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Ya-Chi Ho, MD, PhD
University of California San Francisco
Professor of Medicine, Emeritus
San Francisco, CA
Yvonne Maldonado, MD
University of California San Francisco
Professor of Medicine, Emeritus
San Francisco, CA
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CROI
Conference on Bacteriophages
RWHAP Clinical Conference
Podcasts
Our Voices
Question of the Week
Donate
Contact
CME Courses
HIV In-Person and Virtual Courses
Current On-Demand Courses
About Courses
CME Webinars
Upcoming Webinars
Current On-Demand Webinars
MATE Act CME
About Webinars
Dialogues
Upcoming IAS–USA Dialogues
On-Demand Dialogues
About Dialogues
Topics In Antiviral Medicine
Current Issues for CME
Previous Issues
TAM
Policies and Practices
Permission Request Form
HIV Drug Resistance
Drug Resistance Mutations Chart
Recent Webinars
Journal Articles
Fellow Resources
Fellow Resources
IAS-USA Guidelines
On-Demand Webcasts
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Practice Question of the Week
March 17, 2025: Gender-Affirming Hormone Initiation and ART Considerations
A 44-year-old individual with HIV is currently well controlled with emtricitabine/tenofovir alafenamide and dolutegravir and asks your opinion regarding initiation of gender-affirming hormone treatment (GAHT). She was designated male sex at birth but identifies as a transgender woman. She has discussed her gender incongruence with her primary care physician,who is experienced in providing GAHT, but this physician has also expressed concern due to the patient's HIV infection and antiretroviral therapy (ART) regimen. Which of the following is the best recommendation?
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
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