HIV care outcomes among transgender women compared with cisgender men and women: a retrospective cohort study in two hospitals in Paris, France

Introduction: Transgender women are disproportionately affected by HIV worldwide, yet data on engagement in HIV care and treatment outcomes remain limited and inconsistent, particularly in European healthcare settings. We aimed to compare retention in care and virological outcomes among transgender women and cisgender people living with HIV. Methods: We conducted a retrospective cohort study using routinely collected clinical data from two tertiary hospitals in Paris, France. Adults living with HIV who initiated care between 2008 and 2018 were included and classified as transgender women, cisgender men or cisgender women. Loss to follow-up was defined as the absence of any clinical visit for a continuous 24-month period. Virological response was defined as the time to first HIV viral load <50 copies/mL. Patients with an undetectable viral load at entry into care were excluded from time-to-event analyses. Kaplan-Meier methods and Cox proportional hazards models were used to compare outcomes between groups. Results: A total of 129 transgender women, 1304 cisgender men and 523 cisgender women were included. The majority of transgender women (93.4%) were migrants from Latin America and their mean age at entry into care was lower than that of cisgender patients. After multivariable adjustment, no significant difference in loss to follow-up was observed between transgender women and cisgender men (aHR=1.06, 95% CI 0.72 to 1.63) or cisgender women (aHR=1.07, 95% CI 0.66 to 1.74). Time to virological response did not differ significantly between transgender women and cisgender men (aHR=1.04, 95% CI 0.85 to 1.30) or cisgender women (aHR=1.24, 95% CI 0.98 to 1.60) after adjustment. Conclusions: In this cohort from two Parisian hospitals, transgender women demonstrated retention in care and virological outcomes comparable to those of cisgender people living with HIV. These findings suggest that within supportive healthcare settings, HIV care outcomes among transgender women can be similar to those observed in cisgender populations.