An 18 year-old transgender woman presents to your HIV clinic to establish care. She was diagnosed with HIV two weeks ago and started on bictegravir, tenofovir alafenamide, and emtricitabine. She is taking gender affirming hormone therapy of spironolactone and systemic estradiol.
Workup at the time of HIV diagnosis included a tuberculin skin test that measured 8mm at 48 hours.
She has not received the BCG vaccine and has no history of tuberculosis diagnosis, known exposure, or high risk activities.
She denies weight loss, fever, fatigue, night sweats, cough, or dyspnea. Physical exam and chest x-ray are unremarkable. She feels comfortable on her current medications and requests no changes.