HIV Antiretroviral Treatment and Pre-exposure Prophylaxis in Transgender Individuals

HIV prevalence is elevated among transgender populations with an estimated 13.7% of transgender adults living with HIV in the USA. In addition, transgender people experience significant disparities in biomedical HIV prevention and treatment. The efficacy of topical microbicides for prevention of HIV acquisition have not been tested among transgender people and may be impacted by hormonal therapies and/or surgeries undertaken by some transgender people to align their anatomy with their gender identity. Low pre-exposure prophylaxis (PrEP) uptake and adherence as well as potential drug–hormone interactions impact the efficacy of PrEP among transgender women. Few transgender men have been engaged in the PrEP continuum, and they have been largely excluded from PrEP research until very recently. Prioritisation of hormone therapy over HIV treatment as well as concerns about drug–hormone interactions may impact transgender women’s adherence to antiretroviral therapy. More research is needed to clarify the clinical significance of identified drug–hormone interactions and better inform interventions to improve HIV prevention and care for transgender people.