US: A majority of transgender women with HIV are undetectable

Over two decades, more than 80% of transgender women living with HIV had ever received HIV care, more than 70% were currently in care and more than 60% had an undetectable viral load, according to a systematic review and meta-analysis published in the journal AIDS. There were not enough data on trans men to do a similar analysis for that population.

Behavioral scientist Jeffrey Becasen, MPH, of the Centers for Disease Control and Prevention (CDC), and colleagues went back through databases of HIV literature to find studies published on HIV outcomes among transgender people in the United States. Of the 50 selected studies conducted between 1997 and 2018, 41 had data the researchers considered the most reliable, while the rest were moderately reliable.

Altogether, more than 11,000 transgender people—mostly trans women—participated in the studies (though some people might have taken part in more than one). Most study participants were recruited from community organizations or clinics throughout the United States. Across the studies, the average age ranged from 21 to 51 years old.

Because not enough studies have been done on HIV outcomes among transgender men and nonbinary people, the researchers couldn’t conduct an analysis for these groups. However, they did synthesize what information was available. The two studies with data on trans men found that between 58% and 88% were currently taking antiretroviral treatment and 69% were taking it as prescribed. The studies didn’t provide data on how many men had an undetectable viral load.

In the studies of transgender women, the HIV care continuum breaks down like this: 82% had ever received HIV care, 72% were currently receiving care and 83% were retained in care. However, only 65% of transgender women were linked to care in a timely way, which the researchers defined as within three months of their diagnosis.

Nearly three quarters of the trans women (71%) had ever been prescribed antiretroviral treatment, 66% were currently on treatment and 66% had good adherence. Among all trans women in the studies, 62% had an undetectable viral load on their last test. Looking just at those who were receiving care or on treatment, 67% had viral suppression.

These findings differ from CDC surveillance data for 2018 that showed that 84% of trans women diagnosed with HIV received any HIV medical care and 72% had an undetectable viral load on their last test. For comparison, the CDC estimated that 77% of diagnosed gay and bisexual men received any HIV care and 67% achieved viral suppression in 2018. The corresponding rates for diagnosed cisgender women were 76% and 63%, respectively.

This analysis didn’t include information about whether the trans women had access to gender-affirming services, such as hormones or surgery, both of which have been found to be associated with better HIV care and higher rates of viral suppression. Such integrated care may improve adherence seen in the analysis found.

“Integrating transgender-specific health needs (e.g., hormone therapy) into HIV care might be needed for improving the percentages of transgender persons across the HIV care continuum,” the authors wrote.

By Heather Boerner