Tonia Poteat, PhD, MPH, PA-C
Assistant Professor of Social Medicine
University of North Carolina School of Medicine
University of North Carolina
Gilead Sciences: Grant/Research Support
Viiv Healthcare: Grant/Research Support
Background : Transgender women with HIV face multifactorial risks for cardiovascular disease (CVD). Exogenous estrogen, HIV disease, as well as certain antiretroviral agents (ART) may all serve to increase CVD risk. Exposure to psychosocial minority stress has also been associated with cardiometabolic risk in several populations. However, data on CVD risk among transgender women with HIV are scant.
Methods : We assessed prevalence of 10-year CVD risk >7.5% according to the American College of Cardiology pooled cohort equation in patients receiving HIV care at eight clinics across the US. We calculated crude and adjusted prevalence ratios for elevated CVD risk comparing transgender women with cisgender women and men. Inverse probability weighting was used to adjust for age, race, viral suppression, CD4 cell count, and use of antiretroviral therapy.
Results : 221 transgender women, 2,983 cisgender women, and 13,474 cisgender men were included in the analysis. The mean 10-year CVD risks were 7.7%, 6.8%, and 8.7% for transgender women, cisgender women, and cisgender men, respectively, when calculated using sex assigned at birth. In adjusted analyses, transgender women’s CVD risk increased to 8.1% when calculated using current gender. Transgender women had 22% higher prevalence of elevated CVD risk (i.e. calculated 10-year CVD risk > 7.5%) than cisgender women when calculated using current gender and 34% higher when using sex assigned at birth.
Conclusions : Transgender women with HIV face elevated risk estimates for CVD compared with cisgender women. Interpretation of these results are limited by lack of associated clinical outcome data with which to calibrate risk scores. Long term outcomes data are needed to help clinicians interpret results and effectively address CVD risk among transgender women living with HIV.