Impact of hormonal therapy on HIV-1 immune markers in cis women and gender minorities. HIV Medicine
Sex hormones play a crucial role in modulating the immune response. However, the effects of exogenous sex hormones – administered for contraception, menopause-related symptom management, or gender-affirming therapy – on HIV-related immune markers in people living with HIV are not well understood. In this study, Pasin et al. investigated the impact of these hormones on CD4, CD8, and lymphocyte counts in cis women, trans women, and non-binary individuals within the Swiss HIV Cohort Study.
The study analyzed 3’175 participants (median age 53 years), including 83 trans women and non-binary individuals (3%). The use of sex hormones varied significantly, reflecting diverse treatment indications: most cis women under 40 years were on systemic progestogen alone or combined with estrogen, while those over 60 primarily used local estrogens. Trans women and non-binary participants predominantly used systemic estrogens, either alone or combined with antiandrogens.
The findings revealed that among trans women and non-binary individuals, exogenous sex hormones were associated with increased CD4-cell counts, CD4:CD8 ratios, and total lymphocyte counts compared to those not receiving hormone therapy. Cis women using sex hormones also showed higher CD4-cell counts than those not taking hormones, but no significant impact was observed in older cis women.
In conclusion, the diverse hormonal therapies used underscore the complexity of understanding their effects on the immune system. This study highlights a potential impact of hormonal therapy on immune function, particularly in its influence on CD4 cell counts in people living with HIV. These results emphasize the nuanced effects of hormone therapy on immune markers, varying by both the type of therapy and the population receiving it.