HIV diagnosis and treatment outcomes in cis- and trans-gender women across two European centres: A comparative observational study

Objectives: To compare HIV diagnosis pathways, baseline clinical characteristics and treatment outcomes among cis-gender and trans-gender women newly diagnosed with HIV at two European centres-Padua University Hospital (Italy) and 56 Dean Street, Chelsea and Westminster Hospital (London, UK). Methods: A retrospective observational study was conducted including cis-gender and trans-gender women diagnosed with HIV between 2017 and 2024. Demographic, clinical and virological parameters were collected at baseline and during follow-up. Outcomes included baseline CD4 count, HIV-RNA, antiretroviral therapy (ART) regimen, time to ART initiation and time to viral suppression (<200 copies/mL). Comparisons were made by gender identity and by clinical centre. Results: A total of 115 women were included (74 cis-gender, 41 trans-gender). Trans-gender women were older and more frequently of non-European origin. First-time HIV testing was significantly more common in Padua, where both cis- and trans-gender women presented with lower CD4 counts and higher HIV-RNA, indicating later diagnosis compared with London. Prior engagement with HIV prevention (PrEP/PEP and routine screening) was more frequent at 56 Dean Street. Despite baseline differences, ART regimens-predominantly integrase inhibitor-based-were similar across centres. Time to ART initiation and time to viral suppression did not differ significantly between groups or settings. Conclusions: Cis- and trans-gender women face persistent disparities in HIV diagnosis across European healthcare settings. Later presentation was more common in Padua, reflecting gaps in screening and prevention coverage. Once linked to care, treatment outcomes were similar. Strengthening gender-affirming, context-specific HIV testing and prevention strategies is essential to reduce diagnostic inequities.