Retention in Care and Health Outcomes of Transgender Persons Living With HIV

To the Editor—Little is known about the health outcomes of transgender persons living with human immunodeficiency virus (HIV), or PLWH [1]. Discrimination and social isolation may decrease engagement in care, while concerns about adverse interactions between antiretroviral therapy (ART) and hormone therapy may reduce ART receipt and medication adherence in this population [2–4]. We examined whether retention in care, use of ART, and HIV suppression differed between transgender and nontransgender PLWH. We performed a retrospective cohort study of HIV-infected adults (≥18 years) initiating care at 13 HIV clinics in the HIV Research Network (HIVRN) between 2001 and 2011. Clinics are located in the Northeastern (n = 6), Midwestern (n = 1), Southern (n = 3), and Western (n = 3) regions of the United States. Data from patients’ medical records were abstracted, quality assured, and assembled into a uniform database [5]. All clinics had institutional review board approval. Gender was self-identified and categorized as nontransgender men, nontransgender women, and transgender. Dichotomous outcomes were retention in care (≥2 primary HIV visits ≥90 days apart), use of ART, and HIV suppression (median HIV RNA