Age of Menopause and Menopausal Symptoms in HIV-Infected Women

Fantry, Lori E.; Zhan, Min; Taylor, Gail; Sill, Anne; Flaws, Jodi A.

doi:10.1089/apc.2005.19.703

Cited by 92 publications

(124 citation statements)

References 36 publications

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“…In the 6 months of initial HAART, HIV RNA levels drop rapidly and CD4 cell counts increase, primarily as a result of redistribution from solid lymphoid tissue [34,35]. Therefore, sex-related biological differences may be more likely to be detected with longer antiretroviral therapy use and possibly with subsequent HAART regimens rendered less potent by resistant virus.We chose the age of 50 years to indicate the menopause in women [36,37], with possible misclassification if menopause occurs earlier in HIV-infected women. We also relied on observational clinical data, and residual bias cannot be ruled out, although we controlled for baseline characteristics in multivariable analyses.…”

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confidence: 99%

Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy

et al. 2007

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BackgroundHighly active antiretroviral therapy (HAART) has increased longevity. Currently, women comprise 450% of HIV-infected individuals worldwide. It is not known if there are differences between the sexes in the immunological and virological responses to HAART across the age strata. MethodsImmunological reconstitution and virological response in the first 6 months of a first HAART regimen in two observational clinical HIV-infected cohorts were compared by both sex and age ( 50 vs. o50 years old). ResultsA total of 246 individuals (28% women) were included in the study; 63 cases ( 50 years old) and 183 controls (o50 years old). Over two-thirds of patients had HIV RNA levels o400 HIV-1 RNA copies/mL and CD4 count increases 50 cells/mL at 6 months from therapy initiation. There were no differences in immunological reconstitution across age and sex strata (P 5 0.81) and no differences in virological suppression, even after adjusting for type of HAART (P 5 0.68) or restricting the analysis to women only (P 5 0.81). These results suggest that younger and older women and men may have similar short-term initial HAART outcomes. ConclusionsFurther evaluation of longer term clinical response to initial HAART regimen based on sex and age is indicated, especially with more efficacious and simplified antiretroviral regimens and the associated decrease in mortality.Keywords: age, cohort study, highly active antiretroviral therapy, HIV infection, sex IntroductionWomen account for half of the estimated 46 million HIVinfected adults worldwide [1], and are increasingly affected by the US HIV epidemic [2]. Prior to receiving antiretroviral therapy, younger HIV-infected women have higher CD4 cell counts [3,4] and lower HIV RNA levels [5,6] when compared with HIV-infected men. Levels of endogenous female hormones, or other sex-linked factors, may be an underlying cause of this difference [7,8] and differences in short or longer term treatment responses. Therefore, premenopausal women may respond to a first highly active antiretroviral therapy (HAART) regimen differently from either postmenopausal women or men, regardless of age. In this study, we characterized the 6-month immunological and virological responses to initial HAART by age and sex to clarify sex differences or similarities. MethodsWe relied on the Johns Hopkins University (JHU) and the University of North Carolina (UNC) observational clinical (2) at least three NRTIs. CD4 cell counts and HIV RNA levels obtained closest to 6 months, and within 5-7 months, from therapy initiation were included in the 6 m analysis. All patients 50 years old at HAART initiation were included as cases, and all patients o50 years old at HAART initiation were eligible to be controls and were randomly selected within sex strata at a 1: 3 caseto-control ratio. We excluded 31% of cases (29 of 93) and 36% of controls (108 of 298) because of unavailable BL or 6 m CD4 cell counts and/or HIV RNA levels.Immunological reconstitution was defined as a 425% increase in CD4 cell count from BL to 6 m. A...

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Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy

et al. 2007

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“…4 However, when compared to demographically similar uninfected women, those with HIV do not experience menopause at an earlier age. 5 There is a high prevalence of menstrual irregularities among women living with HIV, secondary to illicit substance abuse; medications including psychotropics, narcotics, methadone, or corticosteroids; and comorbid conditions including diabetes, kidney disease, or liver disease. 6,7 This makes the diagnosis of menopause challenging.…”

Section: Menopausementioning

confidence: 99%

Primary Care of Women Aging with HIV (2014/116)

2015

J Midwife Womens Health

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Women are living longer with HIV infection, but their life expectancy is shorter than for women in the general population. How best to manage the multiple comorbidities and polypharmacy that are common in HIV infected individuals has not been studied. This paper explores areas where the primary care of women with HIV may differ from that of aging women in the general population. We also discuss aspects of care that may not commonly be considered in those under the age of 65, specifically multimorbidity and polypharmacy.Incorporating a gerontologic approach in the care of these women may optimize outcomes until research provides more definitive answers as to how best to collaborate with women with HIV to provide them with optimal care.

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“…[8][9][10] Studies also suggest that women infected with HIV experience a greater number of menopausal symptoms than HIV-uninfected women. 11,12 Because menopause symptoms may come at an earlier age in HIV-infected and drug-using women, 3,4 it is possible that the women may not be aware of the reason for the symptoms.Thus, we performed a cross-sectional study to determine to what peri-and postmenopausal women with and at risk of HIV attribute menopausal symptoms. …”

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Attribution of menopause symptoms in human immunodeficiency virus-infected or at-risk drug-using women

Johnson¹,

Cohen

Howard

et al. 2008

Menopause

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Objective-To examine the relationship of human immunodeficiency virus (HIV) and attribution of menopausal symptoms.Design-Peri-and postmenopausal women participating in a prospective study of HIV-infected and at-risk midlife women (the Ms. Study) were interviewed to determine whether they experienced hot flashes and/or vaginal dryness and to what they attributed these symptoms.Results-Of 278 women, 70% were perimenopausal; 54% were HIV-infected; and 52% had used crack, cocaine, heroin, and/or methadone within the past 5 years. Hot flashes were reported by 189 women and vaginal dryness was reported by 101 women. Overall, 69.8% attributed hot flashes to menopause and 28.7% attributed vaginal dryness to menopause. In bivariate analyses, age 45 years and older was associated with attributing hot flashes and vaginal dryness to menopause, and postmenopausal status and at least 12 years of education were associated with attributing vaginal dryness to menopause, but HIV status was not associated with attribution to menopause. In multivariate analysis, significant interactions between age and menopause status were found for both attribution of hot flashes (P = 0.019) and vaginal dryness (P = 0.029). Among perimenopausal women, older age was independently associated with attribution to menopause for hot flashes (adjusted odds ratio = 1.2, 95% CI: 1.1-1.4, P = 0.001) and vaginal dryness (adjusted odds ratio = 1.3, 95% CI: 1.1-1.6, P = 0.011). None of the tested factors were independently associated with attribution to menopause among postmenopausal women.Address correspondence to: Ellie E. Schoenbaum, MD, Belfer Building, Room 1312, 1300 Morris Park Avenue, Bronx, NY 10461. schoenba@aecom.yu.edu. Financial disclosure: None reported. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusion-Tailored health education programs may be beneficial in increasing the knowledge about menopause among HIV-infected and drug-using women, particularly those who are perimenopausal. KeywordsMenopause; HIV; Menopause symptoms; Attribution; Drug useAs the human immunodeficiency virus (HIV)/acquired immunodeficiency virus (AIDS) epidemic evolves, more women are becoming affected, and in 2005, an estimated 23% of the people living with AIDS in the United States were women, 1 compared with 10% in 1990. 2 As people with HIV are living longer and healthier lives, HIV infection is increasingly viewed as a chronic disease. As a result, many of these women will traverse menopause. Recent data suggest that an earlier onset of natural menopause may be associated with opioid use 3 and HIV. 3,4 However, information about menopause in this population is very limited.Menopause is associated with many symptoms including vasomotor symptoms, vaginal dryness, sleep disturbances, and psychological and cognitive problems. 5 However, hot flashes and vaginal dryness are the two symptoms most conclusively associated with a hypoestrogenic state. 6,7 Studies in middle class and educated women found that hot flashes ...

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Age of Menopause and Menopausal Symptoms in HIV-Infected Women

Cited by 92 publications

References 36 publications

Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy

Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy

Primary Care of Women Aging with HIV (2014/116)

Attribution of menopause symptoms in human immunodeficiency virus-infected or at-risk drug-using women

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