Perfil de saúde em uma coorte de mulheres transexuais e travestis no Rio de Janeiro, Brasil: uso de hormônios, infecção pelo HIV e doença cardiovascular

Introduction: Travestis e transgender women (transwomen) have health specificities related to body changes for feminization and greater vulnerability to HIV infection, besides factors as discrimination and social and economic exclusion that impact their health and are associated to high mortality rates, including cardiovascular diseases. In Brazil, there are no health interventions designed specifically for transwomen. Data on cardiovascular risk among this population are conflicting and restricted to hormone users for feminization with no evaluation of traditional cardiovascular risk factors and HIV infection. Methods: Transcendendo is an open prospective cohort created with the aim to evaluate health profile in transwomen and its association to sociodemographic and behavioral factors, HIV infection, antiretroviral use, hormone use for feminization, cardiovascular and metabolic health. Results from baseline visit are described and stratified according to HIV status. Additionally, we performed a cross-sectional evaluation of the carotid intimal media thickness (cIMT) and its association with sociodemographic covariates, traditional cardiovascular risk factor and other covariates such as HIV infection, cocaine use, hormone use, industrial liquid silicone injection and reassignment surgery history. Results: Transwomen included in the cohort between August 2015 and July 2017 (N=322) had median age of 31 years, being part of a marginalized population with early sexual debut, poor schooling, high proportion of poverty, sex work, sexual and physical violence, problematic drug use, smoking and depression. A high prevalence of HIV infection (54%) and hormone use for feminization (49%) was observed at cohort baseline visit. Most participants (95%) reported lifetime use of hormones, 79% of them without medical supervision. Almost half (49%) reported industrial liquid silicone injection and only 6% performed sexual reassignment surgery. Participants with HIV infection had fewer years of formal education, greater proportions (current and prior) of prostitution, smoking, and drug use. From August 2015 and February 2018, 341 participants were included in the cohort and 308 performed a valid cIMT measure. Among them, traditional cardiovascular risk factors such as age and body mass index (BMI) were associated with increased cIMT in the logistic regression adjusted for age, race and BMI. No association was observed between HIV infection and variables related to the process of feminization with cIMT. Conclusion: Data from the Transcendendo baseline visit describe a scenario of marginalization and vulnerability and help to reduce gaps of knowledge on transwomen health. The traditional cardiovascular risk factors age and BMI were the main factors associated to cIMT increase. Longitudinal studies are needed to better evaluate factors related to transwomen health, and design specific intervention that can help the development of appropriate health interventions for this population.