Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention.
Rollins School of Public Health, Emory University.
AIDS. 2022 Feb 1;36(2):305-315. doi: 10.1097/QAD.0000000000003109.
HIV prevalence is an estimated 14% among transgender women (TW) and 3% among transgender men (TM). HIV care is vital for viral suppression but is hindered by transphobia and HIV stigma. We assessed HIV care outcomes among transgender persons (TG) with HIV in the United States.
Systematic review and meta-analysis of peer-reviewed journal articles.
We searched multiple electronic databases and Centers for Disease Control and Prevention's HIV Prevention Research Synthesis database for 2006-September 2020. Eligible reports were US-based studies that included TG and reported HIV care outcomes. Random-effects models were used to calculate HIV care outcome rates. The protocol is registered with PROSPERO (CRD42018079564).
Few studies reported outcomes for TM; therefore, only TW meta-analysis results are reported. Fifty studies were identified having low-to-medium risk-of-bias scores. Among TW with HIV, 82% had ever received HIV care; 72% were receiving care, and 83% of those were retained in HIV care. Sixty-two percent were currently virally suppressed. Among those receiving HIV care or antiretroviral therapy (ART), 67% were virally suppressed at last test. Sixty-five percent were linked to HIV care 3 months or less after diagnosis. Seventy-one percent had ever been prescribed ART. Approximately 66% were taking ART, and 66% were ART-adherent. Only 56% were currently adherent the previous year.
HIV care outcomes for TW were not ideal, and research gaps exists for TM. High heterogeneity was observed; therefore, caution should be taken interpreting the findings. Integrating transgender-specific health needs are needed to improve outcomes of transgender persons across the HIV care continuum.
据估计，跨性别女性（TW）中的艾滋病毒流行率为 14%，跨性别男性（TM）中的艾滋病毒流行率为 3%。艾滋病毒护理对于病毒抑制至关重要，但却受到跨性别恐惧症和艾滋病毒耻辱感的阻碍。我们评估了美国艾滋病毒感染者中跨性别者（TG）的艾滋病毒护理结果。
对同行评议期刊文章的系统评价和荟萃分析。
我们搜索了多个电子数据库和疾病控制与预防中心的艾滋病毒预防研究综合数据库，以获取 2006 年 9 月至 2020 年的资料。符合条件的报告是基于美国的研究，包括 TG 并报告了艾滋病毒护理结果。使用随机效应模型计算艾滋病毒护理结果的发生率。该方案已在 PROSPERO（CRD42018079564）中注册。
很少有研究报告 TM 的结果；因此，仅报告 TW 的荟萃分析结果。确定了 50 项具有低至中等偏倚风险评分的研究。在患有艾滋病毒的 TW 中，82%的人曾经接受过艾滋病毒护理；72%正在接受护理，其中 83%的人在艾滋病毒护理中得到保留。62%的人目前病毒抑制。在接受艾滋病毒护理或抗逆转录病毒治疗（ART）的人中，67%的人在上一次检测时病毒得到抑制。65%的人在诊断后 3 个月或更短的时间内与艾滋病毒护理联系。71%的人曾经被开处方使用 ART。大约 66%的人正在服用 ART，其中 66%的人对 ART 有依从性。只有 56%的人在去年仍保持依从性。
TW 的艾滋病毒护理结果并不理想，而 TM 的研究空白仍然存在。观察到高度异质性；因此，在解释结果时应谨慎。需要整合跨性别者的特定健康需求，以改善整个艾滋病毒护理过程中跨性别者的结果。
