Trans women living with HIV who do not take their antiretroviral medication (ART) said it was because they were worried about harmful interactions it could cause with their hormone therapy. A study of trans women in Los Angeles showed more than 50% of those living with HIV were concerned ART and feminizing hormone therapy (HT) could result in harmful drug interactions.
Not much is is clinically understood about the interaction between the two treatments.
The National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH) carried out the study. They said the results were concerning. Firstly, because trans women are in a high-risk group for acquiring HIV. But also because starting ART soon after diagnosis prevents long-term health problems and transmitting HIV to a sexual partner.
The NIAID and NIMH presented the survey findings at the 9th International AIDS Society Conference on HIV Science. The conference is currently on in Paris.
CLICK THE HEADER LINK TO READ THE FULL ARTICLE.
The medical establishment really doesn’t know shit about trans bodies. Like, doctors can’t just say, “Don’t worry, it’s absolutely safe to take ARV’s while undergoing HRT.” WHICH WOULD SAVE LIVES.
Trans women think they have to make a choice between them.
And to anyone who looks at this and wonders why on earth anyone would chose hormones over life saving meds, it’s because hormones ARE life saving meds too.
The concern surrounding HIV medication and HRT has to do with a protein in your liver known as cytochrome P450 3A4 (CYP3A4) that is responsible for metabolizing various medications in your body. If a drug interferes with CYP3A4 it can have consequences on the metabolism of other drugs that rely on CYP3A4, causing you to absorb an inappropriate dose of that drug.
A drug that is used in hormonal contraceptives but which is no longer used in hormone replacement therapy for transgender women, ethinyl estradiol, was found to modulate CYP3A4. Because many HIV medicines rely on CYP3A4 this became a concern for HIV+ women taking hormonal contraceptives.
No research has been done on hormone replacement therapy or drugs nowadays used in hormone replacement therapy (micronized estradiol and estradiol valerate). Nonetheless, some doctors are concerned that the estrogen used in HRT have the potential to interfere with CYP3A4 in a significant way and that trans women receiving HIV treatment should be closely monitored for drug interactions.
I want to stress that this is all very theoretical at this point and that no interaction has yet been identified between transgender women’s HRT and antiretroviral drugs (HIV medication). Those who are concerned can read about the current state of research in this literature review which I encourage you to print out and bring with you to give to your doctor.
None of this means that HRT and HIV medications cannot be used at the same time! In fact HIV+ transgender women have been using HRT and antiretroviral medication, successfully, for a very long time. Here are some things that you should keep in mind:
The drug interaction in question, if real, would not in any way fundamentally interfere with the effectiveness of either therapy. The only thing that is of concern is that your dosages might need to be adjusted because the combination of drugs would affect how your body absorbs one or both medications. This kind of adjustment is normal, even when there isn’t a drug interaction. As long as your viral load and serum estradiol are within acceptable limits then your therapy is working and you have nothing to worry about.
People who are extra concerned about this (and you really shouldn’t be) also have the option of using estradiol patches which, because they bypass the liver, should have a minimal impact on CYP3A4 and your HIV medication. Theoretically, it shouldn’t have any more affect on your HIV treatment than the estrogen produced in cisgender women’s bodies. Again, I want to stress that many trans women use oral estradiol with HIV treatment and are just fine so if you can’t afford patches then do not worry about it.
Finally, I want to underscore that doctors prescribe drugs that interact with each other via CYP3A4 all the time. It is not a big deal and there is nothing special about HRT and HIV treatment that would make this combination of drugs different.
So… take the drugs that you need to live a full life and take the drugs you need to live a long life. You’re going to be just fine.
I’m not a physician and I want to stress that even if I were a physician a Tumblr post does not constitute medical advice. I made this post to inform and to empower HIV+ trans women to seek life-saving medical treatment and to understand that HRT is not incompatible with the drugs they need to fight HIV.
Edit: I don’t know why I emphasized CYP3A4′s role during first-pass metabolism. It is important in excretion, too but… the post remains valid regardless. I fixed it, anyway.
It seems like there is a big, popular understanding about where you’ll find wild “Siamese fighting fish” aka “betta fish” in Thailand.
Apparently, the common North American (and European?) idea is that you’ll find beta fish in places like this:
I can understand this misconception, especially if you’ve never experienced what our monsoon seasons are like, nor have ever seen a rice field before… among many other things. The fact is, you’ll never see betta fish in such tiny bodies of water. I have seen tadpoles in small puddles like these… and, in shallow gutters/”khlongs”, I have even found little guppies and fresh water crabs. But try as I might (and I have really tried), I have not once found a single betta fish in these kinds of environments.
Betta fish naturally occur in these kinds of environments:
Yes, the water can be shallow (knee-deep), but the territory is often wide, vast, and dense with soft, vertical growing foliage. The water is not stagnant like in a puddle, nor is it barren with wide open space. In this environment, a wild betta fish has many hiding opportunities.
I can only assume that betta fish do not naturally occur in small puddles (be it in the jungle or otherwise), or within Khlongs/gutters–because it is not an optimal environment for them and they cannot survive it. Please note that I do not, nor have ever raised betta fish. I have only looked to admire them in the wild and these are my observations.
As someone who raises a variety of wild/’exotic’ animals, I have found it critical to the animals health and behavior–to recreate their natural environment as closely as possible, while omitting natural dangers from the set-up. Doing so will allow your animal to exhibit its full range of natural behaviors, and exist optimally. For you, this means being able to watch your animal preform behaviors and show off colors you might never have had the chance to see, otherwise. I my opinion, this is much more rewarding than spending time, energy, and emotions into trying to defend a tiny, barren, and stagnant fishbowl set up.
Urocyon's Jaunts 2.0 