Lake Jordan E, Hyatt Ana N, Feng Han, Miao Hongyu, Somasunderam Anoma, Utay Netanya S, Corey Kathleen E
Department of Medicine, Division of Infectious Diseases, UTHealth McGovern School of Medicine, Houston, Texas, USA.
UTHealth School of Public Health, Houston, Texas, USA.
Transgend Health. 2024 Oct 9;9(5):413-420. doi: 10.1089/trgh.2022.0182. eCollection 2024 Oct.
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.
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.
Participants (=194) had median age 48 years and body mass index 28.3 kg/m; 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.
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.
非酒精性脂肪性肝病（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一般人群，且因性别和年龄而异。我们按性别探讨了NAFLD的特征。
2017年至2020年期间，对接受抗逆转录病毒治疗且无其他已知肝病病因的成年变性女性（TW）、顺性别女性（CW）和顺性别男性（CM）进行了NAFLD筛查。检测了与NAFLD相关的循环因子。分别使用受控衰减参数（CAP）和肝脏硬度测量（LSM）通过瞬时弹性成像评估肝脂肪变性和肝纤维化。方差分析/威尔科克森检验分别比较了正态分布/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（=194）的中位年龄为48岁，体重指数为28.3kg/m；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≥248dB/m（≥S1脂肪变性）时，NAFLD患病率为59%，使用CAP≥260dB/m（≥S2脂肪变性）时为48%，使用CAP≥285dB/m（≥S3脂肪变性）时为32%。与CM和CW相比，TW的中位CAP评分最高，更有可能出现≥S2脂肪变性，且胰岛素抵抗、白细胞介素-6和胎球蛋白-A值最高。接受性别确认激素治疗（GAHT）的TW与未接受GAHT的TW相比，中位CAP评分略高。
接受GAHT的TW的肝脂肪变性程度低于未接受GAHT的TW，尽管与CM和CW相比，TW的总体NAFLD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。
