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. 2024 Sep 23;19(9):e0307990.
doi: 10.1371/journal.pone.0307990. eCollection 2024.

HIV and hepatitis C virus infection and co-infection among trans women in San Francisco, 2020

Izzy Chiu  1   2 , Damiana Cano  2   3 , Matisse Leathers  2   3 , Caitlin M Turner  4 , Dillon Trujillo  1 , Sofia Sicro  2 , Sean Arayasirikul  5 , Kelly D Taylor  4 , Erin C Wilson  2 , Willi McFarland  2   4
Affiliations

HIV and hepatitis C virus infection and co-infection among trans women in San Francisco, 2020

Izzy Chiu et al. PLoS One. .

Abstract

Background: Transgender women (hereafter "trans women") face social marginalization, stigma, and discrimination and experience a high burden of HIV. More recently, trans women have been identified as having a high risk for hepatitis C (HCV) infection. The interaction between these two diseases and the risks for HIV/HCV co-infection among trans women are understudied.

Objective: To characterize epidemiological, behavioral, and socio-structural interactions between HIV and HCV infections among trans women.

Methods: This cross-sectional study examined data from a community-based survey of trans women in San Francisco recruited through respondent-driven sampling (RDS) in 2019/2020. Face-to-face interviews collected data on demographics, medical history, drug injection practices, sexual behavior, and socio-structural factors (e.g., poverty, housing insecurity, incarceration, social support). HIV and HCV antibodies were detected using oral fluid rapid tests and prior diagnosis and treatment were collected by self-report. Blood specimens were collected to confirm antibodies using ELISA. Multinomial logistic regression analysis characterized factors associated with HIV infection alone, HCV infection alone, and HIV/HCV co-infection compared to neither infection.

Results: Among 201 trans women recruited, HIV prevalence was 42.3%; HCV infection by history or current seroprevalence was 28.9%; evidence for both HIV and HCV infection was present for 18.9%. Two-thirds of trans women (67.2%) had been incarcerated; 30.8% had ever injected drugs. History of injection drug use and receiving emotional support from family were factors found in common for HIV infection, HCV infection, and HIV/HCV co-infection compared to no infection. Having a sexual partner who injects drugs was associated with HIV infection alone. Not lacking care due to cost and older age were associated with co-infection. Older age was also associated with HCV infection. Of trans women with HIV infection, 91.8% had accessed HIV care, whereas only 62% with HCV had accessed some form of care.

Conclusions: Our study found high levels of HIV, HCV, and HIV/HCV co-infection among trans women in San Francisco. We found common associations between HIV and HCV through injection practices and emotional support, but having a sexual partner who injects drugs was not associated with HCV infection alone or co-infection. We note a substantial gap in the treatment of HCV for trans women, including those in HIV care, that needs to be urgently addressed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. RDS recruitment tree for trans women, San Francisco, by HIV, HCV, and HIV/HCV infection status, 2020.
N = 201.
Fig 2
Fig 2. HCV care cascade.
Fig 2 shows the cascade of engagement in HCV care: 81.1% of trans women with HCV were previously diagnosed, of whom 59.6% (28/47) received treatment, of whom 85.7% (24/28) completed treatment and 12.5% (3/24) reported reinfection.
See this image and copyright information in PMC

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Grants and funding

This study was funded by the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention [ grant number 6NU62ES005077]. The views expressed in this manuscript are not those of the funders (CDC). Authorization for submission of the manuscript for publication was not required by the CDC. IC, ML, and DC were supported by funding from the National Institute for Mental Health (R25 MH119858). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”.