{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T04:40:11Z","timestamp":1750308011349,"version":"3.41.0"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T00:00:00Z","timestamp":1712707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>We here present a case providing valuable insights for clinicians who deliver care to patients identifying as transgender or nonbinary. A 30\u2010year\u2010old trans woman presented to sexual health services requesting a routine sexual health screen and was subsequently diagnosed with HIV and syphilis. She started antiretrovirals for HIV (bictegravir\/tenoforvir alafenamide\/emtricitabine) 12\u2009days later and was treated with benzathine penicillin G. The patient also had a positive tuberculosis (TB) ELIspot blood test result and further investigations proved the presence of active TB in the chest with mediastinal involvement. She commenced treatment for TB with quadruple therapy, including rifampicin. Due to the clinically significant interaction between rifampicin and bictegravir, the patient's antiretroviral treatment was switched to dolutegravir 50\u2009mg twice daily in combination with tenofovir disoproxil fumarate and emtricitabine. As the patient had transitioned from male to female and was self\u2010medicating with oestrogen\u2010containing feminizing hormone therapy, her hormonal treatment was optimized and blood levels of oestradiol were closely monitored and titrated to manage the drug\u2013drug interaction between rifampicin and oestrogen to ensure the latter would be maintained within the expected therapeutic range. Our case report demonstrates the importance of combining treatment of multiple conditions under 1 team ideally integrated with gender services to prevent multiple attendances and mismanagement of feminizing hormone therapies.<\/jats:p>","DOI":"10.1111\/bcp.16064","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:34:22Z","timestamp":1712795662000},"page":"2383-2386","source":"Crossref","is-referenced-by-count":2,"title":["A case report highlighting drug\u2013drug interactions between 3 life\u2010saving treatments: Feminizing hormones, antiretrovirals and antituberculosis drugs"],"prefix":"10.1111","volume":"90","author":[{"given":"Tara","family":"Suchak","sequence":"first","affiliation":[{"name":"TransPlus Chelsea and Westminster Hospital  London UK"},{"name":"HIV Department Chelsea and Westminster Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margherita","family":"Bracchi","sequence":"additional","affiliation":[{"name":"HIV Department Chelsea and Westminster Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Mercer","sequence":"additional","affiliation":[{"name":"HIV Department Chelsea and Westminster Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances","family":"Lander","sequence":"additional","affiliation":[{"name":"TransPlus Chelsea and Westminster Hospital  London UK"},{"name":"HIV Department Chelsea and Westminster Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2213-1103","authenticated-orcid":false,"given":"Marta","family":"Boffito","sequence":"additional","affiliation":[{"name":"HIV Department Chelsea and Westminster Hospital  London UK"},{"name":"Imperial College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,10]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"MurrayR.Acting on the evidence: ensuring the NHS meets the needs of trans people. [online].https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/blogs\/ensuring-nhs-meets-needs-trans-people"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12900"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0956462415624059"},{"key":"e_1_2_8_5_1","unstructured":"NICE. (n.d.).Tuberculosis. [online].https:\/\/bnf.nice.org.uk\/treatment-summaries\/tuberculosis\/"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz256"},{"key":"e_1_2_8_7_1","unstructured":"Custodio J.M. West S.K. Collins S. Vu A. Xiao D. Martin H. et al. (2018).Pharmacokinetics of bictegravir administered twice daily in combination with rifampin. Conference on Retroviruses and Opportunistic Infections Abstract N 34 4\u20137 March 2018 Boston USA. Accessed 2nd March 2024.https:\/\/www.croiconference.org\/abstract\/pharmacokinetics-bictegravir-administered-twice-daily-combination-rifampin\/"},{"key":"e_1_2_8_8_1","unstructured":"NICE. (n.d.).BNF is only available in the UK. [online]. Accessed 1 Mar. 2024.https:\/\/bnf.nice.org.uk\/drugs\/ethinylestradiol-with-norelgestromin\/#medicinal-forms"},{"key":"e_1_2_8_9_1","unstructured":"Endocrine management of gender incongruence in adults prescribing guidance for non\u2010specialist practitioners. (2019). Accessed 5 Feb. 2024.https:\/\/awttc.nhs.wales\/files\/guidelines-and-pils\/endocrine-management-of-gender-incongruence-in-adults-pdf\/"},{"key":"e_1_2_8_10_1","unstructured":"Standards of Care for the Health of Transsexual Transgender and Gender Nonconforming People The World Professional Association for Transgender Health. (n.d.).https:\/\/www.wpath.org\/media\/cms\/Documents\/SOC%20v7\/SOC%20V7_English.pdf"},{"key":"e_1_2_8_11_1","unstructured":"MitchellLet al. (2019).BASHH recommendations for integrated sexual health services for trans including non\u2010binary people working group. Accessed 2nd March 2024.https:\/\/www.bashh.org\/professionals\/special_interest_groups\/25\/gender_sexual_minorities_gsm\/public"},{"key":"e_1_2_8_12_1","unstructured":"Chung C. Kalra A. Sprague L.andCampbell B.(2016).Positively trans initial report of a national needs assessment of transgender and gender non\u2010conforming people living with HIV."},{"key":"e_1_2_8_13_1","unstructured":"Stonewall. (2018).LGBT in Britain\u2014trans report (2018). [online]. Stonewall.https:\/\/www.stonewall.org.uk\/resources\/lgbt-britain-trans-report-2018"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bcp.16064","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T04:03:46Z","timestamp":1750305826000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1111\/bcp.16064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,10]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/bcp.16064"],"URL":"https:\/\/doi.org\/10.1111\/bcp.16064","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"type":"print","value":"0306-5251"},{"type":"electronic","value":"1365-2125"}],"subject":[],"published":{"date-parts":[[2024,4,10]]}}}