Infectious Disease

Hormone therapy related to virus suppression in transgender women with HIV

August 07, 2021

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Transgender women with HIV who received sex-affirming hormone therapy had significantly higher rates of persistent virus suppression, according to a study published in the Open Forum Infectious Diseases.

Nathan A. Summers, MD, MSc, an assistant professor of medicine at the University of Tennessee’s Health Science Center, and colleagues identified transgender women treated at the center from January 1, 2015 through December 31, 2019, and used electronic patient records to calculate the proportion of patients that have been virally suppressed and maintained.

For the study, the researchers identified 76 HIV-infected people. Two identified as cisgender and 15 had insufficient records, so 59 transgender women were included in the analysis.

The study participants had an average age of 35 years, 86% were black and they had a median CD4 count of 464 cells / µl. Thirteen participants received gender-affirming hormone therapy (GAHT) at baseline, and 31 received it at any point during the study. 28 participants never received GAHT.

According to Summers and colleagues, 55% of the participants were virally suppressed at the start of the study. Among those with detectable viral load, the median viral load was 23,540 copies / ml. Viral load tests at the time of GAHT initiation showed that 86% of these patients were virally suppressed.

In the last 4 years of the study, the proportion of participants with virus suppression 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 maintaining HIV virus suppression cannot be emphasized enough,” the authors write. “Achieving virus suppression leads to improved individual health outcomes and reduces transmission to seronegative partners and has therefore become a major focus of international HIV efforts.”

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Tonia Poteat, Ph.D.

Tonia potato

Although limited by its small sample size and retrospective nature, this study adds to the growing body of research suggesting the benefit of gender-based health care for transgender women with HIV who so choose.

I commend the authors for explicitly indicating that it is unethical to withhold gender-affirming hormone therapy until someone has reached viral suppression, and it is unlikely to be the cause of the associations they found. I hope these results will inspire future prospective studies and encourage HIV carers to ensure that transgender patients receive adequate gender-affirming care.

Tonia Poteat, Ph.D.

Associate Professor of Social Medicine

University of North Carolina School of Medicine

Disclosure: Poteat does not report any relevant financial information.

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