We sought to characterize the cardiovascular disease (CVD) risk factor profile of transgender women with HIV identified through a U.S. healthcare database. Compared with age- and race-matched cisgender men with HIV, transgender women with HIV had an increased prevalence of anemia and lower absolute hemoglobin levels. HIV control was sub-optimal and prevalence of HCV co-infection was high among transgender women. Further study of non-traditional CVD risk factors/immune activation among transgender women with HIV is warranted.