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Determinants for adrenal insufficiency in 100 HIV-infected transwomen: univariate and multivariate analysis (n U 100).
Source publication
Background:
HIV-infected transwomen face multiple specific issues. Economic and social marginalization, sex work, substance abuse, hormonal consumption and silicone injection may affect the course of HIV infection and lead to metabolic and endocrine complications.
Methods:
A matched case-control study was performed between 2013 and 2015 in a Uni...
Citations
... Additionally, in these studies, HIV-negative individuals do not have the same access to preventative healthcare as HIV-positive patients do leading to regularly receive education on risk reduction and nutrition counseling in HIV clinics [28,[80][81][82][83]. Regarding the effect of ART, patients receiving ART were at approximately 1.5 times more likely to develop MetS than those not receiving treatment. By systematically reviewing the literature, the risk of MetS increased with the use of ART, namely the nucleoside reverse transcriptase inhibitors/NRTIs (i.e., didanosine, stavudine, and abacavir) [28,52,60,82,[84][85][86], the non-nucleoside reverse transcriptase inhibitors/NNRTIs (i.e., efavirenz) [87] and the protease inhibitors/PIs (i.e., ritonavir, lopinavir, darunavir, atazanavir, nelfinavir, and saquinavir) [28,84,88,89]. The use of the integrase strand transfer inhibitors/INSTIs like raltegravir and dolutegravir did not adversely influence MetS and may possibly even have a beneficial impact [89]. ...
Background
Metabolic syndrome (MetS) elevates the risk of heart disease and stroke. In recent decades, the escalating prevalence of MetS among people living with HIV/AIDS (PLWHA) has garnered global attention. Despite MetS development being associated with both traditional and HIV-related factors, evidence from prior studies has shown variability across geographical regions. This study aimed to conduct a systematic review and meta-analysis of MetS burdens in adult PLWHA at the regional and global levels, focusing on the common effect size of HIV infection and antiretroviral therapy (ART) on MetS.
Methods
This review followed the PRISMA 2020 guidelines. A comprehensive search and review of original articles related to MetS and HIV published in peer-reviewed journals between January 2000 and December 2023 were conducted. A random effects model was used to calculate the pooled prevalence/incidence of MetS and the common effect size of HIV infection and ART exposure on MetS.
Results
A total of 102 studies from five continents comprising 78,700 HIV-infected participants were included. The overall pooled prevalence of MetS was 25.3%, 25.6% for PLWHA on ART, and 18.5% for those not receiving treatment. The pooled incidence of MetS, calculated from five studies, was 9.19 per 100 person-years. The highest pooled prevalence of MetS was observed in the Americas (30.4%), followed by the Southeast Asia/Western Pacific regions (26.7%). HIV-infected individuals had 1.6 times greater odds of having MetS than non-HIV-infected individuals did (pooled OR = 1.604; 95% CI 1.154–2.230), and ART exposure had 1.5 times greater odds of having MetS than nontreatment had (pooled OR = 1.504; 95% CI 1.217–1.859).
Conclusions
HIV infection and ART exposure contribute significantly to the increased burden of MetS. Regions with a high burden of HIV and MetS should prioritize awareness and integrated care plans for major noncommunicable diseases (NCDs), such as heart disease and stroke. The implementation of integrated care for HIV/AIDS patients and NCDs is essential for addressing the high burden of multimorbidity in PLWHA.
Registration number
INPLASY202290018
... Of the studies on AI in patients with HIV, 10 were conducted in Asia [32][33][34][35][36][37][38][39][40][41], 6 in North America [42][43][44][45][46][47], 5 in Africa [48][49][50][51][52], 3 in Europe [53][54][55], and 2 in South America [56,57]. ...
Background
Despite the high frequency of adrenal insufficiency in patients with tuberculosis or HIV, its diagnosis is often missed or delayed resulting in increased mortality. This systematic review and meta-analysis aimed to document the prevalence, significant clinical features, and predictors of adrenal insufficiency in adult patients with tuberculosis or HIV.
Methods
We systematically searched Medline, EMBASE, CINAHL, Cochrane Library, and Africa Journal Online databases for published studies on adrenal insufficiency in adult patients with tuberculosis or HIV. The pooled prevalence of adrenal insufficiency was determined using random-effect model meta-analysis. A narrative review was used to describe the significant clinical features and predictors of adrenal insufficiency in adult patients with tuberculosis or HIV.
Results
A total of 46 studies involving 4,044 adult participants (1,599 participants with tuberculosis and 2,445 participants with HIV) were included. The pooled prevalence of adrenal insufficiency in participants with tuberculosis was 33% (95% CI 22-45, I2 = 97.7%, p<0.001) and 28% (95% CI 18-38, I2 = 98.9%, p<0.001) in those with HIV. Presentation with multi-drug resistant tuberculosis, abdominal pain, salt craving, myalgia, increased severity and duration of tuberculosis disease, and the absence of nausea predicted adrenal insufficiency in participants with tuberculosis in four studies. Cytomegalovirus antigenemia positivity, rifampicin therapy, and eosinophilia of >3% were reported to predict adrenal insufficiency in participants with HIV in two studies.
Conclusions
Adrenal insufficiency is relatively common in adults with tuberculosis or HIV. Its timely screening, diagnosis, and management in patients with these two conditions should be encouraged to avert mortality.
... Five studies listed in Table 1 examine cortisol levels and HPA functioning but do not include any examination of the role of gender marginalization stressors (Fuss et al., 2019;Hodges-Simeon et al., 2020;Mueller et al., 2006;Pommier et al., 2019;Ristori et al., 2020). The aims in these studies focused only on hormonally mediated pathways and not stress-effects. ...
... Differences between transgender men and transgender women's physiological responses, as found in these studies, could reflect differences in hormonal interactions and/or in differences in stress experience in contexts where gender/sex is considered immutable and binary, as suggested by other studies (DuBois et al., 2017). Studies comparing TGD and cisgender people underscore the need for the field to articulate more explicit parameters clarifying when gender/sex comparisons are most appropriate and how gender experience and gender identity are operationalized (Pommier et al., 2019). ...
... Consistent with a small but growing literature (e.g., Diamond et al., 2021;DuBois, 2012;DuBois et al., 2017;Figueroa et al., 2021;McQuillan et al., 2021;Rich et al., 2020;Rodríguez Madera et al., 2017;Sivaranjani et al., 2019;Zoccola et al., 2017), the current study highlights the priority of applying stress biomarker (e. g., neuroendocrine, immune/inflammatory, metabolic, cardiovascular) research among TGD people with a focus on their lived experiences and unique exposure to gender minority stigma. To date, much of the literature inclusive of cortisol analyses has focused on HPA-axis functioning in association with GAHT (Colizzi et al., 2013;Fuss et al., 2019;Mueller et al., 2006;Ristori et al., 2020) or in comparative analyses with cisgender people without consideration of distinct gender minority stress processes (Hodges-Simeon et al., 2020;Pommier et al., 2019). The current findings emphasize that individual differences in diurnal cortisol functioning among TGD people can be delineated in a meaningful way by incorporating psychosocial measures that capture gender-based stress and resilience processes. ...
... Although transgender PWH usually receive hormonal therapy and could develop endocrine and metabolic complications, carefully conducted studies are limited. A matched case-control study investigated metabolic syndrome and thyroid and adrenal function, comparing transgender women (cases) to cis-gender men with HIV (controls), and found no di erences between the two groups in terms of metabolic syndrome, but a higher frequency of subclinical hypothyroidism (median TSH 1.6-fold higher) associated with a higher BMI and use of steroids as well as adrenal insu ciency (Pommier et al., 2019). A more recent study evaluating in ammation in cryopreserved peripheral blood monocytes from PWH found that estrogen elevated the TLR4 activation induced by lipopolysaccharide (LPS) in cisgender men with HIV, with increased monocyte activation and in ammatory cytokine production (IL-6, TNF-α)-these ndings could have implications for use of estrogens as feminizing hormone therapy in transgender women (Kettelhut et al., 2022), especially in relation to a higher risk of cardiovascular disease (Aranda et al., 2021). ...
Chapter 2: This chapter discusses the global prevalence as well as the geographic distribution of HIV-1 and HIV-2 infections and updates on recent shared global initiatives. The demographic trends in HIV in the United States, especially regarding gender, sexuality, race, ethnicity, age, injection-drug use, socioeconomic status, and recent initiatives are reviewed. Special attention is paid to HIV among communities of color, as well as women, children, and adolescences. The role of HIV in men who have sex with men and the transgender community is reviewed in detail. Chapter 8: HIV Testing and Counselling lists and describes the various types of HIV testing available. The chapter also presents an overview of HIV counselling. HIV testing terminology and algorithms are presented to the reader along with descriptive figures. Laboratory markers for HIV are reviewed. The chapter describes who should be tested, as well as pre and post-test counselling elements. A section of the chapter is dedicated to special populations and environments (blood supply screening, prenatal screening, testing settings) Strategies to improve uptake of HIV testing are discussed.
... Thyroid function abnormalities can also be observed in the antiretroviral therapy course, which make the thyroid screening in HIV-infected patients a reasonable strategy [44,48]. ...
A growing number of findings indicate a relationship between COVID-19 infection and thyroid dysfunction. This association is also strengthened by knowledge on the potential of viral infections to trigger thyroid disorders, although the exact underlying pathogenetic process remains to be elucidated. This review aimed to describe the available data regarding the possible role of infectious agents, and in particular of SARS-CoV-2, in the development of thyroid disorders, summarizing the proposed mechanisms and levels of evidence (epidemiological, serological or direct presence of the viruses in the thyroid gland) by which the infection could be responsible for thyroid abnormalities/diseases. Novel data on the association and mechanisms involved between SARS-CoV-2 vaccines and thyroid diseases are also discussed. While demonstrating a clear causal link is challenging, numerous clues at molecular and cellular levels and the large amount of epidemiological data suggest the existence of this relationship. Further studies should be taken to further investigate the true nature and strength of this association, to help in planning future preventive and therapeutic strategies for more personal and targeted care with attention to the underlying causes of thyroid dysfunction.
... In a chart review, Sokalski et al. [22] noted a trend towards a higher prevalence of adrenal insufficiency among women living with HIV compared with general population data, but the small sample size prevented statistical comparison. Finally, Pommier et al. found significantly lower morning serum cortisol and higher rates of primary adrenal insufficiency upon ACTH stimulation in transgender women living with HIV compared with cisgender men living with HIV [23]. Although several studies noted a trend towards a higher prevalence of low cortisol in people with HIV, a lack of control groups and inconsistent results limited our ability to conclude that people with HIV are at higher risk for clinically significant adrenal insufficiency. ...
... Pommier et. al found that transgender women living with HIV were more likely than cisgender men with HIV to have primary adrenal insufficiency (Table 2) and that 60% of transgender women with HIV with adrenal insufficiency used injectable estrogen-progestin or antiandrogen [23]. Exogenous estrogens are expected to increase transcortin and thus cortisol levels, as reported by Fuss et al. in transwomen on gender-affirming hormone therapy [55], suggesting that factors other than hormone treatment may be affecting the findings reported by Pommier et al. ...
Objectives
People living with HIV experience numerous endocrine abnormalities and psychosocial stressors. However, interactions between HIV, cortisol levels, and health outcomes have not been well described among people living with HIV on effective therapy. Furthermore, methods for measuring cortisol are disparate across studies. We describe the literature reporting cortisol levels in people living with HIV, describe methods to measure cortisol, and explore how this relates to health outcomes.
Methods
We searched the PubMed database for articles published in the past 20 years regarding HIV and cortisol with ≥50% of participants on antiretroviral therapies. Articles included observational, case‐control, cross‐sectional, and randomized controlled trials analyzing cortisol by any method. Studies were excluded if abnormal cortisol was due to medications or other infections. Variables were extracted from selected studies and their quality was assessed using the Newcastle–Ottawa Scale.
Results
In total, 19 articles were selected and included, covering the prevalence of abnormal cortisol (n = 4), exercise (n = 4), metabolic syndrome and/or cardiovascular disease (n = 2), mental health and cognition (n = 9), and sex/gender (n = 6). Cortisol was measured in serum (n = 7), saliva (n = 8), urine (n = 2), and hair (n = 3) specimens. Comparisons between people with and without HIV were inconsistent, with some evidence that people with HIV have increased rates of hypocortisolism. Depression and cognitive decline may be associated with cortisol excess, whereas anxiety and metabolic disease may be related to low cortisol; more data are needed to confirm these relationships.
Conclusions
Data on cortisol levels in the era of antiretroviral therapy remain sparse. Future studies should include controls without HIV, appropriately timed sample collection, and consideration of sex/gender and psychosocial factors.
... However, data on possible interactions are scarce 19 and contradictory. 20 TRHIV women are more adherent to ART when they have few side effects and when female hormone effectiveness is not affected. 21 With regard to transgender men, little information is available about interactions between masculinising hormone and ART. ...
Introduction
Transgender identity is poorly accepted in France, and data on living conditions and the daily difficulties transgender people encounter are scarce. This lack of data reinforces their invisibility in social life, contributes to their stigmatisation and probably increases the burden of HIV infection, especially for HIV-positive transgender people (TRHIV). The main objective of the community-based research study ANRS Trans&HIV is to identify personal and social situations of vulnerability in TRHIV, the obstacles they encounter in terms of access to and retention in medical care, and their gender affirmation and HIV care needs.
Methods and analysis
ANRS Trans&HIV is a national, comprehensive, cross-sectional survey of all TRHIV currently being followed in HIV care units in France. TRHIV women are exclusively included in the quantitative component, and TRHIV men in the qualitative component. Data are collected by community-based interviewers and will be analysed to explore patient care pathways and living conditions in the TRHIV population with regard to gender affirmation and HIV. Data collection began in October 2020 and should be completed in December 2021. The statistical analyses techniques used will be adapted to each of the study’s objectives and to the type of data collected (cross-sectional ( questionnaires ) and retrospective ( biographical trajectory )). The study’s results will provide a greater understanding of TRHIV health needs in order to suggest possible national recommendations for comprehensive HIV and gender affirmation medical care.
Ethics and dissemination
ANRS Trans&HIV was approved by Inserm’s Ethical Evaluation Committee (no 20-694 on 12 May 2020) and is registered with the National Commission on Informatics and Liberty under number 2518030720. Potential participants are informed about the study through an information note provided by their attending HIV physician. All results published in peer-reviewed journals will be disseminated to the HIV transgender community, institutional stakeholders and healthcare providers.
Trial registration number
NCT04849767 .
... Sixty-four studies examining the prevalence of nutrition-related health outcomes in transgender individuals compared to cisgender individuals met inclusion criteria (Table 3). Studies were all observational in nature, including 11 cohort studies [11,15,17,30,32,51,61,74,102,120,121,141], four caseecontrol studies [117,140,192,195], forty cross-sectional studies [11,12,18,20,21,25,26,31, 34,43e45,48e50,57,60,62,66,70,89,90,94,98,103,112,114,116,124, 128,135,144,148,155,156,165,184,185,196,197], eight scoping [39] or systematic reviews [41,56,63,99,134,149,186], and one guideline [3]. Samples sizes in primary studies ranged from 104 to 7454 individuals from the target populations. ...
Objective
The objective of this scoping review is to describe the extent, range, and nature of available literature examining nutrition-related intermediate and long-term health outcomes in individuals who are transgender. Specific sub-topics examined include 1) dietary intake, 2) nutrition-related health disparities, 3) validity and reliability of nutrition assessment methods, 4) the effects of nutrition interventions/exposures, and 5) hormone therapy.
Methods
A literature search was conducted using MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and other databases for peer-reviewed articles published from January 1999 until December 5, 2019 to identify studies addressing the research objective and meeting eligibility criteria. Conference abstracts and registered trials published or registered in the five years prior to the search were also included. Findings were reported in a study characteristics table, a bubble chart and heat maps.
Results
The search of the databases identified 5403 studies, including full peer-reviewed studies, systematic reviews, conference abstracts and registered trials. Following title/abstract screening, 189 studies were included in the narrative analysis. Ten studies reported dietary intake in transgender individuals, 64 studies reported nutrition-related health disparities in transgender compared to cisgender individuals, one study examined validity and reliability of nutrition assessment methods, two studies reported nutrition interventions, and 127 studies reported on the intermediate and health effects of hormone therapy.
Conclusion
Individuals who are transgender have unique nutrition needs, which may vary according to the stage and type of gender-affirmative therapy that they are undergoing. There is scant research examining effective nutrition therapy methods for nutrition professionals working with transgender individuals. More research is needed in order to inform evidence-based clinical practice guidelines for nutrition practitioners working with transgender individuals.
... Sixty-four studies examining the prevalence of nutrition-related health outcomes in transgender individuals compared to cisgender individuals met inclusion criteria (Table 3). Studies were all observational in nature, including 11 cohort studies [11,15,17,30,32,51,61,74,102,120,121,141], four caseecontrol studies [117,140,192,195], forty cross-sectional studies [11,12,18,20,21,25,26,31, 34,43e45,48e50,57,60,62,66,70,89,90,94,98,103,112,114,116,124, 128,135,144,148,155,156,165,184,185,196,197], eight scoping [39] or systematic reviews [41,56,63,99,134,149,186], and one guideline [3]. Samples sizes in primary studies ranged from 104 to 7454 individuals from the target populations. ...
Objectives
To describe the extent, range and nature of literature examining the nutrition-related intermediate and long-term health outcomes in individuals who are transgender. Specific sub-topics include dietary intake, nutrition-related health disparities, validity and reliability of nutrition assessment methods, and the effects of nutrition interventions/exposures and hormone therapy.
Methods
A literature search was conducted of Medline, Embase, PsycINFO, CINAHL, Web of Science, and other databases from 1999 though 2019 to identify peer-reviewed articles published in English that addressed the research objective. Conference abstracts and registered trials were eligible if they were published in 2015 or later. Each title/abstract and eligible full-text article was screened by two reviewers and discrepancies were determined by consensus. Data was extracted by one reviewer and confirmed by a second reviewer.
Results
The literature search identified 3020 original studies, abstracts or registered trials, 424 full-text articles were reviewed for inclusion and 188 were included in qualitative analysis, including 17 systematic reviews. Populations examined included adults (n = 159), adolescents (n = 61) and children (n = 11). The vast majority of included articles examined the effects of hormone therapy on intermediate outcomes (n = 118) such as anthropometric, bone density and laboratory measures, or health outcomes (n = 18) such as cardiovascular disease events or quality of life. There was also considerable research examining the prevalence of health outcomes, such as eating disorders, malnutrition status, or diabetes, in transgender compared to cisgender populations. However, there was a paucity of data describing dietary intake (n = 10), validity and reliability of nutrition assessment methods (n = 1) or the effects of nutrition interventions on nutrition-related outcomes (n = 3) in transgender individuals. Nearly all evidence, except for three hormone trials, was observational in nature.
Conclusions
There is a need for research that examines medical nutrition therapy to promote health and prevent or treat adverse health outcomes that are prevalent in individuals who are transgender.
Funding Sources
Academy of Nutrition and Dietetics.
Background
Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, with an increasing incidence over the last decades. Human immunodeficiency virus (HIV)-induced immune deficiency was one of risk factors for cancer tumorigenesis and development. The aim of this study was to describe the clinicopathological features of PTC in HIV-infected patients and discuss possible connections between PTC and HIV infection.
Methods
A total of 17670 patients from September 2009 to April 2022 who underwent PTC surgery for the first time were analyzed retrospectively. At last, 10 patients of PTC with HIV infection (HIV-positive group) and 40 patients without HIV infection (HIV-negative group) were included. The differences in general data and clinicopathological characteristics between the HIV-positive group and the HIV-negative group were analyzed.
Results
There were statistically significant differences in age and gender between the HIV-positive group and the HIV-negative group ( P <0.05), and males and <55 years old accounted for a higher proportion in the HIV-positive group. The differences in tumor diameter and capsular invasion between the HIV-positive group and HIV-negative group were statistically significant ( P <0.05). Meanwhile, in terms of extrathyroid extension (ETE), lymph node metastasis and distant metastasis, the HIV-positive group were significantly higher than the HIV-negative group ( P <0.001).
Conclusion
HIV infection was a risk factor for larger tumors, more severe ETE, more lymph node metastasis, and more distant metastasis. HIV infection could promote PTC proliferation and make PTC more aggressive. Many factors such as tumor immune escape, secondary infection, etc. may are responsible for these effects. More attention and more thorough treatment should be paid to these patients.
