Evidence map›Paper›PMID 40158515›Full record

Observational studyThe lancet. HIV2025

HIV seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study.

Sari L Reisner, David R Pletta, Kenneth H Mayer, Madeline B Deutsch, Tonia Poteat, Jennifer Potter, Andrea L Wirtz, Alexander Harris, Juwan Campbell, Alex S Keuroghlian and 3 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The lancet. HIV, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. The HIV Reservoir and Immune Landscape Across the Life Course of Women: Implications for Cure Strategies.American journal of reproductive immunology (New York, N.Y. : 1989) · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Sari L ReisnerDepartment of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: sreisner@umich.edu.
David R PlettaDepartment of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Departments of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Kenneth H MayerThe Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Madeline B DeutschFamily Community Medicine, University of California San Francisco, San Francisco, CA, USA.
Tonia PoteatDivision of Healthcare in Adult Populations, Duke School of Nursing, Durham, NC, USA.
Jennifer PotterThe Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Andrea L WirtzDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Alexander HarrisCallen-Lorde Community Health Center, New York, NY, USA.
Juwan CampbellThe Fenway Institute, Fenway Health, Boston, MA, USA.
Alex S KeuroghlianThe Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston/Harvard Medical School, Boston, MA, USA.
Jaclyn M W HughtoThe Fenway Institute, Fenway Health, Boston, MA, USA; Departments of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
Alex GonzalezThe Fenway Institute, Fenway Health, Boston, MA, USA.
Asa E RadixCallen-Lorde Community Health Center, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.

Funding

Connecting the Dots: HIV, COVID-19, and Structural Racism in Gender Minority WomenR01MD013498 · NIMHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI PERREIRA, KRISTA M, POTEAT, TONIA C · 2018 to 2022
$3.8M
NIMHD NIH HHS R01 MD013498
6 · The paper itself

Abstract

backgroundGender-affirming hormone therapy is medically necessary for many transgender, non-binary, and gender-diverse (trans) individuals and might improve HIV clinical outcomes for trans people. This study evaluated gender-affirming hormone therapy delivered in primary care as an intervention to improve HIV outcomes for trans adults in the USA.

methodsLEGACY is a longitudinal cohort of trans adult participants receiving primary care at two US federally qualified health centres: Fenway Health (Boston, MA, USA) and Callen-Lorde Community Health Center (New York, NY, USA). Eligibility criteria were age at least 18 years, gender identity differing from assigned sex at birth, past 12-month medical visit, and signed consent with no research exclusion documented in electronic health record data. Eligible participants contributed electronic health data from 2013 to 2019. The exposure was gender-affirming hormone therapy prescription. Clinical outcomes were HIV seropositivity (all participants) and viral non-suppression (participants with HIV; ≥200 copies per mL) in the past 12 months. Log-Poisson generalised estimating equations assessed the longitudinal association of gender-affirming hormone therapy prescription (puberty blockers, anti-androgens, oestrogens, progesterone, and testosterone) with outcomes, adjusting for individual-level confounders.

findingsAmong the 8109 trans participants in 2019, median age was 29 years (IQR 24-37). 2960 (36·5%) were transgender women, 2541 (31·3%) were transgender men, 1507 (18·6%) were non-binary, and 1101 (13·6%) were another trans identity. 4446 (54·8%) were White, 1323 (16·3%) were Black or African American, 498 (6·1%) were multiracial, and 1663 (20·5%) were Hispanic or Latinx. 2736 (33·7%) of 8109 participants were publicly insured and 451 (5·6%) participants were uninsured. In 2013, 2549 (85·5%) of 2983 participants were prescribed gender-affirming hormone therapy, 272 (9·1%) of 2983 participants were HIV seropositive, and 61 (22·4%) of 272 participants were not virally suppressed. In 2019, 7252 (89·4%) of 8109 participants were prescribed gender-affirming hormone therapy, 560 (6·9%) of 8109 participants were HIV seropositive, and 88 (15·7%) of 560 participants were not virally suppressed. Gender-affirming hormone therapy prescription was associated with reduced rates of HIV seropositivity (adjusted risk ratio [RR] 0·63, 95% CI 0·56-0·70) and viral non-suppression (adjusted RR 0·56, 95% CI 0·45-0·69) across follow-up.

interpretationGender-affirming care is important for optimising HIV outcomes among trans people. Our results underscore the vital role of gender-affirming models of care and access to gender-affirming hormone therapy for trans people.

fundingPatient-Centered Research Outcomes Institute and the National Institutes of Health.

Indexed as

Gender-Affirming ProceduresHIV InfectionsHIV SeropositivityTransgender PersonsAdultFemaleHumansLongitudinal StudiesMaleMiddle AgedPrimary Health CareUnited StatesViral LoadYoung Adult

Identifiers

PMID40158515
PMCPMC12355900

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.