Dr. Jordan Lake
Dr. Jordan Lake

New research spearheaded by Dr. Jordan Lake, associate professor in the Division of Infectious Diseases in the Department of Internal Medicine, is shedding light on challenges health care teams face in treating HIV among transgender women.

Lake, who was recruited to The University of Texas System as a Rising STAR in September last year, said she first began researching this issue when she realized there was a lack of clinical understanding of how to best treat transgender women, and that concerns from providers and patients exist around whether antiretroviral therapy (ART) and feminizing hormone therapy (HT) have drug interactions. She said transgender women have rates of HIV infection 34 times greater than the U.S. general population. A 2013 study by the Centers for Disease Control and Prevention estimates that 22 percent of transgender women were living with HIV in five high-income countries like the United States.

“In the course of treating HIV-positive transgender women in my clinic, I saw that, despite very high rates of HIV infection in this population, there was a lack of knowledge on optimal treatment,” Lake said.

As the leader of the published study, Lake and other investigators surveyed 87 transgender women in Los Angeles prior to her move to UT. The study, which began while she was at the University of California-Los Angeles, found that 69 percent of respondents were on some type of hormone therapy but also that a quarter of all transgender women and 34 percent of transgender women were using hormone therapy without medical supervision.

Even more worrisome is that 57 percent of those living with HIV were concerned about potential drug interactions using both ART and HT, but only 49 percent discussed possible drug interactions with a health care provider, and 40 percent of the HIV-positive transgender women did not take HIV medications, hormones or both as directed due to fear of these interactions.

Lake said there is continued enrollment in the study here in Houston and her team hopes to have Houston-specific data ready soon. She said plenty of work needs to be done with regards to better understanding drug interactions and how best to approach treatment for HIV-positive transgender women.

“HIV medications are currently tested for interactions with estrogens and progesterones at the doses used in the general population for birth control and hormone replacement therapy in post-menopausal women, but these doses are much lower than those often taken by transgender women,” Lake said.

Drug interactions are also only one major concern, she said.

“These hormones affect many organ systems in the body, many of which are also affected by HIV infection like the liver and bones,” Lake said. “An understanding of their full scope of physiologic effects is needed. Much of the prior research on transgender women is not specific to HIV-infected persons or currently recommended hormone regimens.”

Lake and her team’s findings were presented at the 9th International AIDS Society Conference on HIV Science in Paris this year.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” Judith Currier, M.D., co-director of the Center for AIDS Research and Education at UCLA, co-investigator on the study and vice chair of the AIDS Clinical Trials Group, said in a press release. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Lake said she looks forward to continuing her research.

“Gaining trust in the individual communities is critical to the work and takes time, but has been very rewarding,” Lake said.