The HIV care continuum and determinants of antiretroviral therapy initiation among transgender women in France (1997–2023): a longitudinal cohort study
Abstract
Background Studies on transgender women living with HIV (TWH) are scarce in Europe. We aimed to describe TWH and their care continuum during years 1997-2023 in France, focusing on determinants of time to antiretroviral therapy (ART) initiation. Methods In this longitudinal cohort study, we included treatment-naïve TWH with immuno-virological data from the ANRS CO4 French Hospital Database on HIV (FHDH). HIV care continuum outcomes, ART and viral suppression rates, and time intervals between HIV diagnosis, ART initiation, and viral suppression, were analyzed across three calendar periods (1997-2004, 2005-2012, and 2013-2023). Factors associated with time to ART initiation were assessed for each period using Cox models adjusted for age, geographic origin, year and region of enrollment, time between diagnosis and enrollment, and baseline immuno-virological status. Findings 801 TWH entered care between January 1, 1997 and December 31, 2023, mostly originating from Latin America (65%, 522/801), with a median age of 31 years [IQR, 27-36]. Between 1997-2004 and 2013-2023, time to ART initiation after entering care decreased from 3.9 [0-31] to 0.5 [0.2-1.2] months. More advanced HIV disease was associated with faster ART initiation until 2012 (hazard ratio [HR]: 3.17, 95% CI 2.14-4.68 for CD4 <200/ mm 3 or AIDS in 2005-2012). In 2013-2023, baseline viral load ≥100,000 was associated with faster ART initiation (HR: 1.45, 95% CI 1.14-1.86), whereas originating from Latin America (HR: 0.68, 95% CI 0.50-0.91) or other countries outside France (HR: 0.65, 95% CI 0.45-0.95) was associated with delayed ART initiation. Time to viral suppression after ART initiation decreased from 6.2 [3.0-27.9] in 1997-2004 to 2.3 [1.1-5.7] months in 2013-2023. Over the same periods, TWH on ART with viral suppression increased from 74.7% (109/146) to 95.5% (315/330).
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BibTeX
@article{hemery2026care,
title = {{The HIV care continuum and determinants of antiretroviral therapy initiation among transgender women in France (1997–2023): a longitudinal cohort study}},
author = {Juliette Hemery and Pierre Tattevin and Esaïe Marshall and Margot Annequin and Thibault Chiarabini and Nathalie Dournon and Anaenza Freire Maresca and Jade Ghosn and Valentina Isernia and Florence Michard and Segolene Perrineau and Giovanna Rincon and Elisabeth Rouveix and Bruno Spire and Pierre de Truchis and Sophie Grabar},
journal = {The Lancet Regional Health - Europe},
year = {2026},
month = aug,
doi = {10.1016/j.lanepe.2026.101820},
url = {https://inserm.hal.science/inserm-05733119v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The HIV care continuum and determinants of antiretroviral therapy initiation among transgender women in France (1997–2023): a longitudinal cohort study
AU - Juliette Hemery
AU - Pierre Tattevin
AU - Esaïe Marshall
AU - Margot Annequin
AU - Thibault Chiarabini
AU - Nathalie Dournon
AU - Anaenza Freire Maresca
AU - Jade Ghosn
AU - Valentina Isernia
AU - Florence Michard
AU - Segolene Perrineau
AU - Giovanna Rincon
AU - Elisabeth Rouveix
AU - Bruno Spire
AU - Pierre de Truchis
AU - Sophie Grabar
PY - 2026
DA - 2026/08/20
JO - The Lancet Regional Health - Europe
DO - 10.1016/j.lanepe.2026.101820
UR - https://inserm.hal.science/inserm-05733119v1
AB - Background Studies on transgender women living with HIV (TWH) are scarce in Europe. We aimed to describe TWH and their care continuum during years 1997-2023 in France, focusing on determinants of time to antiretroviral therapy (ART) initiation. Methods In this longitudinal cohort study, we included treatment-naïve TWH with immuno-virological data from the ANRS CO4 French Hospital Database on HIV (FHDH). HIV care continuum outcomes, ART and viral suppression rates, and time intervals between HIV diagnosis, ART initiation, and viral suppression, were analyzed across three calendar periods (1997-2004, 2005-2012, and 2013-2023). Factors associated with time to ART initiation were assessed for each period using Cox models adjusted for age, geographic origin, year and region of enrollment, time between diagnosis and enrollment, and baseline immuno-virological status. Findings 801 TWH entered care between January 1, 1997 and December 31, 2023, mostly originating from Latin America (65%, 522/801), with a median age of 31 years [IQR, 27-36]. Between 1997-2004 and 2013-2023, time to ART initiation after entering care decreased from 3.9 [0-31] to 0.5 [0.2-1.2] months. More advanced HIV disease was associated with faster ART initiation until 2012 (hazard ratio [HR]: 3.17, 95% CI 2.14-4.68 for CD4 <200/ mm 3 or AIDS in 2005-2012). In 2013-2023, baseline viral load ≥100,000 was associated with faster ART initiation (HR: 1.45, 95% CI 1.14-1.86), whereas originating from Latin America (HR: 0.68, 95% CI 0.50-0.91) or other countries outside France (HR: 0.65, 95% CI 0.45-0.95) was associated with delayed ART initiation. Time to viral suppression after ART initiation decreased from 6.2 [3.0-27.9] in 1997-2004 to 2.3 [1.1-5.7] months in 2013-2023. Over the same periods, TWH on ART with viral suppression increased from 74.7% (109/146) to 95.5% (315/330).
SN - 2666-7762
ER -