CLINICAL CORNER

by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

May 2, 2019


Featured Literature:
Poteat, Tonia et al. Characterizing the HIV Care Continuum among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-Series Analysis
Clinical Infectious Diseases, ciz322, https://doi.org/10.1093/cid/ciz322 Published: 23 April 2019

Current CDC estimates are that one in five transgender women (TW) in the U.S. are living with HIV. Prior studies suggest that TW are less likely to be engaged and retained in care and consequently have lower rates of viral suppression than other persons living with HIV. Data from the population of TW remain limited due to small sample sizes and cross-sectional design of most studies. This study included TW from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). The NA-ACCORD prospectively collects data on more than 180,000 adults with HIV from various clinical sites in the US and Canada. For this study, the researchers attempted to characterize the HIV care continuum with TW compared to Cisgender men (CM) and women (CW) from 2001 through 2015. The two primary outcomes were retention in care (two visits in 12 months at least 90 days apart) and viral suppression (HIV-RNA < 200 copies). The study population included 396 TW, 14,094 CW and 101,667 CM. It was found that TW were significantly less likely to be retained in care than CW and CM. Overall estimates of retention in care were consistently lower in TW with little change over time. Retention in care estimates did decline slightly in CW and CM. Regarding viral suppression, all three groups showed significant improvements in viral suppression. Transgender women and CW had similar numbers with VL < 200 copies over time (TW: 36% vs. 35% in 2001 and 80% vs. 83% in 2015). The rates of viral suppression for CM were 41% in 2001 and 87% in 2015. These differences did not reach statistical significance after adjusting for race, age, and HIV risk group. The authors conclude that TW have challenges with retention in HIV care but those who are engaged in care achieve viral suppression comparable to CW and CM. Further studies are needed to better to understand the disparities in care engagement as well as determine effective interventions for reaching this underserved patient population.


Commentary:
This study from NA-ACCORD helps advance the limited but growing data we have regarding the HIV care of TW. They did find that clinical sites which provided both HIV and gender-affirming care (provision of hormones) have more success with viral suppression. Encouraging is the percentage of PLWH from all groups with viral suppression through 2015.

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