Oestradiol concentrations in trans women with HIV suppressed on unboosted integrase inhibitor regimens versus trans women without HIV taking oral oestradiol: a pilot study.

BACKGROUND: Feminizing hormone therapy (FHT) is essential to many trans women. Concern about negative drug interactions between FHT and ART can be an ART adherence barrier among trans women with HIV. OBJECTIVES: In this single-centre, parallel group, cross-sectional pilot study, we measured serum oestradiol concentrations in trans women with HIV taking FHT and unboosted integrase strand transfer inhibitor (INSTI)-based ART versus trans women without HIV taking FHT. METHODS: We included trans women with and without HIV, aged ≥18 years, taking ≥2 mg/day of oral oestradiol for at least 3 months plus an anti-androgen. Trans women with HIV were on suppressive ART ≥3 months. Serum oestradiol concentrations were measured prior to medication dosing and 2, 4, 6 and 8 h post-dose. Median oestradiol concentrations were compared between groups using Wilcoxon rank-sum tests. RESULTS: Participants (n = 8 with HIV, n = 7 without) had a median age of 32 (IQR: 28, 39) years. Among participants, the median oral oestradiol dose was 4 mg (range 2-6 mg). Participants had been taking FHT for a median of 4 years (IQR: 2, 8). Six trans women with HIV were taking bictegravir/emtricitabine/tenofovir alafenamide and two were taking dolutegravir/abacavir/lamivudine. All oestradiol concentrations were not significantly different between groups. Eleven (73%) participants had target oestradiol concentrations in the range 200-735 pmol/L at C4h (75% among women with HIV, 71% among those without HIV). CONCLUSIONS: Oestradiol concentrations were not statistically different in trans women with HIV compared with those without HIV, suggesting a low probability of clinically relevant drug-drug interactions between FHT and unboosted INSTI-based ART.

HIV prevalence among a retrospective clinical cohort of transgender women in Canada: Results of the Montreal-Toronto Trans study, collected 2018-2019.

BACKGROUND: HIV prevalence data among transgender (trans) people are not routinely collected in national estimates, including Canada, contributing to gender-based inequities. We examined HIV prevalence and associated factors among trans women in clinical care in two large Canadian cities. METHODS: Retrospective chart data of trans women aged 16+ were collected from six family medicine and/or HIV clinics in Montreal and Toronto, Canada, 2018-2019. Multinomial logistic regression was used to analyze factors associated with documented HIV positive or missing HIV status relative to documented HIV negative status. RESULTS: Among 1,059 patients, 7.5% were HIV positive, 54.4% HIV negative, and 38.1% missing HIV data. Findings showed lower odds of being HIV positive for those <30 years or 30-50 years (vs. >50 years); higher odds were seen for those: of Black race/ethnicity (vs. white), landed immigrant or refugee (vs. Canadian citizen), receiving social assistance (vs. not), and whom ever having used recreational drugs. CONCLUSIONS: Albeit high, the prevalence of HIV was lower than expected based on global estimates. Missing HIV status data suggest gaps in testing. Findings highlight socioeconomic and clinical realities among trans women in Canada and inform future HIV prevention and support.

Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data.

OBJECTIVE: To compare rates of cervical, breast, and colorectal cancer screening between patients who are transgender and those who are cisgender (ie, nontransgender). DESIGN: Cross-sectional study. SETTING: A multisite academic family health team in Toronto, Ont, serving more than 45 000 enrolled patients. PARTICIPANTS: All patients enrolled in the family health team who were eligible for cervical, breast, or colorectal cancer screening. Patients were identified as transgender using an automated search of the practice electronic medical record followed by manual audit. MAIN OUTCOME MEASURES: Screening rates for cervical, breast, and colorectal cancer calculated using data from the electronic medical record and provincial cancer screening registry. Screening rates among the transgender and cisgender populations were compared using 2 tests, and logistic regression modeling was used to understand differences in screening after adjustment for age, neighbourhood income quintile, and number of primary care visits. RESULTS: A total of 120 transgender patients were identified as eligible for cancer screening. More than 85% of transgender patients eligible for breast cancer screening were assigned male at birth. Transgender patients were less likely than cisgender patients (n = 20 514) were to be screened for cervical (56% vs 72%, P = .001; adjusted odds ratio [OR] of 0.39; 95% CI 0.25 to 0.62), breast (33% vs 65%, P < .001; adjusted OR = 0.27; 95% CI 0.12 to 0.59), and colorectal cancer (55% vs 70%, P = .046; adjusted OR = 0.50; 95% CI 0.26 to 0.99). CONCLUSION: In this setting, transgender patients were less likely to receive recommended cancer screening compared with the cisgender population. Future research and quality improvement activities should aim to understand and address potential patient, provider, and system factors.