With guest Dr. Asa Radix, Chris reviews the case of a 32-year-old transgender woman who was diagnosed with HIV testing while receiving gender-affirming care. With a viral load of 82,000 and CD4 count of 365, she had no resistance mutations and no other known major medical conditions. Asa walks Chris through the approach to ART and gender-affirming HIV and primary care for this patient.

References Cited:

• Braun HM, Candelario J, Hanlon CL, et al. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health. 2017 Oct;4(5):371-375. PMID: 28876170.
• Blumenthal J, Acevedo-Quinones M, Phanuphak N, et al.  No Clinically Significant Drug–Drug Interactions with Co-administration of Feminizing or Masculinizing Hormone Therapy and Twice-yearly Lenacapavir PrEP in Gender-Diverse Persons, Open Forum Infectious Diseases, Volume 13, Issue Supplement_1, January 2026, ofaf695.525, https://doi.org/10.1093/ofid/ofaf695.525.
• de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019 May 14;365:l1652. PMID: 31088823.
• Huang YA, Radix A, Zhu W, et al. HIV Testing and Preexposure Prophylaxis Prescriptions Among U.S. Commercially Insured Transgender Men and Women, 2014 to 2021. Ann Intern Med. 2024 Jan;177(1):12-17. PMID: 38109739.
• Reisner SL, Pletta DR, Mayer KH, et al. HIV seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study. Lancet HIV. 2025 Apr;12(4):e283-e292. PMID: 40158515.
• Rodriguez-Hart C, Zhao G, Goldstein Z, Radix A, Torian L. An Exploratory Study to Describe Transgender People with HIV Who Accessed Medicaid and Their Viral Suppression Over Time in New York City, 2013-2017. Transgend Health. 2023 Oct 4;8(5):429-436. PMID: 37810942.

Related Guidelines and Resources:

• NYSDOH AIDS Institute Clinical Guidelines:
  - Primary Care for Adults With HIV
  - Selecting an Initial ART Regimen
  - Drug-Drug Interaction Guide: From HIV Prevention to Treatment
• Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) Adult Antiretroviral Guidelines: US DHHS Guidelines with Australian Commentary > Transgender People With HIV
• Fenway Health: Medical Care of Trans and Gender Diverse Adults
• University of California San Francisco (UCSF): Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People > Initiating Hormone Therapy
• World Professional Association for Transgender Health (WPATH): Standards of Care for the Health of Transgender and Gender Diverse People, Version 8