Transgender Women with HIV Demonstrate Unique Non-Alcoholic Fatty Liver Disease Profiles

Authors

Jordan E Lake
Ana N Hyatt
Han Feng
Hongyu Miao
Anoma Somasunderam
Netanya S Utay
Kathleen E Corey

Language

English

Publication Date

10-1-2024

Journal

Transgender Health

DOI

10.1089/trgh.2022.0182

PMID

39449788

PMCID

PMC11496901

PubMedCentral® Posted Date

10-9-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Purpose: Non-alcoholic fatty liver disease (NAFLD) prevalence and severity may be higher in people with human immunodeficiency virus (HIV) than the general population, and vary with sex and age. We explored NAFLD characteristics by gender.

Methods: Adult transgender women (TW), cisgender women (CW), and cisgender men (CM) with HIV on antiretroviral therapy and without other known causes of liver disease underwent screening for NAFLD (2017-2020). Circulating factors associated with NAFLD were measured. Hepatic steatosis and fibrosis were assessed using transient elastography by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. Analysis of variance/Wilcoxon testing compared normally/non-normally distributed variables, respectively. Logistic regression evaluated factors associated with CAP and LSM.

Results: Participants (n=194) had median age 48 years and body mass index 28.3 kg/m2; 42% were CM, 37% TW, and 21% CW; 95% were non-white; and 16% had diabetes, 40% dyslipidemia, and 49% hypertension. NAFLD prevalence was 59% using CAP ≥248 dB/m (≥S1 steatosis), 48% using CAP ≥260 dB/m (≥S2 steatosis), and 32% using CAP ≥285 dB/m (≥S3 steatosis). Compared to CM and CW, TW had the highest median CAP scores, were more likely to have ≥S2 steatosis, and had the highest insulin resistance, interleukin-6, and fetuin-A values. TW off versus on gender-affirming hormone therapy (GAHT) had slightly higher median CAP scores.

Conclusion: TW on GAHT had less hepatic steatosis than TW not on GAHT, although overall NAFLD severity was greater than expected for TW compared to CM and CW. The effects of estrogen supplementation and androgen deprivation on liver health in TW require further study.

Keywords

gender diversity, hepatic steatosis, HIV, NAFLD, transgender women

Published Open-Access

yes

Recommended Citation

Lake, Jordan E; Hyatt, Ana N; Feng, Han; et al., "Transgender Women with HIV Demonstrate Unique Non-Alcoholic Fatty Liver Disease Profiles" (2024). Faculty, Staff and Student Publications. 1159.
https://digitalcommons.library.tmc.edu/uthsph_docs/1159