Epidemiological dynamics and molecular characteristics of HIV-1 among transgender women in the Midwest region of Brazil

Bruno Vinícius Diniz E Silva¹SYLVIA LOPES MAIA TEIXEIRA²Paulie Marcelly Ribeiro dos Santos³Larissa Silva Magalhães^3,4José Henrique Pilotto²Ingebourg George⁵Carlos Silva de Jesus²Rayana Katylin Mendes Da Silva²Karlla Antonieta Amorim Caetano⁴Robert Lewis Cook⁶Regina MB Martins¹SHEILA ARAUJO TELES^4*Monick Lindenmeyer Guimarães²Megmar Aparecida dos Santos Carneiro¹

• ¹Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil, Goiânia, Brazil
• ²Laboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute, Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
• ³Pontifical Catholic University of Goiás, Goiânia, Goiânia, Goiás, Brazil, Goiânia, Brazil
• ⁴Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil, Goiânia, Brazil
• ⁵Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
• ⁶University of Florida, Gainesville, Florida, USA, Gainesville, United States

Introduction: The human immunodeficiency virus (HIV) epidemic disproportionately affects key populations, including transgender women (TGW). Understanding the epidemiological and molecular characteristics on HIV-1 infection among TGW in Brazil, a continental country, is important to support decisions about public health policies. Therefore, this cross-sectional study aimed to evaluate the HIV prevalence and associated risk factors, recency of infection, genetic diversity of HIV-1, transmission clusters, and drug resistance mutations among TGW in Goiás, a state in the Midwest region of Brazil. Methods: A total of 440 participants from three cities in Goiás (Goiânia, Itumbiara, and Jataí) were recruited using Respondent-Driven Sampling. Serum samples were screened for anti-HIV antibodies using rapid tests and an enzyme-linked immunosorbent assay. Recent acquisitions were identified from plasma samples using the Limiting Antigen Avidity assay. Deoxyribonucleic acid was extracted from blood samples, and the partial polymerase gene (protease/reverse transcriptase region) was amplified using a nested polymerase chain reaction. Sequences were subtyped, analyzed for potential transmission networks, and assessed for drug resistance using the Stanford HIVdb program. Results: Most participants were young, single, self-identified as Black or mixed-race, and had a secondary education level or less. Many reported early sexual debut and multiple high-risk behaviors for sexually transmitted infections. The overall prevalence was 27.3%, with 43.2% classified as recent acquisitions and 56.8% as long-standing. Being over 25 years of age and engaging in chemsex were significantly associated with infection (p<0.05). Regarding genetic diversity, subtype B was the most prevalent, followed by F1 and C. Ten transmission clusters were identified; each composed of at least two sequences. High prevalence of drug resistance mutations (39.1%) was observed among TGW. Conclusions: These findings underscore the high burden of HIV-1 among TGW in the Midwest region of Brazil and highlight the importance of serological and molecular surveillance in guiding targeted interventions aimed at preventing HIV acquisition and formulating well-informed public health policies for this key population.