Hormone therapy associated with viral suppression in transgender women with HIV
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Transgender women with HIV who received gender-affirming hormone therapy experienced significantly higher rates of sustained viral suppression, according to a study published in Open Forum Infectious Diseases.
Nathan A. Summers, MD, MSc, an assistant professor of medicine at the University of Tennessee Health Science Center, and colleagues identified transgender women who received care at the center from Jan. 1, 2015, through Dec. 31, 2019, and used electronic health record data to calculate the proportion of patients who were virally suppressed and retained in care.
The researchers identified 76 people living with HIV for the study. Two identified as cisgender, and 15 had insufficient records, leaving 59 transgender women who were included in the analysis.
Study participants had a mean age of 35 years, 86% were Black, and they had a median CD4 count of 464 cells/µL. Thirteen participants were receiving gender-affirming hormone therapy (GAHT) at baseline, and 31 received it at any point during the study. Twenty-eight participants did not receive GAHT at any point in time.
At study entry, 55% of participants were virally suppressed, according to Summers and colleagues. Among those with detectable viral loads, the median viral load was 23,540 copies/mL. Viral load testing at the time of GAHT initiation showed 86% of those patients were virally suppressed.
Over the last 4 years of the study, the proportion of participants who were virally suppressed was higher in the GAHT cohort: 73% vs. 59%, 64% vs. 57%, 61% vs. 44% and 71% vs. 36% (P = 0.04).
“The importance of achieving and sustaining HIV viral suppression cannot be overstated,” the authors wrote. “Achieving viral suppression leads to improved individual health outcomes and reduces transmission to seronegative partners, and as such has become a primary focus of international HIV efforts.”
Perspective
Back to TopTonia Poteat, PhD
While this study was limited by the small sample size and retrospective nature, it does contribute to the growing body of research suggesting the benefits of gender-affirming medical care for transgender women living with HIV who desire it.
I commend the authors for explicitly noting that withholding gender affirming hormone therapy until someone achieves viral suppression is unethical and unlikely to be the reason for the associations they found. I hope these findings will inspire future prospective studies and encourage HIV care providers to ensure that transgender patients get appropriate gender-affirming care.
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