Volume 6, Issue 7

ART-Associated Weight Gain and PrEP/Gender-Affirming Hormone Therapy DDI

In this issue:

Consensus is near universal that all people with HIV should be on ART and all those at elevated risk of acquiring HIV should be on PrEP. But concerns about ART-associated weight gain have made some patients reluctant to begin treatment. Transgender people may delay or refuse PrEP initiation because of fears about drug-drug interactions between PrEP and their gender-affirming therapy (GAHT). How should these patient concerns be addressed? What does the evidence say? 

Those are some of the questions Dr. Sarah Puryear, from the Division of HIV, ID, and Global Medicine at the University of California, San Francisco, addresses in this issue of eHIV Review. 

Learning objectives:

  • Explain the risks and benefits of treatment with integrase strand inhibitors (INSTI) and tenofovir alafenamide fumarate (TAF) with regard to weight gain. 
  • Describe the known drug-drug interactions between gender-affirming hormone therapy (GAHT) and PrEP.  


Sarah B. Puryear, MD, MPH
Sarah B. Puryear, MD, MPH

Assistant Professor of Medicine 
Division of HIV, ID, and Global Medicine at the University of California, San Francisco 
San Francisco, California

Program Directors:

Ethel D. Weld, MD, PhD

Assistant Professor of Medicine and Pharmacology and Molecular Sciences
Division of Infectious Diseases
Division of Clinical Pharmacology
Johns Hopkins School of Medicine
Baltimore, Maryland

Matthew Spinelli, MD, MAS

Assistant Professor
HIV, ID, and Global Medicine
Zuckerberg San Francisco General Hospital
San Francisco, California

Justin Alves, RN, ACRN, CARN

Nurse Educator – Office Based Addiction Treatment, Training and Technical Assistance Program
Boston Medical Center
Boston, Massachusetts

Length of activity:

1.0 hour Physicians
1.0 contact hour Nurses

Launch date: April 29, 2021
Expiration date: April 28, 2023