I recently attended the Conference on Retroviruses and Opportunistic Infections meeting in Boston along with 4,000 other HIV experts and researchers. So this issue will also be devoted to what I learned there. As promised I have a section on Transgenders. I have treated transgenders for years and have studied to keep current. I learned a lot from the speaker during one of the main lectures of the conference. This topic was so important to the conference organizers that they had it in a time slot that had no competing lectures.
It is very hard to estimate the total number of transgenders since they are a small minority and have more stigma than most minority groups. The best estimate is 0.3% or 698,000 in the US. In Asia the estimates are 0.7-2.9%. In India there estimate 1-6 million. Female to Males are a very small number and studies show <1% of the population. Most of her (Tonia C. Poteat PA-C, MS, PhD at The Johns Hopkins
University, Baltimore, MD) comments were on Male to Females:
African descent has twice as many transgenders compared to Anglos. The top 5 health concerns of HIV positive transgenders are:
Gender affirming and non-discriminatory care
Hormone therapy and side effects
Mental health care including trauma and personal care
Antiviral therapy and side effects
If an HIV provider prescribed hormones then the the trans-women were three times more likely to have a great viral load response and keep appointments. Many trans-women believe that antivirals lower effective levels of the hormones so they get hormones from the provider and from the outside.
Condoms work. PrEP works in trans-women well since it has greater levels in the anal tissues compared to a lady’s vagina.
Many transgenders use fillers whether it be implants or injections. Of course having a non-medical specialist inject silicone or other fillers is risky for a poor result.
A new vagina made from outside skin is called a neovagina and the ability to transmit HIV is unknown.
It is difficult for a transwoman to find a job or a partner and the partners they do find are high risk (violence, mental illness, substance abuse, etc), 64% engage in sex work.
Transwomen have more homelessness, unstable housing, and less transportation. It is no wonder that transwomen have poorer response to antivirals due to the chaos level in their lives. Be extra nice to transgenders!
TYPES OF FAT
Too much fat around your intestines can send out hormones that tell the body you are inflamed and that causes hardening of the arteries. Bad fat! The fat you pinch on your abdomen is superficial fat, and acts differently. Over half of HIV patients are binge drinkers of alcohol and that increases the bad fat. The damage from drinking 30 drinks a month in a normal person is like 70 drinks in an HIV patient. Low carbohydrate diets decrease the bad fat.
Fatty liver disease which can kill like alcoholic liver disease and chronic hepatitis is more common in HIV. Watch your weight please. This goes along with all the other problems mentioned here: hardening of the arteries, more bad fat.
Another study I heard recently showed that youth who do resistance (weights) and cardio (e.g. cycling) have much less risk of diabetes. This was more important than having obesity or not. Encourage your young friends and relatives to exercise and you can join them!
TIGHTENING PRESCRIPTIONS FOR OPIATES
There are new guidelines from the CDC to decrease the prescribing of, abuse of, and deaths from opiates (Norco®, Percocet®, morphine, Oxycontin®, oxycodone, Tylenol #3®). If you have chronic pain, expect changes in these prescription rules from your pain specialist or primary provider.
TREATMENT AS PREVENTION (TASP) UPDATE
If your HIV viral load is undetectable then there is a 6% chance you have virus in your semen if you have been undetectable in your blood for 6 months. If longer then there is much less a chance. If there is a viral load in semen then it ranged from 363-955—which is pretty low but theoretically infectious. There were no transmissions in this study. So this confirms that it is very unlikely to be able to transmit HIV from semen from a person with undetectable viral load in his blood; but using a condom lowers that low risk even further.
ADOLESCENT DEATHS FROM HIV
The number one cause of death in Africa in adolescents is HIV and it is the second leading cause in the rest of the world. Youth are risk takers and sensation seekers. If they program themselves in good habits or bad before age 20 then those are the habits that are easy to have after that. Advise your young friends to think twice before taking risks and seeking thrills.
Be Safe! Wear protection. Keep those questions coming.
Daniel Pearce, D.O., FACOI
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Assistant TB Physician, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center
REFERENCES: My notes from CROI, Medscape®