HIV treatment adherence and outcomes improving among HIV-positive transgender people

HIV-positive transgender people are just as likely to stay in care, take their medication and have similar outcomes as other men and women living with the disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania and published online May 30 in Clinical Infectious Diseases. The study - which looked at almost 37,000 patients at 13 HIV clinics from 2001 to 2011 in the US - suggests an encouraging shift from earlier work documenting poor retention in care and drug adherence in transgender people, a high risk group for HIV.

In the retrospective analysis, led by Baligh R. Yehia, MD, MPP, MSHP, a clinical instructor in the division of Infectious Diseases at Penn Medicine, researchers found that transgender people receiving care had similar rates of retention, antiretroviral therapy (ART) coverage and HIV suppression as nontransgender men and women over the 10 year period.

Dr. Yehia says there are several factors that could explain why care and suppression rates have improved and become more equal. "It's a combination of things: there have been great advances in HIV therapy and management over the last decade and increased attention from advocates and groups on identifying people infected with HIV quickly, linking them to care in a timely fashion, and starting treatment earlier," he says. "In addition, there is an increased focus on lesbian, gay, bisexual, and transgender (LGBT) health in general.

"Over the past five years, leading federal institutions and national organizations, including the Institute of Medicine, American Medical Association (AMA), and the American Association of Medical Colleges, have emphasized the importance of improving the health of LGBT populations by understanding and addressing their unique health care needs, identifying research gaps and opportunities, and developing educational activities to address the needs of LGBT trainees, faculty, staff, and patients."

For the study, Dr. Yehia and colleagues, including Kelly A. Gebo, MD, MPH, of the Johns Hopkins University School of Medicine, retrospectively looked at 36,845 patients from 13 clinics within the HIV Research Network, a consortium that cares for HIV-infected patients across the nation, from 2001 to 2011. Of the group, 285 self-identified as transgender.

Researchers found that transgender persons were retained in care, received ART, and achieved HIV suppression 80 percent, 76 percent, and 68 percent of the time during the 10 years, respectively. Similarly, men were 81 percent, 77 percent and 69 percent, while women were 81 percent, 73 percent, and 63 percent.

Antiretroviral treatment (ART) improves the health and prolongs the lives of persons with HIV. Studies that included mostly heterosexual HIV-discordant couples (one partner is HIV-infected and the other is not) have shown that ART use by persons with HIV can reduce the risk of sexually transmitting HIV to others by over 90%. Current U.S. HIV treatment guidelines support initiation of ART for persons with HIV for their personal health benefit and to prevent transmission of HIV infection. To maximize individual and public health benefits, high levels of adherence to ART are critical.