3389/frph.2023.1150370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Transgender and gender non-binary (TGNB) individuals are disproportionally affected by HIV and face high rates of discrimination and stigmatization, resulting in limited access to HIV prevention services. Pre-exposure prophylaxis (PrEP) is highly efficacious for reducing the risk of HIV transmission. However, little research is available regarding PrEP awareness and utilization among TGNB adolescents and young adults (AYA). Methods TGNB AYA ages 15-24 years old were recruited between December 2021 and November 2022 for participation in a one-time, anonymous online survey study to assess PrEP awareness and perceptions, as well as barriers to its use. Participants were recruited from seven academic centers offering gender-affirming care to TGNB AYA across the United States. Results Of the 156 TGNB AYA individuals who completed the survey, most (67%) were aware of PrEP; however, few (7%) had been prescribed PrEP. Many (60%) had not spoken to a medical provider and, even if the medication was free and obtained confidentially, most participants did not plan to take PrEP due to low perceived HIV risk, lack of PrEP knowledge, and concern about interactions between their hormone therapy and PrEP. Discussion These findings underscore the need for broad PrEP educational efforts for both TGNB AYA and their providers to improve knowledge, identify potential PrEP candidates among TGNB AYA and improve access by addressing identified barriers.
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Affiliation(s)
- Arianna Rodriguez
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina Voss
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Jonathan Warus
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Megan Jacobs
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
| | - Kacie M. Kidd
- Division of Adolescent Medicine, WVU Medicine Children’s, Morgantown, WV, United States
| | | | - Jill Blumenthal
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
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7
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Amariles P, Rivera-Cadavid M, Ceballos M. Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy-Update 2022: Systematic Review. Pharmaceutics 2023; 15:2488. [PMID: 37896248 PMCID: PMC10610003 DOI: 10.3390/pharmaceutics15102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The clinical outcomes of antiretroviral drugs may be modified through drug interactions; thus, it is important to update the drug interactions in people living with HIV (PLHIV). AIM To update clinically relevant drug interactions in PLHIV on antiretroviral therapy with novel drug interactions published from 2017 to 2022. METHODS A systematic review in Medline/PubMed database from July 2017 to December 2022 using the Mesh terms antiretroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full-text access were retrieved. The clinical relevance of drug interactions was grouped into five levels according to the gravity and probability of occurrence. RESULTS A total of 366 articles were identified, with 219 (including 87 citation lists) were included, which allowed for the identification of 471 drug interaction pairs; among them, 291 were systematically reported for the first time. In total 42 (14.4%) and 137 (47.1%) were level one and two, respectively, and 233 (80.1%) pairs were explained with the pharmacokinetic mechanism. Among these 291 pairs, protease inhibitors (PIs) and ritonavir/cobicistat-boosted PIs, as well as integrase strand transfer inhibitors (InSTIs), with 70 (24.1%) and 65 (22.3%) drug interaction pairs of levels one and two, respectively, were more frequent. CONCLUSIONS In PLHIV on antiretroviral therapy, we identify 291 drug interaction pairs systematically reported for the first time, with 179 (61.5%) being assessed as clinically relevant (levels one and two). The pharmacokinetic mechanism was the most frequently identified. PIs, ritonavir/cobicistat-boosted PIs, and InSTIs were the antiretroviral groups with the highest number of clinically relevant drug interaction pairs (levels one and two).
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Affiliation(s)
- Pedro Amariles
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, UdeA, AA 1226, Medellin 050010, Colombia; (M.R.-C.); (M.C.)
- Research Group on Pharmaceutical Care, University of Granada, 18071 Granada, Spain
| | - Mónica Rivera-Cadavid
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, UdeA, AA 1226, Medellin 050010, Colombia; (M.R.-C.); (M.C.)
| | - Mauricio Ceballos
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, UdeA, AA 1226, Medellin 050010, Colombia; (M.R.-C.); (M.C.)
- Research Group on Pharmacy Regency Technology, University of Antioquia, Medellin 050010, Colombia
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Cattani VB, Jalil EM, Eksterman L, Torres T, Wagner Cardoso S, Castro CRV, Monteiro L, Wilson E, Bushman L, Anderson P, Veloso VG, Grinsztejn B, Estrela R. Estradiol and Spironolactone Plasma Pharmacokinetics Among Brazilian Transgender Women Using HIV Pre-Exposure Prophylaxis: Analysis of Potential Interactions. Clin Pharmacokinet 2023; 62:1031-1041. [PMID: 37261664 PMCID: PMC10338392 DOI: 10.1007/s40262-023-01248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVE An important barrier to HIV prevention among transgender women (TGW) is the concern that oral pre-exposure prophylaxis (PrEP) negatively affects the efficacy of feminizing hormone therapy (FHT). We aimed to assess the impact of PrEP on FHT pharmacokinetics (PK) among TGW from Brazil. METHODS We performed a drug-drug interaction sub-study among TGW enrolled in a daily oral PrEP demonstration study (PrEParadas, NCT03220152). Participants had a first PK assessment (PK1) 15 days after FHT (estradiol valerate 2-6 mg plus spironolactone 100-200 mg) initiation and then started PrEP (tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg). A second PK evaluation was performed 12 weeks later (PK2). Blood samples were collected prior and after the directly observed dosing (0, 0.5, 1, 2, 4, 6, 8, and 24 hours). Pharmacokinetic parameters of estradiol, spironolactone, and metabolites were estimated by non-compartmental analysis (Monolix 2021R2, Lixoft®) and compared as geometric mean ratios (GMRs, 90% confidence interval [CI]). RESULTS Among 19 TGW who completed the substudy, median age was 26 years (interquartile range: 23-27.5). Estradiol area under the plasma concentration-time curve (AUCτ) and trough concentrations did not differ between PK1 and PK2 evaluations (GMR [90% CI]: 0.89 [0.76-1.04] and 1.06 [0.94-1.20], respectively). Spironolactone and canrenone AUCτ were statistically lower at PK2 than PK1 (0.76 [0.65-0.89] and 0.85 [0.78-0.94], respectively). Canrenone maximum concentration was also lower at PK2 than PK1 (0.82 [0.74-0.91]). CONCLUSION Estradiol PK was not influenced by PrEP concomitant use. The small differences observed in some spironolactone and canrenone PK parameters should not prevent the concomitant use of estradiol-based FHT and PrEP. TRIAL REGISTRATION This trial (NCT03220152) was registered on July 18, 2017.
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Affiliation(s)
- Vitória Berg Cattani
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil.
| | - Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Leonardo Eksterman
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Thiago Torres
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Cristiane R V Castro
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Erin Wilson
- University of California, San Francisco, USA
| | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Rita Estrela
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil.
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Restar A, Minalga BJ, Quilantang MI, Adamson T, Dusic E, van der Merwe LA, Millet G, Rosadiño D, Laguing T, Lett E, Everhart A, Phillips G, Janamnuaysook R, Seekaew P, Baker K, Ashley F, Wickersham J, Wallace SE, Operario D, Gamarel KE. Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations. Curr HIV/AIDS Rep 2023; 20:160-169. [PMID: 37012537 PMCID: PMC10071255 DOI: 10.1007/s11904-023-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Pre-exposure prophylaxis (PrEP) represents one of the most effective methods of prevention for HIV, but remains inequitable, leaving many transgender and nonbinary (trans) individuals unable to benefit from this resource. Deploying community-engaged PrEP implementation strategies for trans populations will be crucial for ending the HIV epidemic. RECENT FINDINGS While most PrEP studies have progressed in addressing pertinent research questions about gender-affirming care and PrEP at the biomedical and clinical levels, research on how to best implement gender-affirming PrEP systems at the social, community, and structural levels remains outstanding. The science of community-engaged implementation to build gender-affirming PrEP systems must be more fully developed. Most published PrEP studies with trans people report on outcomes rather than processes, leaving out important lessons learned about how to design, integrate, and implement PrEP in tandem with gender-affirming care. The expertise of trans scientists, stakeholders, and trans-led community organizations is essential to building gender-affirming PrEP systems.
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Affiliation(s)
- Arjee Restar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.
| | | | - Ma Irene Quilantang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Tyler Adamson
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emerson Dusic
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Greg Millet
- The Foundation for AIDS Research, amfAR, amfAR, Washington, D.C, USA
| | | | - Tanya Laguing
- LoveYourself Inc, Manila, Philippines
- DIOSSA Inc, Taguig, Philippines
| | - Elle Lett
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Avery Everhart
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Tangerine Community Health Clinic, Bangkok, Thailand
| | - Pich Seekaew
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kellan Baker
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Whitman-Walker Institute, Washington, D.C, USA
| | - Florence Ashley
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Wickersham
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephaun E Wallace
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Global Health, University of Washington, Seattle, WA, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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10
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Van Gerwen OT, Blumenthal JS. Providing gender-affirming care to transgender and gender-diverse individuals with and at risk for HIV. TOPICS IN ANTIVIRAL MEDICINE 2023; 31:3-13. [PMID: 37018731 PMCID: PMC10089290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Transgender and gender-diverse populations have unique medical and psychosocial needs. It is important that clinicians address these needs with a gender-affirming approach in all aspects of health care for these populations. Given the significant burden of HIV experienced by transgender people, such approaches in providing HIV care and prevention are essential both to engage this population in care and to work toward ending the HIV epidemic. This review presents a framework for practitioners caring for transgender and gender-diverse individuals to deliver affirming, respectful health care in HIV treatment and prevention settings.
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11
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Cirrincione LR, Grieve VLB, Holloway J, Marzinke MA. Inclusion of Transgender and Gender Diverse People in Phase III Trials: Examples from HIV Pharmacologic Prevention Studies. Clin Pharmacol Ther 2023; 113:557-564. [PMID: 36416569 PMCID: PMC9957832 DOI: 10.1002/cpt.2801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Although at least 25 million adults are transgender worldwide, few phase III clinical trials have enrolled transgender and gender diverse (TGD) people. HIV is the only therapeutic area to include TGD people intentionally in phase III randomized clinical trials during the development of certain newer HIV pharmacologic prevention interventions. Pharmacologic assessments for HIV prevention efficacy in TGD populations are important, as there may be specific considerations for product use and potential interactions with hormone therapies. Herein, we summarize ongoing and completed phase III HIV trials that included TGD people as part of the study population, we examine investigators' strategies for recruiting and engaging TGD priority populations in these phase III trials, and we comment on the implications of these studies for prioritizing TGD populations in clinical pharmacology research within the phase III clinical trial landscape.
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Affiliation(s)
| | | | - Jay Holloway
- Independent Researcher, Los Angeles, California, USA
| | - Mark A Marzinke
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Townes A, Pyra M, Smith DK, Babu AS, Williams T, Wiener J, Henny KD, Schneider J. PrEP Use and Adherence among Transgender Persons in Chicago, IL (SHIPP Study, 2014-2018, USA). AIDS Behav 2023; 27:901-908. [PMID: 36094640 PMCID: PMC10374105 DOI: 10.1007/s10461-022-03826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/25/2022]
Abstract
Few studies investigating daily oral preexposure prophylaxis (PrEP) focus on transgender persons. The Sustainable Health Center Implementation PrEP Pilot (SHIPP) Study included a large observational cohort of transgender persons with implications for PrEP in the United States. We examined data from SHIPP's observational cohort and its Medication Adherence Substudy (MAS) to understand adherence among transgender participants in Chicago, IL. We assessed adherence by the proportion of days covered (PDC) for PrEP medication prescriptions, self-reported interview data, and concentrations of intracellular tenofovir diphosphate (TFV-DP) in dried blood spot (DBS) samples. Between 2014 and 2018, there were 510 transgender participants, 349 (68.4%) transgender women and 152 (29.8%) transgender men. Forty-five of these participants were enrolled in the MAS, 31 (68.9%) transgender women and 9 (20.0%) transgender men. By the 3-month follow up, 100% of MAS participants who completed an interview reported taking 4 or more doses of PrEP in the previous week. At 6, 9, and 12 months, taking 4 or more doses in the past week was reported by 81.0%, 94.1%, and 83.3% of participants, respectively. Results from TFV-DP DBS indicated that fewer participants reached the same level of adherence (4 or more doses/week) at clinical visits compared to self-report and even fewer participants reached this level of adherence based on the calculated PDC. Among participants who remained on PrEP throughout the study, DBS adherence levels declined after the first three months. There remains a critical need to develop strategies to address barriers and interventions that support PrEP adherence among transgender people.
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Affiliation(s)
- Ashley Townes
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA. .,Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road, NE, Mailstop 8-4, 30329, Atlanta, GA, USA.
| | - Maria Pyra
- Howard Brown Health, Chicago, IL, USA.,University of Chicago, Chicago, IL, USA
| | - Dawn K Smith
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road, NE, Mailstop 8-4, 30329, Atlanta, GA, USA
| | | | | | - Jeffrey Wiener
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road, NE, Mailstop 8-4, 30329, Atlanta, GA, USA
| | - Kirk D Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road, NE, Mailstop 8-4, 30329, Atlanta, GA, USA
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13
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Teng F, Sha Y, Fletcher LM, Welsch M, Burns P, Tang W. Barriers to uptake of PrEP across the continuum among transgender women: A global scoping review. Int J STD AIDS 2023; 34:299-314. [PMID: 36793197 DOI: 10.1177/09564624231152781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Although preexposure prophylaxis (PrEP) has demonstrated high efficacy for HIV prevention, rates of PrEP uptake remain low among the transgender population, especially in transgender women (TGW). We conducted this scoping review to assess and characterize barriers to PrEP use along the PrEP care continuum among TGW. METHODS We conducted this scoping review by searching studies in Embase, PubMed, Scopus, and Web of Science. Eligibility criteria included: reporting a PrEP related quantitative result among TGW; peer-reviewed and published in English between 2010-2021. RESULTS Globally, high willingness (80%) to use PrEP was found, yet uptake and adherence (35.4%) were low. TGW experiencing hardship, including poverty, incarceration, and substance use, were associated with higher odds of PrEP awareness but lower odds of PrEP use. Structural and social barriers such as stigma, medical mistrust, and perceived racism can be important barriers for PrEP continuation. High social cohesion and hormone replacement therapy were associated with greater odds of awareness. In addition, our study confirmed prior research showing that PrEP does not lower feminizing hormone levels in TGW. CONCLUSIONS Significant demographic factors among TGW that are associated with PrEP engagement. It is imperative to focus on TGW as a population with independent needs, requiring specific PrEP care guidelines and tailored resource allocation, that fully considers individual-, provider-, and community/structural-level barriers and facilitators. The present review also indicates that combining PrEP care with GAHT or broader gender-affirmation care may facilitate PrEP use.
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Affiliation(s)
- Fei Teng
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Yongjie Sha
- 568921University of North Carolina Project-China, Guangzhou, China
| | - Lauren M Fletcher
- Department of Academic Affairs, Rowland Medical Library, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Welsch
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Paul Burns
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, 568921University of North Carolina Project-China, Guangzhou, China
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14
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Thongsak N, Manojai N, Apiputhipan R, Rongram N, Mattawanon N, Bunyatisai W, Plubin B, Nakharutai N, Thumronglaohapun S, Srikummoon P, Wongsawat K, Traisathit P, Homkham N. Risk Factors Associated with Loss to Follow-up Among Transgender Women Receiving HIV Pre-exposure Prophylaxis in Chiang Mai province, Thailand. AIDS Behav 2023; 27:473-483. [PMID: 35930202 PMCID: PMC9362098 DOI: 10.1007/s10461-022-03782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
Although HIV pre-exposure prophylaxis (PrEP) is free in Thailand, many transgender women discontinue taking it after initiation. We determined the loss to follow-up (LTFU) rate of transgender women who initiated PrEP at the Mplus Foundation, Chiang Mai, Thailand, and identified associated risk factors using Cox proportional hazard models. Of 235 participants who initiated PrEP, 59 (55%) out of 108 remaining participants had reactive syphilis. The LTFU rate at 6 months was 38% (95% confidence interval [CI]: 29-48%). Multivariable analysis indicates that LTFU is independently associated with age ≥ 26 years old (adjusted hazard ratio [aHR] = 2.09; 95% CI: 1.06-4.14) and reactive syphilis (aHR = 1.98; 95% CI:1.01-3.88). Delayed appointment scheduling by the PrEP providers and the syphilis clinic was associated with transgender women having reactive syphilis, and the lockdown policy during the COVID-19 pandemic might have influenced them to discontinue PrEP and their subsequent LTFU.
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Affiliation(s)
- Natthapat Thongsak
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Natnita Mattawanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Walaithip Bunyatisai
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Bandhita Plubin
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Nawapon Nakharutai
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Salinee Thumronglaohapun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokkan Wongsawat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand.
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15
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Determinants of Pre-exposure Prophylaxis (PrEP) Implementation in Transgender Populations: A Qualitative Scoping Review. AIDS Behav 2022; 27:1600-1618. [PMID: 36520334 PMCID: PMC9753072 DOI: 10.1007/s10461-022-03943-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
We conducted a scoping review of contextual factors impeding uptake and adherence to pre-exposure prophylaxis in transgender communities as an in-depth analysis of the transgender population within a previously published systematic review. Using a machine learning screening process, title and abstract screening, and full-text review, the initial systematic review identified 353 articles for analysis. These articles were peer-reviewed, implementation-related studies of PrEP in the U.S. published after 2000. Twenty-two articles were identified in this search as transgender related. An additional eleven articles were identified through citations of these twenty-two articles, resulting in thirty-three articles in the current analysis. These thirty-three articles were qualitatively coded in NVivo using adapted constructs from the Consolidated Framework for Implementation Research as individual codes. Codes were thematically assessed. We point to barriers of implementing PrEP, including lack of intentional dissemination efforts and patience assistance, structural factors, including sex work, racism, and access to gender affirming health care, and lack of provider training. Finally, over 60% of articles lumped cisgender men who have sex with men with trans women. Such articles included sub-samples of transgender individuals that were not representative. We point to areas of growth for the field in this regard.
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16
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Karim QA, Archary D, Barré-Sinoussi F, Broliden K, Cabrera C, Chiodi F, Fidler SJ, Gengiah TN, Herrera C, Kharsany ABM, Liebenberg LJP, Mahomed S, Menu E, Moog C, Scarlatti G, Seddiki N, Sivro A, Cavarelli M. Women for science and science for women: Gaps, challenges and opportunities towards optimizing pre-exposure prophylaxis for HIV-1 prevention. Front Immunol 2022; 13:1055042. [PMID: 36561760 PMCID: PMC9763292 DOI: 10.3389/fimmu.2022.1055042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Preventing new HIV infections remains a global challenge. Young women continue to bear a disproportionate burden of infection. Oral pre-exposure prophylaxis (PrEP), offers a novel women-initiated prevention technology and PrEP trials completed to date underscore the importance of their inclusion early in trials evaluating new HIV PrEP technologies. Data from completed topical and systemic PrEP trials highlight the role of gender specific physiological and social factors that impact PrEP uptake, adherence and efficacy. Here we review the past and current developments of HIV-1 prevention options for women with special focus on PrEP considering the diverse factors that can impact PrEP efficacy. Furthermore, we highlight the importance of inclusion of female scientists, clinicians, and community advocates in scientific efforts to further improve HIV prevention strategies.
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Affiliation(s)
- Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kristina Broliden
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Center for Molecular Medicine, Stockholm, Sweden
| | - Cecilia Cabrera
- AIDS Research Institute IrsiCaixa, Institut de Recerca en Ciències de la Salut Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Sarah J. Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London UK and Imperial College NIHR BRC, London, United Kingdom
| | - Tanuja N. Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carolina Herrera
- Department of Infectious Disease, Section of Virology, Faculty of Medicine, Imperial College London, London, United Kingdom,*Correspondence: Carolina Herrera,
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lenine J. P. Liebenberg
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sharana Mahomed
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Menu
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France,MISTIC Group, Department of Virology, Institut Pasteur, Paris, France
| | - Christiane Moog
- Laboratoire d’ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Gabriella Scarlatti
- Viral Evolution and Transmission Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nabila Seddiki
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa,JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Mariangela Cavarelli
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
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17
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Yager J, Brooks KM, Brothers J, Mulligan K, Landovitz RJ, Reirden D, Malhotra M, Glenny C, Harding P, Powell T, Anderson PL, Hosek S. Gender-Affirming Hormone Pharmacokinetics Among Adolescent and Young Adult Transgender Persons Receiving Daily Emtricitabine/Tenofovir Disoproxil Fumarate. AIDS Res Hum Retroviruses 2022; 38:939-943. [PMID: 35815468 PMCID: PMC9910105 DOI: 10.1089/aid.2022.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Transgender persons have an increased vulnerability to HIV infection yet have not been well-represented in past clinical trials for pre-exposure prophylaxis (PrEP). Because of this, there are few data available to understand whether gender-affirming hormone concentrations are influenced by PrEP agents in transgender men (TM) and transgender women (TW). The objective of this study was to compare gender-affirming hormone concentrations with versus without emtricitabine (F, FTC)-tenofovir disoproxil fumarate (TDF). TM and TW without HIV, aged 15-24 years, were enrolled for 1 month of directly observed daily F/TDF. Participants were required to be receiving a stable hormone dose (estradiol or testosterone) for at least 1 month or three consecutive doses, whichever was longer, before enrollment and willing to continue the same dose. Intensive pharmacokinetic (PK) sampling for gender-affirming hormones was collected before and 2-3 weeks after daily F/TDF. Serum estradiol and total testosterone were determined by liquid chromatography-tandem mass spectrometry; free testosterone by equilibrium dialysis. Maximum concentrations (Cmax) and area under the curve (AUClast) were log-transformed and compared between baseline and on F/TDF using geometric mean ratios (GMRs) with 95% confidence intervals (CIs). Twenty-five TW and 24 TM were enrolled (median age: 20 and 21 years, respectively). In TW, estradiol Cmax (GMR [95% CI]: 0.85 [0.65-1.11]) and AUClast (GMR [95% CI]: 0.87 [0.73-1.03]) were comparable on F/TDF versus baseline. In TM, similar comparability was observed for PrEP versus baseline including total testosterone Cmax (GMR [95% CI]: 0.91 [0.80-1.03]) and AUClast (GMR [95% CI]: 0.91 [0.81-1.04]) and free testosterone Cmax (GMR [95% CI]: 0.89 [0.74-1.07]) and AUClast (GMR [95% CI]: 0.88 [0.74-1.03]). Estradiol and testosterone exposures in young TW and TM did not significantly differ on F/TDF versus baseline. These findings should reassure patients and providers that F/TDF can be used as PrEP without concern for altering gender-affirming hormone PK. ClinicalTrials.gov (NCT03652623).
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Affiliation(s)
- Jenna Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Kristina M. Brooks
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Jennifer Brothers
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Kathleen Mulligan
- Department of Medicine, Division of Endocrinology and Metabolism, University of California San Francisco, San Francisco, California, USA
| | - Raphael J. Landovitz
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel Reirden
- Department of Adolescent Medicine, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Meenakshi Malhotra
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Carrie Glenny
- Department of Adolescent Medicine, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Paul Harding
- Department of Pediatric Infectious Diseases, University of Colorado–Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tina Powell
- Department of Pediatric Infectious Diseases, University of Colorado–Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, USA
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18
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 520] [Impact Index Per Article: 260.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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19
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Dang M, Scheim AI, Teti M, Quinn KG, Zarwell M, Petroll AE, Horvath KJ, John SA. Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review. AIDS Patient Care STDS 2022; 36:236-248. [PMID: 35687813 PMCID: PMC9242706 DOI: 10.1089/apc.2021.0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.
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Affiliation(s)
- Madeline Dang
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle Teti
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Address correspondence to: Steven A. John, PhD, MPH, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202, USA
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20
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Abstract
This cross-sectional study used 2012 to 2019 Oregon Medicaid claims to estimate the prevalence of PrEP use and identify determinants of high adherence across transgender and cisgender men and women. Gender identity (cisgender woman/man; transgender, assigned female sex at birth [AFAB]; transgender, assigned male sex at birth [AMAB]) was based on medical history and enrollment records. Proportion of days covered ≥ 0.80 was considered high adherence to PrEP. The association between gender identity and PrEP uptake or high adherence was estimated using multivariable logistic regression. 1555 PrEP users, including 171 (11.0%) cis women, 1171 (75.3%) cis men, 67 (4.3%) AFAB, and 146 (9.4%) AMAB individuals, were included. The probability of PrEP use per 10,000 people was highest in transgender groups (AMAB 546.8, 95% CI 462.4-631.3; AFAB 226.5, 95% CI 173.4-279.6), followed by cisgender men (20.6, 95% CI 19.4, 21.8) and women (2.6, 95% CI 2.2, 3.0). High adherence was significantly lower in AMAB recipients (72.6%) than cisgender women (86.0%) and cisgender men (82.2%). Among the 279 PrEP users with female on their enrollment record, 76 (27.2%) were AMAB, while among the 1276 PrEP users with male on their enrollment record, 35 (2.7%) were AFAB. This demonstrates the importance of surveillance methods that take gender identity into account in addition to sex assigned at birth. There were significant differences in PrEP use and adherence by gender identity. PrEP surveillance, outreach, and prescribing practices must consider gender identity-unique risk factors.
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Affiliation(s)
- Jae Downing
- Department of Health Policy and Management, OHSU-PSU School of Public Health, Portland, OR, USA
| | - Kimberly Yee
- Department of Health Policy and Management, OHSU-PSU School of Public Health, Portland, OR, USA.
- OHSU-PSU School of Public Health, 840 SW Gaines St, Gaines Hall, Room 230, Portland, OR, 97239, USA.
| | - Jae M Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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21
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Tanaudommongkon A, Chaturvedula A, Hendrix CW, Fuchs EJ, Shieh E, Bakshi RP, Marzinke MA. Population pharmacokinetics of tenofovir, emtricitabine and intracellular metabolites in transgender women. Br J Clin Pharmacol 2022; 88:3674-3682. [PMID: 35285974 PMCID: PMC9296590 DOI: 10.1111/bcp.15310] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022] Open
Abstract
Aims Transgender women (TGW) have been underrepresented in trials and use gender‐affirming hormonal therapies (GAHT) that may alter renal function by significantly increasing creatinine clearance. Population pharmacokinetic (popPK) models and simulations would aid in understanding potential differences in emtricitabine/tenofovir disproxil fumarate (F/TDF) parent–metabolite concentrations in TGW on GAHT when compared to cisgender men (CGM) not exposed to GAHT. Methods Pharmacokinetic (PK) data from a Phase 1, open‐label clinical trial with directly observed therapy of daily F/TDF consisting of 8 TGW and 8 CGM was utilized for model building. PopPK analysis was performed using nonlinear mixed effects modelling (NONMEM 7.5.0). Covariates of body weight, creatinine clearance, and gender were evaluated. Final models were subjected to Monte Carlo simulations to compare drug exposure following once daily and on‐demand (IPERGAY 2 + 1 + 1) dosing of F/TDF. Results Tenofovir (TFV) and emtricitabine PK were best described by a 2‐compartment model, first‐order absorption/elimination with absorption lag time. Parent models were linked to their metabolites by first order formation and elimination. Creatinine clearance was a significant covariate influencing clearance in both models. Simulations demonstrated that at least 2, weekly 2 + 1 + 1 cycles of on‐demand dosing in TGW on GAHT is necessary for TFV‐diphosphate to reach similar exposure after the initial week of on‐demand dosing in CGM not on GAHT. Conclusion PopPK models of TFV, emtricitabine and intracellular metabolites in TGW were established. Dose simulations revealed that TGW should be treated for at least 2 weeks to have comparable exposures to CGM.
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Affiliation(s)
- Asama Tanaudommongkon
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ayyappa Chaturvedula
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eugenie Shieh
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rahul P Bakshi
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark A Marzinke
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Shan D, Ning Z, Yu M, Zheng H, Yang J, Gong H, Li J, Liu H, Liu L, Wang V, Ran X, Han M, Zhang D. HIV incidence and risk factors among transgender women and cisgender men who have sex with men in two cities of China: a prospective cohort study. Infect Dis Poverty 2022; 11:26. [PMID: 35256001 PMCID: PMC8900389 DOI: 10.1186/s40249-022-00947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/14/2022] [Indexed: 02/07/2023] Open
Abstract
Background HIV epidemic among men who have sex with men (MSM) remains a major public health concern in China. Despite a growing body of research on transgender women worldwide, little is known about Chinese transgender women within MSM. We sought to estimate HIV incidence and distinguish risk factors of HIV acquisition among them from that among cisgener (non-transgender) MSM (cis-MSM). Methods We conducted an open cohort study among Chinese MSM, including those who were identified as transgender in Shanghai and Tianjin. Participants were initially recruited by local community-based organizations from January to June, 2016, and were followed up approximately every 6 months until June 2018. At each visit, a structured questionnaire was used to gather information on demographics, sexual risk behaviors, and HIV status. HIV incidence was calculated as the number of seroconversions divided by total number of person-years of follow-up among HIV-negatives at baseline. Risk factors of HIV acquisition were assessed by univariate and multivariate Cox regression models with time-dependent variables. Results A total of 1056 participants contributed 1260.53 person-years (PYs) of follow-up, 33 HIV seroconversions occurred during the follow-up period, yielding an estimated HIV incidence of 2.62 (95% CI 1.80–3.68) per 100 PYs. HIV incidence among transgender women was 4.42 per 100 PYs, which was significantly higher than that of 1.35 per 100 PYs among cis-MSM, demonstrating a threefold higher odds of HIV infection than cis-MSM. For transgender women, those lived locally ≤ 2 years (adjusted hazard ratio [aHR] = 1.76, 95% CI 1.13–2.76) and unprotected anal sex last time (aHR = 4.22, 95% CI 1.82–9.79) were more likely to acquire HIV. For cis-MSM, factors associated with HIV acquisition were frequency of anal sex ≥ 3 times in past one month (aHR = 4.19, 95% CI 1.06–16.47) and unprotected anal sex last time (aHR = 5.33, 95% CI 1.52–18.73). Conclusions Compared to cis-MSM, transgender women were at higher risk of HIV acquisition, highlighting an urgent need of tailored prevention. Future HIV program should consider to include them to ensure that this population in China are not left behind. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00947-3.
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23
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Similar Sexual Behaviour yet Different Outcomes: Comparing Trans and Gender Diverse and Cis PrEP Users in Germany Based on the Outcomes of the PrApp Study. SEXES 2022. [DOI: 10.3390/sexes3010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Little knowledge about pre-exposure prophylaxis (PrEP) use in trans and gender diverse (TGD) communities in Germany exists. The PrApp Study collected data on PrEP use and sexual behaviour among PrEP users in Germany. Descriptive methods and logistic regression were used to describe PrEP use among TGD and cis persons. A total of 4350 PrEP users in Germany were included, with 65 (1.5%) identified as TGD. Compared to cis participants, TGD participants were younger (median age 29 vs. 37 years) and more likely to have a lower income (adjusted odds ratio (aOR) = 4.4; 95% confidence interval (CI) = 2.4–8.2) and be born outside Germany (aOR = 2.5; 95% CI = 1.3–4.5). On-demand PrEP use was higher in TGD participants (aOR = 1.9; 95% CI = 1.0–3.5) and numerically more TGD obtained PrEP from informal sources (aOR = 1.8; 95% CI = 0.9–3.5). Testing behaviour, condom use, and number of sexual partners were comparable between both groups. Socioeconomic disparities may constitute structural barriers for TGD people to access PrEP, leading to more informal and on-demand use. PrEP providers need to reduce access barriers for TGD PrEP users and provide information on safe PrEP use for this population.
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24
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Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication. BMC Public Health 2022; 22:17. [PMID: 34991548 PMCID: PMC8740429 DOI: 10.1186/s12889-021-12425-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use. METHODS This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues. RESULTS Twelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP's effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication. CONCLUSIONS Without acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.
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25
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Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention. AIDS Behav 2021; 25:3987-3999. [PMID: 34138377 PMCID: PMC8210500 DOI: 10.1007/s10461-021-03353-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/05/2023]
Abstract
Pre-exposure prophylaxis (PrEP) uptake among women in the United States has been low. To increase uptake, we developed a peer outreach and navigation PrEP intervention. Semi-structured qualitative interviews with 32 cisgender women and 3 transgender women were conducted to assess the intervention. We used a thematic approach to identify barriers to, and facilitators of the intervention. Facilitators included interest in PrEP, offer of health and social services, the intervention’s women-focused approach, and peer outreach and navigation. Barriers were perceived HIV risk, concerns about medication side effects or interactions, housing insecurity and travel, co-occurring health-related conditions, and caregiving responsibilities. We recommend that future interventions consider packaging PrEP in local community settings, such as syringe exchange programs; include services such as food and housing assistance; use peers to recruit and educate women; integrate a culturally appropriate women’s focus; and consider providing same-day PrEP.
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26
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Tomson A, McLachlan C, Wattrus C, Adams K, Addinall R, Bothma R, Jankelowitz L, Kotze E, Luvuno Z, Madlala N, Matyila S, Padavatan A, Pillay M, Rakumakoe MD, Tomson-Myburgh M, Venter WDF, de Vries E. Southern African HIV Clinicians' Society gender-affirming healthcare guideline for South Africa. South Afr J HIV Med 2021; 22:1299. [PMID: 34691772 PMCID: PMC8517808 DOI: 10.4102/sajhivmed.v22i1.1299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022] Open
Abstract
No abstract available.
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Affiliation(s)
- Anastacia Tomson
- My Family GP, Cape Town, South Africa.,Shemah Koleinu, Cape Town, South Africa
| | - Chris/Tine McLachlan
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.,Department of Psychology, College of Human Sciences, University of South Africa, Pretoria, South Africa.,Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Psychological Society of South Africa, Johannesburg, South Africa
| | - Camilla Wattrus
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Kevin Adams
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Department of Plastic Surgery, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Ronald Addinall
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Department of Social Development, Faculty of Humanities, University of Cape Town, Cape Town, South Africa.,Southern African Sexual Health Association, Cape Town, South Africa
| | - Rutendo Bothma
- Wits Reproductive Health Institute, Johannesburg, South Africa
| | | | - Elliott Kotze
- Psychologist, Independent Practice, Cape Town, South Africa
| | - Zamasomi Luvuno
- School of Nursing and Public Health, Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nkanyiso Madlala
- Department of Psychology, College of Human Sciences, University of South Africa, Pretoria, South Africa.,Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Psychological Society of South Africa, Johannesburg, South Africa
| | | | | | - Mershen Pillay
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Department of Speech-Language Therapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Speech-Language Therapy, Faculty of Health Sciences, Massey University, Auckland, New Zealand
| | - Mmamontsheng D Rakumakoe
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Quadcare, Johannesburg, South Africa
| | | | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elma de Vries
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Cape Town Metro Health Services, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
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Cetlin M, Fulda ES, Chu SM, Hamnvik OPR, Poteat T, Zanni MV, Toribio M. Cardiovascular Disease Risk Among Transgender People with HIV. Curr HIV/AIDS Rep 2021; 18:407-423. [PMID: 34626323 DOI: 10.1007/s11904-021-00572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Transgender individuals are at disproportionate risk for HIV infection, with prevalence rates highest among transgender women of color. Antiretroviral therapy (ART)-treated people with HIV (PWH) are at increased risk for cardiovascular disease (CVD), in relation to persistent systemic immune activation and metabolic dysregulation. The purpose of this review is to examine parameters which may affect CVD risk among transgender PWH. RECENT FINDINGS Among transgender women and men, prospective longitudinal studies have shown that gender-affirming hormonal therapy (GAHT) is associated with select deleterious cardiometabolic effects such as increases in visceral adipose tissue. Retrospective studies among transgender women and men suggest an increase in CVD risk, such as venous thromboembolism, cerebrovascular accidents, and myocardial infarction. Studies among transgender PWH adhering to GAHT and ART suggest heightened systemic immune activation/inflammation. Prospective longitudinal studies assessing factors associated with increased CVD events among transgender PWH are needed to guide the development of CVD prevention strategies in this at-risk population.
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Affiliation(s)
- Madeline Cetlin
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Evelynne S Fulda
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah M Chu
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ole-Petter R Hamnvik
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Markella V Zanni
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, 55 Fruit Street, 5 LON 207, Boston, MA, 02114, USA.
| | - Mabel Toribio
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. .,Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, 55 Fruit Street, 5 LON 207, Boston, MA, 02114, USA.
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28
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Peterson S, Ibrahim M, Anderson PL, Moore CM, MaWhinney S. A comparison of covariate selection techniques applied to pre-exposure prophylaxis (PrEP) drug concentration data in men and transgender women at risk for HIV. J Pharmacokinet Pharmacodyn 2021; 48:655-669. [PMID: 34013454 DOI: 10.1007/s10928-021-09763-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) containing antiretrovirals tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) can reduce the risk of acquiring HIV. Concentrations of intracellular tenofovir-diphosphate (TFV-DP) measured in dried blood spots (DBS) have been used to quantify PrEP adherence; although even under directly observed dosing, unexplained between-subject variation remains. Here, we wish to identify patient-specific factors associated with TFV-DP levels. Data from the iPrEX Open Label Extension (OLE) study were used to compare multiple covariate selection methods for determining demographic and clinical covariates most important for drug concentration estimation. To allow for the possibility of non-linear relationships between drug concentration and explanatory variables, the component selection and smoothing operator (COSSO) was implemented. We compared COSSO to LASSO, a commonly used machine learning approach, and traditional forward and backward selection. Training (N = 387) and test (N = 166) datasets were utilized to compare prediction accuracy across methods. LASSO and COSSO had the best predictive ability for the test data. Both predicted increased drug concentration with increases in age and self-reported adherence, the latter with a steeper trajectory among Asians. TFV-DP reductions were associated with increasing eGFR, hemoglobin and transgender status. COSSO also predicted lower TFV-DP with increasing weight and South American countries. COSSO identified non-linear relationships between log(TFV-DP) and adherence, weight and eGFR, with differing trajectories for some races. COSSO identified non-linear log(TFV-DP) trajectories with a subset of covariates, which may better explain variation and enhance prediction. Future research is needed to examine differences identified in trajectories by race and country.
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Affiliation(s)
- Skyler Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, 84108, USA
| | - Mustafa Ibrahim
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, University of Colorado Anschutz Medical Campus, V20-C238, Room 4101, 12850 E. Montview Blvd, Aurora, CO, 80045, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, University of Colorado Anschutz Medical Campus, V20-C238, Room 4101, 12850 E. Montview Blvd, Aurora, CO, 80045, USA
| | - Camille M Moore
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Center for Genes, Environment and Health, National Jewish Health, 1400 Jackson St., Denver, CO, 80206, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl, Aurora, CO, 80045, USA.
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Marzinke MA, Radix A. Healthcare Is a Spectrum: The Utilization of Population-Specific Reference Intervals Is Essential in the Standard of Care for Transgender Patients. J Appl Lab Med 2021; 6:7-10. [PMID: 33438733 DOI: 10.1093/jalm/jfaa206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Mark A Marzinke
- Department of Pathology, Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Baltimore, MD
| | - Asa Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
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30
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Malone J, Reisner SL, Cooney EE, Poteat T, Cannon CM, Schneider JS, Radix A, Mayer KH, Haw JS, Althoff KN, Wawrzyniak AJ, Beyrer C, Wirtz AL. Perceived HIV Acquisition Risk and Low Uptake of PrEP Among a Cohort of Transgender Women With PrEP Indication in the Eastern and Southern United States. J Acquir Immune Defic Syndr 2021. [PMID: 34397742 DOI: 10.1097/qai.0000000000002726]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood. METHODS This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women-specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum. RESULTS PrEP indication prevalence using transgender women-specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk. CONCLUSIONS These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
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Affiliation(s)
- Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | - Asa Radix
- School of Medicine, New York University, New York, NY
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Fenway Community Health Center, The Fenway Institute, Boston, MA
| | - J Sonya Haw
- Division of Endocrinology, Metabolism, and Lipids, School of Medicine, Emory University, Atlanta, GA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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31
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del Río‐González AM, Lameiras‐Fernández M, Modrakovic D, Aguayo‐Romero R, Glickman C, Bowleg L, Zea MC. Global scoping review of HIV prevention research with transgender people: Transcending from trans-subsumed to trans-centred research. J Int AIDS Soc 2021; 24:e25786. [PMID: 34473421 PMCID: PMC8412127 DOI: 10.1002/jia2.25786] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/19/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Globally, transgender populations are disproportionally impacted by HIV and effective HIV prevention interventions targeting these populations are critically needed. Such interventions require research focused on the specific needs and experiences of transgender people. This methodological review aims to determine the extent to which HIV prevention research has included transgender participants by subsuming them into non-transgender populations, or by centring them either in comparison with other groups or as the sole focus of research. METHODS We searched five electronic databases (e.g. SCOPUS) for empirical studies that focused on HIV prevention and included transgender participants, published through 31 December 2020. For each study, we extracted information on: (a) types of inclusion of transgender participants; (b) total sample size and number/percentage of transgender participants; (c) country(ies) where study was conducted; (d) HIV research topics; (e) methods (i.e. quantitative, qualitative or mixed-methods research) and (f) gender identity of transgender participants. RESULTS AND DISCUSSION Of 667 HIV prevention studies included in the review, 38.5% subsumed transgender participants into cisgender populations (most frequently combining transgender women with cisgender men who have sex with men), 20.4% compared transgender and cisgender participants and 41.1% focused exclusively on transgender populations. Our global scoping review also revealed that these three types of transgender inclusion in HIV prevention research vary greatly over time, place and thematic areas. Transgender women are the focus of the majority of reviewed studies, whereas transgender men and gender expansive people are rarely included as participants. CONCLUSIONS Inclusion of transgender persons as participants in HIV prevention research has significantly increased, particularly in the last decade. Further research centred on transgender participants and their experiences are needed to develop effective HIV prevention interventions for transgender populations. We advocate for HIV prevention research to move from subsuming transgender people, to trans-centred research that asks questions that focus on their specific needs and experiences. We provide recommendations to move from trans-subsumed to trans-centred HIV prevention research.
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Affiliation(s)
- Ana María del Río‐González
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Djordje Modrakovic
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Rodrigo Aguayo‐Romero
- Brigham and Women's Hospital/Harvard Medical School/The Fenway InstituteBostonMassachusettsUSA
| | - Courtney Glickman
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Lisa Bowleg
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Maria Cecilia Zea
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
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32
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Malone J, Reisner SL, Cooney E, Poteat T, Cannon CM, Schneider J, Radix A, Mayer KH, Haw JS, Althoff KN, Wawrzyniak AJ, Beyrer C, Wirtz AL. Perceived HIV Acquisition Risk and Low Uptake of PrEP Among a Cohort of Transgender Women With PrEP Indication in the Eastern and Southern United States. J Acquir Immune Defic Syndr 2021; 88:10-18. [PMID: 34397742 PMCID: PMC8371736 DOI: 10.1097/qai.0000000000002726] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood. METHODS This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women-specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum. RESULTS PrEP indication prevalence using transgender women-specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk. CONCLUSIONS These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
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Affiliation(s)
- Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sari L. Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women’s Hospital, Boston, MA
| | - Erin Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | - Asa Radix
- New York University School of Medicine, New York, NY
| | - Kenneth H. Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, US
| | - J. Sonya Haw
- Division of Endocrinology, Metabolism, and Lipids, Emory University school of Medicine, Atlanta, GA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew J. Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Sekabira R, McGowan I, Yuhas K, Brand RM, Marzinke MA, Manabe YC, Frank I, Eron J, Landovitz RJ, Anton P, Cranston RD, Anderson P, Mayer KH, Amico KR, Wilkin TJ, Chege W, Kekitiinwa AR, McCauley M, Gulick RM, Hendrix CW. Higher colorectal tissue HIV infectivity in cisgender women compared with MSM before and during oral preexposure prophylaxis. AIDS 2021; 35:1585-1595. [PMID: 33831911 PMCID: PMC8483241 DOI: 10.1097/qad.0000000000002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to compare HIV-negative cisgender women (CGW) with MSM for mucosal tissue differences in pharmacokinetics, HIV infectivity and cell phenotype. DESIGN A substudy of HPTN 069/ACTG A5305, 48-week study of three oral candidate preexposure prophylaxis regimens: maraviroc, maraviroc/emtricitabine and maraviroc/tenofovir disoproxil fumarate (TDF) compared with a TDF/emtricitabine control group. METHODS Plasma, peripheral blood mononuclear cells and cervical and colorectal tissue biopsies were collected at Baseline (no drug), Week 24 and 48 (on drug), and Week 49 (1-week postdrug). Drug concentrations were assessed in all matrices. HIV infectivity was assessed using tissue biopsy 'explants' challenged with HIV ex vivo followed by HIV p24 measurement. Flow cytometry evaluated colorectal cell phenotype. RESULTS Thirty-seven CGW and 54 MSM participated. CGW's colorectal explant p24 was higher than MSM before (0.31 log10, P = 0.046), during (1.01-1.19 log10, P = 0.016) and one week after (0.61 log10, P = 0.011) study drug dosing. Pooling regimens, cervical explant p24 did not differ among visits. CGW had higher plasma maraviroc and colorectal tissue tenofovir diphosphate and lower colorectal tissue emtricitabine (all P < 0.005) compared with MSM. Each study drug's cervical tissue concentrations were more than 10-fold below paired colorectal concentrations (P < 0.001). Cell phenotype sex differences included 4% higher CD38+/CD8+ cells at baseline and 3-7% higher CD69+/CD8+ cells throughout Weeks 24-49 in CGW compared with MSM (P < 0.05). CONCLUSION Colorectal explants in CGW demonstrated greater HIV infectivity than MSM with and without study drugs. Small differences in adherence, drug concentration and colorectal tissue flow cytometry cannot fully explain this difference.
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Affiliation(s)
- Rogers Sekabira
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
| | - Ian McGowan
- University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
- Orion Biotechnology, Ottawa, Ontario, Canada
| | - Krista Yuhas
- Fred Hutchinson Cancer Research Center, Medical School, Pittsburgh, Pennsylvania
| | - Rhonda M Brand
- University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Mark A Marzinke
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yukari C Manabe
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian Frank
- University of Pennsylvania, Infectious Disease Division, Philadelphia, Pennsylvania
| | - Joseph Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raphael J Landovitz
- University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, California, USA
| | - Peter Anton
- University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, California, USA
| | | | | | | | - K Rivet Amico
- University of Michigan, School of Public Health, Ann Arbor, Michigan
| | | | - Wairimu Chege
- Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | | | | | | | - Craig W Hendrix
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bekker LG, Brown B, Joseph-Davey D, Gill K, Moorhouse M, Delany-Moretlwe S, Myer L, Orrell C, Rebe K, Venter WF, Wallis CL. Southern African guidelines on the safe, easy and effective use of pre-exposure prophylaxis: 2020. South Afr J HIV Med 2020; 21:1152. [PMID: 33354364 PMCID: PMC7736681 DOI: 10.4102/sajhivmed.v21i1.1152] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 12/28/2022] Open
Abstract
No abstract available.
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Affiliation(s)
- Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Dvora Joseph-Davey
- Department of Epidemiology, University of California, Los Angeles, United States of America
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kathrine Gill
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Michelle Moorhouse
- Wits Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kevin Rebe
- Life Vincent Pallotti Hospital, Cape Town, South Africa
- Department of Medicine and Infectious Diseases, University of Cape Town, Cape Town, South Africa
| | - W.D. Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carole L. Wallis
- BARC-SA, Speciality Molecular Division, Lancet Laboratories, Johannesburg, South Africa
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35
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Radix AE. Management and Prevention of HIV Among Transgender Adults. TOPICS IN ANTIVIRAL MEDICINE 2020; 28:474-478. [PMID: 34107207 PMCID: PMC8224242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transgender individuals face discrimination, violence, social exclusion, and other social, political, and economic factors that result in increased vulnerability to HIV. Rates of viral suppression and uptake of preexposure prophylaxis are lower among transgender individuals than the general population. HIV clinics can help improve these rates by promoting inclusivity and tailoring care to the specific needs of transgender patients. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Asa E. Radix, MD, PhD, MPH, on August 18, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-radix/.
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Affiliation(s)
- Asa E Radix
- New York University School of Medicine, New York, NY, USA
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Lee S, Meyler P, Mozel M, Tauh T, Merchant R. Asymptomatic carriage and transmission of SARS-CoV-2: What do we know? Can J Anaesth 2020; 67:1424-1430. [PMID: 32488493 PMCID: PMC7266417 DOI: 10.1007/s12630-020-01729-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Risk to healthcare workers treating asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the operating room depends on multiple factors. This review examines the evidence for asymptomatic or pre-symptomatic carriage of SARS-CoV-2, the risk of transmission from asymptomatic patients, and the specific risks associated with aerosol-generating procedures. Protective measures, such as minimization of aerosols and use of personal protective equipment in the setting of treating asymptomatic patients, are also reviewed. Source We examined the published literature as well as Societal guidelines. Principal findings There is evidence that a proportion of those infected with SARS-CoV-2 have detectable viral loads prior to exhibiting symptoms, or without ever developing symptoms. The degree of risk of transmission from asymptomatic patients to healthcare providers will depend on the prevalence of disease in the population, which is difficult to assess without widespread population screening. Aerosol-generating procedures increase the odds of viral transmission from infected symptomatic patients to healthcare providers, but transmission from asymptomatic patients has not been reported. Techniques to minimize aerosolization and appropriate personal protective equipment may help reduce the risk to healthcare workers in the operating room. Some societal guidelines recommend the use of airborne precautions during aerosol-generating procedures on asymptomatic patients during the coronavirus disease pandemic, although evidence supporting this practice is limited. Conclusion Viral transmission from patients exhibiting no symptoms in the operating room is plausible and efforts to reduce risk to healthcare providers include reducing aerosolization and wearing appropriate personal protective equipment, the feasibility of which will vary based on geographic risk and equipment availability.
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Affiliation(s)
- Susan Lee
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada.
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada.
| | - Paula Meyler
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
| | - Michelle Mozel
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
| | - Tonia Tauh
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
| | - Richard Merchant
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
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