HIV in Transgender People: Module

CE / CME

Increased Risk of HIV Acquisition Among Transgender Individuals

Pharmacists: 0.75 contact hour (0.075 CEUs)

Nurses: 0.75 Nursing contact hour

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit

Released: September 27, 2022

Expiration: September 26, 2023

Antonio E. Urbina
Antonio E. Urbina, MD

Activity

Progress
1
Course Completed

References

  1. Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet. 2016;388(10042):390-400.
  2. Meerwijk EL, Sevelius JM. Transgender population size in the United States: a meta-regression of population-based probability samples. Am J Public Health. 2017;107:e1-e8.
  3. Flores AR, Herman JL, Gates GJ, et al. 2016. How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute.
  4. Johns MM, Lowry R, Andrzejewski J, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:67-71.
  5. James SE, Herman JL, Rankin S, et al. The report of the 2015 U.S. Transgender Survey.  transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf. Accessed September 7, 2022.
  6. Human Rights Campaign. Fatal violence against the transgender and gender non-conforming community in 2022. www.hrc.org/resources/fatal-violence-against-the-transgender-and-gender-non-conforming-community-in-2022. Accessed September 7, 2022.
  7. UNAIDS. HIV and transgender and other gender-diverse people: Human rights fact sheet series. www.unaids.org/sites/default/files/media_asset/04-hiv-human-rights-factsheet-transgender-gender-diverse_en.pdf. Accessed September 7, 2022.
  8. UNAIDS. Evidence review: implementation of the 2016-2021 UNAIDS strategy on the fast-track to end AIDS: UNAIDS strategy beyond 2021. www.unaids.org/sites/default/files/media_asset/PCB47_CRP3_Evidence_Review_EN.pdf. Accessed September 7, 2022.
  9. Baral SD, Poteat T, Strömdahl S, et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:214-222.
  10. Becasen JS, Denard CL, Mullins MM, et al. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006-2017. Am J Public Health. 2019;109(1):e1-e8. 
  11. Bukowski LA, Chandler CJ, Creasy SL, et al. Characterizing the HIV care continuum and identifying barriers and facilitators to HIV diagnosis and viral suppression among black transgender women in the United States. J Acquir Immune Defic Syndr. 2018;79:413-420.
  12. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2019. www.cdc.gov/hiv/group/gender/transgender/hiv-diagnoses.html. Accessed September 7, 2022.
  13. Centers for Disease Control and Prevention. HIV infection, risk, prevention, and testing behaviors among transgender women. www.cdc.gov/hiv/group/gender/transgender/hiv-prevalence.html. Accessed September 7, 2022.
  14. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2020. www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2020-updated-vol-33.pdf. Accessed September 7, 2022.
  15. Chung C, Anand K, Laurel S, et al. Positively trans: initial report of a national needs assessment of transgender and gender non-conforming people living with HIV. transgenderlawcenter.org/wp-content/uploads/2016/02/PositivelyTrans-2015-7-border-FINAL.pdf. Accessed September 7, 2022.
  16. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update. www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf. Accessed September 7, 2022.
  17. Deutsch M, Chakravarty D, Rebchook, et al. Associations between self-reported hormone use patterns and indicators of HIV care among transgender women of color in four US cities. Presented at: National HIV Prevention Conference; December 6-9, 2015. Abstract 1886.
  18. May MT, Gompels M, Delpech V, et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS. 2014;28:1193-1202.
  19. Calabrese SK, Mayer KH. Providers should discuss U=U with all patients living with HIV. Lancet HIV. 2019;6:e211-e213.
  20. Goldstein D, Sarkodie, E, Hardy WD, et al. Trans females receiving gender-affirming surgical referrals are more likely to have durable virologic suppression at Whitman-Walker Health, 2008-2017. Presented at: IDWeek 2019; October 2-6, 2019. Abstract 1321.
  21. Xia Q, Seyoum S, Wiewel EW, et al. Reduction in gaps in high CD4 count and viral suppression between transgender and cisgender persons living with HIV in New York City, 2007-2016. Am J Public Health. 2019;109:126-131.
  22. Cabotegravir extended-release injectable suspension prescribing information. Research Triangle Park, NC: ViiV Healthcare; 2021.
  23. Poteat TC. HIV in transgender populations: charted and uncharted waters. Presented at: Conference on Retroviruses and Opportunistic Infections; February 22-25, 2016. Abstract 79.
  24. Emcitabine and tenofovir disoproxil fumarate prescribing information. Foster City, CA: Gilead Sciences; 2020.
  25. Emtricitabine and tenofovir alafenamide prescribing information. Foster City, CA: Gilead Sciences; 2020.
  26. Mayer KH, Molina J-M, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020;396:239-254.
  27. CDN. Comparison of key clinical and logistical factors in choosing a PrEP regimen. cdn.hivguidelines.org/wp-content/uploads/20220531071804/NYSDOH-AI_PrEP-Table-1_5-31-22_mbh.pdf. Accessed September 7, 2022.
  28. Negredo E, Domingo P, Pérez-Álvarez N, et al. Improvement in bone mineral density after switching from tenofovir to abacavir in HIV-1-infected patients with low bone mineral density: two-centre randomized pilot study (OsteoTDF study). J Antimicrob Chemother. 2014;69:3368-3371.
  29. Molina J-M, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373:2237-2246.
  30. Blumenthal J, Goyal R, Burke L, et al. The bidirectional effects of hormone therapy and PrEP in transgender individuals. Presented at: Conference on Retroviruses and Opportunistic Infections; February 12-16, 2022. Abstract 84.
  31. Malone J, Reisner SL, Cooney EE, et al. Perceived HIV acquisition risk and low uptake of PrEP among a cohort of transgender women with PrEP indication in the eastern and southern United States. J Acquir Immune Defic Syndr. 2021;88:10-18.
  32. Garnett M, Hirsch-Moverman Y, Franks J, et al. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city. AIDS Care. 2018;30:9-17.
  33. Ramautarsing RA, Meksena R, Sungsing T, et al. Evaluation of a pre-exposure prophylaxis programme for men who have sex with men and transgender women in Thailand: learning through the HIV prevention cascade lens. J Int AIDS Soc. 2020;23(suppl 3):e25540.
  34. Landowitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med. 2021;385:595-608.
  35. Markowitz M, Frank I, Grant RM, et al. Safety and tolerability of long-acting cabotegravir injections in HIV-uninfected men (ECLAIR): a multicentre, double-blind, randomised, placebo-controlled, phase 2a trial. Lancet HIV. 2017;4:e331-e340.
  36. Landowitz RJ, Li S, Eron JJ, et al. Tail-phase safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in HIV-uninfected adults: a secondary analysis of the HPTN 077 trial. Lancet HIV. 2020;7:e472-e481.
  37. Hodge D, Back DJ, Gibbons S, et al. Pharmacokinetics and drug–drug interactions of long-acting intramuscular cabotegravir and rilpivirine. Clinical Pharmacokinetics. 2021;60:835-853.
  38. Gritsztejn B, Hanscom B, Wang Z, et al. Transgender women (TGW) in HPTN 083: an evaluation of safety, efficacy, and gender affirming hormonal therapy (GAHT) interactions with long-acting cabotegravir (CAB-LA). Presented at: AIDS 2022; July 29 - August 2, 2022. Abstract EPLBC04.
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  40. Sevelius JM, Carrico A, Johnson MO. Antiretroviral therapy adherence among transgender women living with HIV. J Assoc Nurses AIDS Care. 2010;21:256-264.
  41. Sevelius JM, Saberi P, Johnson MO. Correlates of antiretroviral adherence and viral load among transgender women living with HIV. AIDS Care. 2014;26:976-982.
  42. Sevelius JM, Patouhas E, Keatley J, et al. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47:5-16.
  43. Sevelius J, Chakravarty D, Neilands TB, et al. Evidence for the model of gender affirmation: the role of gender affirmation and healthcare empowerment in viral suppression among transgender women of color living with HIV. AIDS Behav. 2021;25(suppl 1):64-71.
  44. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines. www.cdc.gov/std/treatment-guidelines/trans.htm#:~:text=For%20transgender%20persons%20with%20HIV,NAAT%20for%20gonorrhea%20and%20chlamydia. Accessed September 7, 2022.
  45. Patton ME, Kidd S, Llata E, et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men—STD Surveillance Network, United States, 2010-2012. Clin Infect Dis. 2014;58:1564-1570