Neuropsychological, immunovirological, and socioeconomic profile of transgender women living with HIV: a retrospective cross-sectional study from an Italian reference center

IntroductionTransgender women experience a disproportionate burden of HIV infection and intersecting social vulnerabilities. While virological outcomes among those retained in care are increasingly documented, data integrating neuropsychological health and socioeconomic determinants, particularly in European settings, remain scarce. Suboptimal cognitive performance may persist despite viral suppression, potentially undermining quality of life and long-term engagement in care.We aim to provide an integrated characterization of the immunovirological, neuropsychological, and socioeconomic profile of TW living with HIV attending a tertiary HIV reference center.MethodsWe conducted a retrospective cross-sectional study at the outpatient HIV clinic of Luigi Sacco University Hospital, Milan, between 2011 and 2023. We included adult TW living with HIV who had adequate proficiency in Italian and had undergone standardized neuropsychological assessment. Clinical, immunovirological, neuropsychological, and socioeconomic data were extracted from medical records and analyzed descriptively.ResultsNinety-five participants were included, predominantly Latin American migrants (95.8%) engaged in sex work (95.6%), with high rates of regular substance use (69.5%). Most participants were virologically suppressed at the time of neuropsychological assessment (78.5%), and nearly all had CD4 counts above 200 cells/µL (97.9%). Nonetheless, performances below normative thresholds were frequently observed, particularly on tests assessing processing speed and sustained attention (45.3%) and immediate verbal memory (60.0%). Sixty percent of participants (51/85) self-reported at least one complaint across memory, attention, and mental speed domains. Among participants with below-threshold performances immunovirological characteristics appeared broadly comparable to those with preserved performances across all tests, whereas benzodiazepine use was numerically more prevalent on 6 out of 8 measures, followed by regular substance use to a lesser extent. Educational attainment showed no consistent direction across tests.ConclusionsIn this clinic-based population of TW living with HIV, performances below normative thresholds across several neuropsychological measures and marked socioeconomic vulnerability were frequently observed despite generally favorable virological outcomes. These findings support the integration of neuropsychological evaluation, substance use assessment, and gender-affirming services into comprehensive, multidisciplinary HIV care models for this population.