For Transgender Women, PrEP Is Safe to Use With Estradiol as Feminizing Hormone Therapy, Study Says

Eight years after emtricitabine/tenofovir disoproxil fumarate (Truvada) as pre-exposure prophylaxis (PrEP) was established as efficacious for preventing HIV, transgender women using estradiol as feminizing hormone therapy (FHT) can now feel assured that "PrEP does not affect hormones," as Akarin Hiransuthikul, M.D., with the Thai Red Cross AIDS Research Centre put it while presenting the results of iFACT at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, the Netherlands on July 23, 2018.

"As tenofovir blood levels were observed to decrease by 13%, this decrease is within range that brings protection from HIV infection, continued Hiransuthikul. He said that it remains unclear why FHT caused this decrease of tenofovir levels in the blood, and they are continuing to explore whether these levels also drop in other parts of the body that are important for preventing HIV acquisition, such as the rectal cavity.

These findings mark a crucial point in the history of PrEP delivery among trans women, as they offer clarity for health care providers, PrEP outreach campaigns, and trans women using estradiol as FHT who, respectively, have remained concerned over the years about prescribing, promoting, and using PrEP with FHT.

Since PrEP was first approved for clinical use in the U.S. in 2012, PrEP awareness, acceptability, and use -- all of which are important indicators of PrEP initiation and uptake -- among trans women has continually been low. In one study between 2012 and 2015, only one in three trans women in Boston and Chicago were aware of PrEP, and only one in four found PrEP to be acceptable to use. No changes in the proportion of awareness were observed over these years. Furthermore, only 5% of the 300 trans women in the study reported ever taking PrEP. Similarly, in studies conducted in Brazil and Thailand, only a small portion of trans women found PrEP to be acceptable and initiated use.

This low utilization of PrEP among trans women on FHT can be attributed to several components, including provider hesitancy to prescribe, lack of promotional campaigns, and personal concerns about negative side effects of PrEP on FHT.

Some prior studies that explore health care providers' role in delivering PrEP to trans women have shown that providers have continually been hesitant to prescribe PrEP to trans women on FHT mainly due to having little-to-no scientific knowledge about how PrEP and FHT may interact inside the body. As there are currently no specific and official standard of care clinical guidelines on how to initiate and monitor PrEP with FHT among trans women from principal national and global public health agencies, such as the Centers for Disease Control and Prevention, the World Health Organization, or the World Professional Association for Transgender Health, many health care providers are deterred from prescribing these life-saving medicines altogether, while others proactively monitor physiological effects through routine blood tests.

Moreover, PrEP and FHT research on trans women has continually lagged within the HIV prevention scientific community. Because this type of research has not been prioritized, there are few public health promotional campaigns aimed at increasing PrEP awareness and use among trans women on FHT.  Read more via the BodyPro