Chronic Disease Multimorbidity Among Transgender People Living With HIV in North America

Despite the growing importance of HIV clinical care and research, scarce research has investigated multimorbidity among transgender populations. This study investigated multimorbidity burden for transgender people living with HIV using data from a large longitudinal cohort collaboration representative of HIV care-engaged adults in North America with cisgender (cis) comparators. Multivariable Poisson regression estimated chronic disease multimorbidity (HIV and ≥1 of chronic kidney disease, liver fibrosis, type two diabetes mellitus, hypertension, hyperlipidemia, and anxiety/depression) prevalence and incidence rate ratios by gender identity from January 2000 through December 2016 among adults (≥18 years old) engaged in HIV care in the United States and Canada among the North American TRAnsgender Cohort Collaboration, nested within the North American AIDS Cohort Collaboration on Research and Design. The total study sample included 301 transgender women (TW), 26 transgender men (TM), 11,504 cis women (CW), and 51,029 cis men (CM). At study entry, TW and TM were younger and more TW and TM were Black compared with CM. The prevalence and incidence of chronic disease multimorbidity were elevated for transgender PWLH, though without consistent statistically significant effects. Suggestive evidence of elevated multimorbidity and potential disparity among TW and TM compared with CW and CM in the current study highlights the importance of future studies with improved gender ascertainment and the ability to recruit larger transgender samples. Attention to intervenable chronic disease risk factors including smoking, and potentially unique vulnerabilities for TW vs TM, is also warranted.