Cardiovascular disease risk among transgender women living with HIV in the United States

Gosiker, Bennett J.; Lesko, Catherine R.; Rich, Ashleigh J; Crane, Heidi M.; Kitahata, Mari M.; Reisner, Sari L.; Mayer, Kenneth H.; Fredericksen, Rob J.; Chander, Geetanjali; Mathews, W. Christopher; Poteat, Tonia

doi:10.1371/journal.pone.0236177

Cited by 10 publications

(6 citation statements)

References 46 publications

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“…However, existing research suggests that people who are TGD with HIV may be at even higher risk for CVD than people who are cisgender with HIV. 62 Understanding this difference in CVD among those living with HIV requires additional research following best practices for research among people who are TGD.…”

Section: Additional Risk Factors and Considerationsmentioning

confidence: 99%

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Streed¹,

Beach²,

Caceres³

et al. 2021

Circulation

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144

113

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There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behaviors. Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population.

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Section: Additional Risk Factors and Considerationsmentioning

confidence: 99%

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Streed¹,

Beach²,

Caceres³

et al. 2021

Circulation

Self Cite

144

113

View full text Add to dashboard Cite

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“…Sex-related differences in immune activation in HIV may be influenced by hormonal effects on immune cell function, specifically related to sex-specific expression of TLRs [77,78], sex-specificity of the microbiome [79] and behavioural factors, which may not become relevant until puberty, as these sex differences have not been found in prepubertal children [80]. Similarly, the transgender population is disproportionately affected by HIV and is at a higher risk of CVD due to HIV-related risks and, potentially, due to hormone therapy [81][82][83]. The role of inflammation in the transgender population with HIV and how it may differ from the cisgender population has not been well studied.…”

Section: Sex As a Biological Factormentioning

confidence: 99%

HIV and cardiovascular disease: the role of inflammation

Dirajlal-Fargo

Funderburg

2022

Current Opinion in HIV and AIDS

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Purpose of reviewHIV and antiretroviral therapy (ART) use are linked to an increased incidence of atherosclerotic cardiovascular disease (ASCVD). Immune activation persists in ART-treated people with HIV (PWH), and markers of inflammation (i.e. IL-6, C-reactive protein) predict mortality in this population. This review discusses underlying mechanisms that likely contribute to inflammation and the development of ASCVD in PWH.Recent findingsPersistent inflammation contributes to accelerated ASCVD in HIV and several new insights into the underlying immunologic mechanisms of chronic inflammation in PWH have been made (e.g. clonal haematopoiesis, trained immunity, lipidomics). We will also highlight potential pro-inflammatory mechanisms that may differ in vulnerable populations, including women, minorities and children.SummaryMechanistic studies into the drivers of chronic inflammation in PWH are ongoing and may aid in tailoring effective therapeutic strategies that can reduce ASCVD risk in this population. Focus should also include factors that lead to persistent disparities in HIV care and comorbidities, including sex as a biological factor and social determinants of health. It remains unclear whether ASCVD progression in HIV is driven by unique mediators (HIV itself, ART, immunodeficiency), or if it is an accelerated version of disease progression seen in the general population.

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“…Most non-communicable conditions data relate to cardiovascular or cerebrovascular (38% of datapoints, n = 65), metabolic or endocrine (23%, n = 40), or other non-communicable conditions (e.g., kidney disease or arthritis; 19% overall, n = 33). Trans people experience a high burden of non-communicable conditions: for example, hypertension prevalence was as high as 73% in a cross-sectional study of 221 trans women living with HIV in the U.S. [ 35 ], and diabetes prevalence was as high as 24.7% among 88 trans people aged 45 and older in a population-based survey in the U.S. [ 36 ]. There was a dearth of research on age-related non-communicable conditions, including dementia (n = 0 datapoints), arthritis (n = 6 datapoints), cancer (n = 18 datapoints), and hypertension (n = 23 datapoints).…”

Section: Resultsmentioning

confidence: 99%

Health status of transgender people globally: A systematic review of research on disease burden and correlates

Scheim,

Rich,

Zubizarreta

et al. 2024

PLoS ONE

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Background and objectives Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and correlates in trans adolescents and adults over a 20-month period to identify knowledge gaps and assess methodological characteristics including measurement of gender identity, community engagement, and study quality. Data sources, eligibility criteria, and synthesis methods We searched seven databases using terms related to (a) transgender populations and (b) health or disease. Eligible studies were in English, French, or Spanish and reported original quantitative data on mental health or substance use conditions, infectious diseases, or non-communicable conditions in at least 25 trans individuals aged 15+. Quality assessment was performed in duplicate on a 10% sample of articles and findings were summarized using narrative synthesis. Results The 328 included studies were conducted in 45 countries, with most from North America (54%) and limited research from South Asia (3%), Sub-Saharan Africa (3%), and the Middle East and North Africa (2%). Most studies used cross-sectional designs (73%) and convenience sampling (65%). Only 30% of studies reported any form of community engagement. Mental health and substance use disorders were the most studied area (77% of studies) and non-communicable conditions the least (16%). Available data indicated that trans populations experience high disease burden with considerable heterogeneity within and across settings. Of 39 articles assessed for quality, 80% were rated as fair, 18% as poor, and 3% as good quality. Conclusions and implications Geographic, gender-specific, and topical gaps remain in trans health, but we found more research from African countries, with transmasculine people, and on non-communicable conditions than previous syntheses. Areas for growth in trans health research include community engagement, non-binary health, chronic and age-related conditions, and health determinants. Registration PROSPERO CRD42021234043.

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Cardiovascular disease risk among transgender women living with HIV in the United States

Cited by 10 publications

References 46 publications

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

HIV and cardiovascular disease: the role of inflammation

Health status of transgender people globally: A systematic review of research on disease burden and correlates

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