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Studies of pre-exposure HIV prophylaxis (PrEP) have raised concerns about the effectiveness of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in transgender women (TGW). One potential explanation is that use of feminizing hormone therapy may alter the pharmacokinetics of TDF/FTC, particularly at the tissue level, resulting in lower concentrations of the active drugs, TDF-diphosphate (TDF-dp) and FTC-triphosphate (FTC-tp).
Twelve persons taking TDF/FTC for HIV treatment or PrEP with documented good adherence were enrolled (4 transgender women, all taking spironolactone, and 8 cisgender control subjects). The investigators measured concentrations of the parent drugs (TDF and FTC), metabolites (TDF-dp and FTC-tp), and the naturally occur…