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Alexis Arquette kept her HIV diagnosis a secret for nearly three decades.

According to TMZ, Arquette’s death certificate lists cardiac arrest as the cause of death, but also states her HIV diagnosis as an underlying cause. She reportedly lived with HIV for 29 years.

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The death certificate says that Arquette was diagnosed with a bacterial infection of the heart three weeks before her death. She died of a heart attack on September 11 while surrounded by her family, including siblings David Arquette, Patricia Arquette, Richmond Arquette and Rosanna Arquette.

On the day of her death, Richmond Arquette paid tribute to his sister in both male and female pronouns.

“I am feeling immense gratitude to have been afforded the luxury of sharing life with him/her, for learning from Alexis, for being given the gift of being able to love him/her and to be loved by him/her. He was a force,” he wrote

Arquette’s name on the death certificate is listed as “Robert Alexis,” and the sex is listed as “male.” Arquette transitioned from man to woman in the early 2000s.

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