Alexis Arquette suffered from HIV for 29 years, according to newly released death certificate

Friends and family of beloved and accomplished transgender actress Alexis Arquette have spent the past weeks grieving Arquette’s death at 47. Arquette’s death certificate, released Tuesday, only further adds to the tragedy, revealing Arquette struggled with HIV for 29 years prior to her death, and while cardiac arrest contributed to her death, it was primarily caused by HIV.

According to the document, Arquette additionally suffered from a bacterial infection in her heart for three weeks before her Sept. 11 death. It has previously been incorrectly noted that Arquette died from AIDS, but most people with HIV actually die of related infections. Arquette’s ex-boyfriend, Robert Dupont, told Radar Online last week that Arquette was placed in an “induced coma” ahead of her death.

Arquette’s death certificate still identifies her as Robert and as a man, despite her transition beginning in the early 2000s. Arquette went public with her transition in 2006, and served as a vocal advocate for transgender rights for years.

While tragic, Arquette’s death ultimately did not come as a surprise to her family. Her brother, Richard Arquette, released a statement after her passing, claiming Arquette was prepared for death, and believed the “other side” was one neutral to gender. “In the days leading to her death, she told us she was already visiting the other side. And that where she was going, there was only one gender,” he said. “That on the other side, we are free from all of the things that separate us in this life, and that we are all one.”