Barney S. Graham, MD, PhD

A. Counsel her that a change in her ART regimen to bictegravir/emtricitabine/tenofovir alafenamide is recommended to reduce the risk of drug-drug interaction with GAHT

B. Advise her that she can proceed with GAHT but inform her and her primary care physician that higher than usual estradiol doses will likely be needed

C. Recommend the transdermal route rather than the oral route for estradiol administration to avoid induction of hepatic clearance of ART

D. Inform her that her HIV control may worsen upon initiation of GAHT and necessitate a change in therapy

E. Reassure her that she can proceed with standard GAHT without any adjustment based on her ART

Barney S. Graham, MD, PhD

Barney S. Graham, MD, PhD

Former Deputy Director National Institute of Allergy and Infectious Diseases Vaccine Research Center

National Institutes of Health

Bethesda, MD

March 17, 2025: Gender-Affirming Hormone Initiation and ART Considerations