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

IF 2 4区 医学 Q1 Social Sciences Transgender Health Pub Date : 2024-10-09 eCollection Date: 2024-10-01 DOI:10.1089/trgh.2022.0182
Jordan E Lake, Ana N Hyatt, Han Feng, Hongyu Miao, Anoma Somasunderam, Netanya S Utay, Kathleen E Corey
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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.

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感染艾滋病毒的跨性别女性表现出独特的非酒精性脂肪肝特征
目的:非酒精性脂肪肝(NAFLD)在人类免疫缺陷病毒(HIV)感染者中的患病率和严重程度可能高于普通人群,并且随性别和年龄而变化。我们探讨了非酒精性脂肪肝的性别特征:成年变性女性(TW)、双性恋女性(CW)和双性恋男性(CM)接受了非酒精性脂肪肝筛查(2017-2020年)。测量了与非酒精性脂肪肝相关的循环因素。肝脏脂肪变性和肝纤维化分别通过受控衰减参数(CAP)和肝脏硬度测量(LSM)的瞬态弹性成像技术进行评估。方差分析/Wilcoxon 检验分别比较了正态/非正态分布变量。逻辑回归评估了与 CAP 和 LSM 相关的因素:参与者(n=194)的中位年龄为 48 岁,体重指数为 28.3 kg/m2;42% 为 CM,37% 为 TW,21% 为 CW;95% 为非白人;16% 患有糖尿病,40% 患有血脂异常,49% 患有高血压。使用 CAP≥248 dB/m(≥S1 脂肪变性)时,非酒精性脂肪肝患病率为 59%;使用 CAP≥260 dB/m(≥S2 脂肪变性)时,患病率为 48%;使用 CAP≥285 dB/m(≥S3 脂肪变性)时,患病率为 32%。与 CM 和 CW 相比,TW 的 CAP 中位数得分最高,更有可能出现≥S2 脂肪变性,胰岛素抵抗、白细胞介素-6 和胎脂素-A 值也最高。未接受性别确认激素疗法(GAHT)的 TW 的 CAP 评分中位数略高:结论:与未接受 GAHT 治疗的 TW 相比,接受 GAHT 治疗的 TW 肝脂肪变性程度较轻,但与 CM 和 CW 相比,TW 的总体非酒精性脂肪肝严重程度高于预期。雌激素补充和雄激素剥夺对 TW 肝脏健康的影响需要进一步研究。
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来源期刊
Transgender Health
Transgender Health Social Sciences-Gender Studies
CiteScore
4.30
自引率
10.00%
发文量
122
期刊最新文献
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