Gender-affirming hormone therapy decreases d-dimer but worsens insulin sensitivity in transgender women.
Gender-affirming hormone therapy decreases d-dimer but worsens insulin sensitivity in transgender women.
复制标题
性别肯定激素疗法会降低跨性别女性的 d-二聚体，但会恶化胰岛素敏感性。
DOI：
10.1111/hiv.13522
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发表时间：
2023
期刊：
影响因子：
3
通讯作者：
Funderburg,Nicholas
中科院分区：
文献类型：
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作者：
Lake,JordanE;Miao,Hongyu;Bowman,EmilyR;Clark,JesseL;Hyatt,AnaN;Kettelhut,Aaren;Lama,JavierR;Reisner,SariL;Mayer,KennethH;Perez-Brumer,Amaya;Funderburg,Nicholas
目的性别肯定激素疗法(GAHT)和HIV会增加变性人女性(TW)的心血管风险，但缺乏量化GAHT治疗后心脏代谢变化的数据，特别是在患有HIV的TW中。参与者报告说，性行为是艾滋病毒感染或传播的高风险。所有人都接受了艾滋病毒/性传播感染的检测，并接受了12个 月的GAHT(戊酸雌二醇酯和螺内酯)、暴露前预防或抗逆转录病毒治疗(ART)。结果总共170TW(32例艾滋病病毒感染者，138例非艾滋病病毒感染者)的中位年龄为27岁 ，70%的人曾使用过GHTT。在基线水平，HIV携带者的PCSK9、sCD14、sCD163、IL-6、sTNFRI/II、CRP和RAGE水平显著高于无HIV携带者。高密度脂蛋白和总胆固醇较低，胰岛素和血糖参数相似。所有携带艾滋病毒的TW都开始了抗逆转录病毒治疗，但只有5人在任何时候都实现了病毒学抑制。如果没有HIV，就没有TW启动PrEP。在6个 月后，所有受试者都开始进行伽玛刀治疗，并且胰岛素、血糖和HOMA-IR恶化。D-二聚体也有较大幅度的下降。在有无HIV感染的TW中也有类似的变化。结论在TW的这个独特的队列中，GAHT降低了d-二聚体，但恶化了胰岛素敏感性。由于PrEP摄取率和ART依从性非常低，观察到的效果主要归因于GAHT的使用。需要进一步的研究来更好地了解HIV血清状态对TW心脏代谢的影响。
ObjectivesGender‐affirming hormonal therapies (GAHT) and HIV increase cardiovascular risk for transgender women (TW), yet there is a paucity of data quantifying cardiometabolic changes following GAHT initiation, particularly among TW with HIV.MethodsThe Féminas study enrolled TW from October 2016 to March 2017 in Lima, Peru. Participants reported sexual activity that was high risk for HIV acquisition or transmission. All were tested for HIV/ sexually transmitted infection and were given access to GAHT (oestradiol valerate and spironolactone), HIV pre‐exposure prophylaxis (PrEP) or antiretroviral therapy (ART) for 12 months. Biomarker measurement was done on stored serum, whereas fasting glucose and lipids were measured in real time.ResultsIn all, 170 TW (32 with HIV, 138 without HIV) had median age 27 years and 70% prior GAHT use. At baseline, PCSK9, sCD14, sCD163, IL‐6, sTNFRI/II, CRP and EN‐RAGE levels were significantly higher in TW with HIV than in TW without HIV. High‐density lipoprotein and total cholesterol were lower and insulin and glucose parameters were similar. All TW with HIV started ART, but only five achieved virological suppression at any time. No TW without HIV initiated PrEP. Over 6 months, all participants initiated GAHT and had worsening insulin, glucose and HOMA‐IR. Large d‐dimer decreases also occurred. Similar changes occurred in TW with and without HIV.ConclusionsIn this unique cohort of TW, GAHT decreased d‐dimer but worsened insulin sensitivity. Because PrEP uptake and ART adherence were very low, observed effects are primarily attributed to GAHT use. Further study is needed to better understand cardiometabolic changes in TW by HIV serostatus.