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Suchak T, Bracchi M, Mercer M, Lander F, Boffito M. A case report highlighting drug-drug interactions between 3 life-saving treatments: Feminizing hormones, antiretrovirals and antituberculosis drugs. Br J Clin Pharmacol 2024. [PMID: 38599659 DOI: 10.1111/bcp.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
We here present a case providing valuable insights for clinicians who deliver care to patients identifying as transgender or nonbinary. A 30-year-old trans woman presented to sexual health services requesting a routine sexual health screen and was subsequently diagnosed with HIV and syphilis. She started antiretrovirals for HIV (bictegravir/tenoforvir alafenamide/emtricitabine) 12 days later and was treated with benzathine penicillin G. The patient also had a positive tuberculosis (TB) ELIspot blood test result and further investigations proved the presence of active TB in the chest with mediastinal involvement. She commenced treatment for TB with quadruple therapy, including rifampicin. Due to the clinically significant interaction between rifampicin and bictegravir, the patient's antiretroviral treatment was switched to dolutegravir 50 mg twice daily in combination with tenofovir disoproxil fumarate and emtricitabine. As the patient had transitioned from male to female and was self-medicating with oestrogen-containing feminizing hormone therapy, her hormonal treatment was optimized and blood levels of oestradiol were closely monitored and titrated to manage the drug-drug interaction between rifampicin and oestrogen to ensure the latter would be maintained within the expected therapeutic range. Our case report demonstrates the importance of combining treatment of multiple conditions under 1 team ideally integrated with gender services to prevent multiple attendances and mismanagement of feminizing hormone therapies.
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Affiliation(s)
- Tara Suchak
- TransPlus, Chelsea and Westminster Hospital, London, UK
- HIV Department, Chelsea and Westminster Hospital, London, UK
| | | | - Maria Mercer
- HIV Department, Chelsea and Westminster Hospital, London, UK
| | - Frances Lander
- TransPlus, Chelsea and Westminster Hospital, London, UK
- HIV Department, Chelsea and Westminster Hospital, London, UK
| | - Marta Boffito
- HIV Department, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Lake JE, Miao H, Bowman ER, Clark JL, Hyatt AN, Kettelhut A, Lama JR, Reisner SL, Mayer KH, Perez-Brumer A, Funderburg N. Gender-affirming hormone therapy decreases d-dimer but worsens insulin sensitivity in transgender women. HIV Med 2023; 24:1144-1149. [PMID: 37386803 PMCID: PMC10755063 DOI: 10.1111/hiv.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Gender-affirming hormonal therapies (GAHT) and HIV increase cardiovascular risk for transgender women (TW), yet there is a paucity of data quantifying cardiometabolic changes following GAHT initiation, particularly among TW with HIV. METHODS The Féminas study enrolled TW from October 2016 to March 2017 in Lima, Peru. Participants reported sexual activity that was high risk for HIV acquisition or transmission. All were tested for HIV/ sexually transmitted infection and were given access to GAHT (oestradiol valerate and spironolactone), HIV pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) for 12 months. Biomarker measurement was done on stored serum, whereas fasting glucose and lipids were measured in real time. RESULTS In all, 170 TW (32 with HIV, 138 without HIV) had median age 27 years and 70% prior GAHT use. At baseline, PCSK9, sCD14, sCD163, IL-6, sTNFRI/II, CRP and EN-RAGE levels were significantly higher in TW with HIV than in TW without HIV. High-density lipoprotein and total cholesterol were lower and insulin and glucose parameters were similar. All TW with HIV started ART, but only five achieved virological suppression at any time. No TW without HIV initiated PrEP. Over 6 months, all participants initiated GAHT and had worsening insulin, glucose and HOMA-IR. Large d-dimer decreases also occurred. Similar changes occurred in TW with and without HIV. CONCLUSIONS In this unique cohort of TW, GAHT decreased d-dimer but worsened insulin sensitivity. Because PrEP uptake and ART adherence were very low, observed effects are primarily attributed to GAHT use. Further study is needed to better understand cardiometabolic changes in TW by HIV serostatus.
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Affiliation(s)
- Jordan E. Lake
- University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 2.112, Houston, TX 77030, USA
| | - Hongyu Miao
- Florida State University, 600 W College Ave, Tallahassee, FL 32306, USA
| | - Emily R. Bowman
- The Ohio State University, 453 West 10 Ave, Columbus, OH 43210, USA
| | - Jesse L. Clark
- University of California, Los Angeles, 405 Hilgard Ave., Los Angeles 90095, CA, USA
| | - Ana N. Hyatt
- University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 2.112, Houston, TX 77030, USA
| | - Aaren Kettelhut
- The Ohio State University, 453 West 10 Ave, Columbus, OH 43210, USA
| | - Javier R. Lama
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Lima 15063, Peru
| | - Sari L. Reisner
- Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
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Cottrell ML, Prince HMA, Schauer AP, Sykes C, Maffuid K, Poliseno A, Chun TW, Huiting E, Stanczyk FZ, Peery AF, Dellon ES, Adams JL, Gay C, Kashuba ADM. Decreased Tenofovir Diphosphate Concentrations in a Transgender Female Cohort: Implications for Human Immunodeficiency Virus Preexposure Prophylaxis. Clin Infect Dis 2020; 69:2201-2204. [PMID: 30963179 DOI: 10.1093/cid/ciz290] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022] Open
Abstract
Feminizing hormone therapy (FHT) may interact with human immunodeficiency virus preexposure prophylaxis (PrEP). We found that transgender women who took FHT exhibited a 7-fold lower rectal tissue ratio of PrEP's active metabolites vs competing deoxynucleotides compared to cisgender women and men (P = .03) that inversely correlated with estradiol (ρ = -0.79; P < .05). Thus, FHT may negatively impact PrEP efficacy. Clinical Trials Registration . NCT02983110.
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Affiliation(s)
- Mackenzie L Cottrell
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics
| | - Heather M A Prince
- School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Amanda P Schauer
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics
| | - Craig Sykes
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics
| | - Kaitlyn Maffuid
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics
| | - Amanda Poliseno
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics
| | - Tae-Wook Chun
- HIV Immunovirology Unit, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Erin Huiting
- HIV Immunovirology Unit, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Frank Z Stanczyk
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Anne F Peery
- School of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill
| | - Evan S Dellon
- School of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill
| | - Jessica L Adams
- Philadelphia College of Pharmacy, University of the Sciences, Pennsylvania.,Cooper University Hospital Early Intervention Program, Camden, New Jersey
| | - Cindy Gay
- School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Angela D M Kashuba
- Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics.,School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill
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Ackerley CG, Billingsley JM, Tharp GK, Amancha PK, Tangpricha V, Smith SA, Amara R, Bosinger SE, Kelley CF. Short Communication:Transgender Women on Feminizing Hormone Therapy Demonstrate a Distinct Rectal Mucosal Transcriptome from Cisgender Men. AIDS Res Hum Retroviruses 2020; 36:771-774. [PMID: 32611248 DOI: 10.1089/aid.2020.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Among transgender women (TGW), the effects of feminizing hormone therapy use on rectal mucosal (RM) HIV transmission are largely unknown. In this small pilot study, we compared the RM transcriptome in TGW utilizing feminizing hormone therapy with a group of cisgender men who have sex with men (MSM) engaging in condomless receptive anal intercourse (AI) and to a group of cisgender men who had never engaged in AI. There were 498 differentially expressed genes (DEGs) in TGW compared with men who had never engaged in AI, and 154 DEGs compared with the MSM. Among TGW, a unique RM transcriptome was identified that implicated pathways critical for mucosal immune responses, including upregulation of genes that mediate immune cell activation and the production of cytokines and other immune signaling molecules. Furthermore, gene set enrichment analyses identified immune signatures that implicated enrichment of proinflammatory immunological pathways in TGW, specifically involving interferon-α, interleukin-6, and tumor necrosis factor-α signaling, whereas metabolic pathways were shown to be enriched among the cisgender male groups. These findings suggest that TGW have a distinct RM immune environment influenced by the use of feminizing hormones, and consequently, there is an urgent need for further investigation into the immunological effects of gender-affirming hormone therapy and its potential impact on HIV mucosal transmission risk for transgender individuals.
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Affiliation(s)
- Cassie G. Ackerley
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Decatur, Georgia, USA
| | - James M. Billingsley
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Gregory K. Tharp
- Yerkes NHP Genomics Core Laboratory, Yerkes National Primate Research Center, Atlanta, Georgia, USA
| | - Praveen K. Amancha
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Decatur, Georgia, USA
| | - Vin Tangpricha
- Department of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine and the Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - S. Abigail Smith
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Decatur, Georgia, USA
| | - Rama Amara
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
- Division of Microbiology and Immunology, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Steven E. Bosinger
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
- Yerkes NHP Genomics Core Laboratory, Yerkes National Primate Research Center, Atlanta, Georgia, USA
| | - Colleen F. Kelley
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Decatur, Georgia, USA
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